Glimepiride

Glimepiride primarily acts by stimulating the release of insulin from functioning pancreatic beta cells. It binds to the sulfonylurea receptor (SUR1) on the beta-cell membrane, leading to the closure of ATP-sensitive potassium channels. This causes depolarization of the beta cell, opening of voltage-dependent calcium channels, and subsequent influx of calcium, which triggers insulin secretion. It also has some extrapancreatic effects, enhancing insulin sensitivity in peripheral tissues.

Adult

Initial dose: 1 mg orally once daily with breakfast or the first main meal. Titration: May be increased in increments of 1 mg at 1-2 week intervals, based on blood glucose response, up to a maximum of 8 mg once daily.

Pediatric

Not generally recommended for pediatric patients due to insufficient data on efficacy and safety.

Renal adjustment

No dose adjustment is needed for eGFR 50-79 mL/min/1.73m². For eGFR <50 mL/min/1.73m², initiate at 1 mg once daily and titrate cautiously with close monitoring for hypoglycemia. Avoid use in severe renal impairment (eGFR <30 mL/min/1.73m²), preferring alternative agents.

Max dose

6 mg/day

• Type 1 Diabetes Mellitus
• Diabetic Ketoacidosis (with or without coma)
• Hypersensitivity to glimepiride or other sulfonylureas/sulfonamides
• Severe renal impairment (eGFR <30 mL/min/1.73m²)
• Severe hepatic impairment
• Pregnancy
• Lactation
• pregnancy (change to insulin advised)
• nursing mothers
• liver dysfunction
• kidney dysfunction