Metformin + Glimepiride

Metformin, a biguanide, reduces hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Glimepiride, a sulfonylurea, primarily stimulates insulin release from pancreatic beta cells. This combination provides a synergistic effect by addressing both insulin resistance and inadequate insulin secretion, leading to improved glycemic control in type 2 diabetes. Combination rationale: This fixed-dose combination leverages the complementary mechanisms of action of metformin and glimepiride. Metformin reduces hepatic glucose production and improves insulin sensitivity, while glimepiride stimulates pancreatic insulin secretion. Combining these agents provides comprehensive glycemic control, addressing both insulin resistance and beta-cell dysfunction, making it an effective option for patients inadequately controlled by monotherapy.

Adult

Initial dose is typically one tablet once daily with breakfast or the first main meal. Common strengths available in India include Metformin 500mg/Glimepiride 1mg, Metformin 500mg/Glimepiride 2mg, Metformin 1000mg/Glimepiride 1mg, Metformin 1000mg/Glimepiride 2mg. Dosing should be individualized based on patient's current regimen, effectiveness, and tolerability, with gradual titration.…

Pediatric

Not recommended for use in pediatric patients due to lack of established safety and efficacy.

Renal adjustment

Metformin: eGFR ≥45 mL/min/1.73 m²: standard dose (up to 2000 mg/day). eGFR 30-44 mL/min/1.73 m²: do not initiate; if already on it, cap at 1000 mg/day and monitor renal function every 3 months. eGFR <30 mL/min/1.73 m²: contraindicated. Glimepiride: use with caution, reduced starting and maintenance doses may be required, with close monitoring for hypoglycemia; avoid in significant renal impairment.

Hepatic adjustment

Contraindicated in severe hepatic impairment due to increased risk of lactic acidosis (metformin) and severe hypoglycemia (glimepiride).

Geriatric

Start with the lowest effective dose. Careful monitoring of renal function is essential due to increased risk of renal impairment in the elderly. Increased susceptibility to hypoglycemia. Dose adjustments may be necessary.

Max dose

Metformin component: 2000 mg/day; Glimepiride component: 8 mg/day. Total daily dose should not exceed these individual maximums.

• Hypersensitivity to metformin, glimepiride, other sulfonylureas, sulfonamides, or any excipient
• Renal dysfunction (eGFR < 30 mL/min/1.73 m²)
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
• Congestive heart failure requiring pharmacological treatment
• Acute myocardial infarction
• Severe infections
• Dehydration
• Shock
• Hepatic impairment
• Acute alcohol intoxication or chronic alcoholism
• Type 1 diabetes mellitus
• Pregnancy and lactation
• Surgery