glimepiride, Amaryl (cont.)

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DOSING: Like other medicines used to treat diabetes, the dose of glimepiride is individualized using periodic measurements of blood sugar to determine the best dose. The recommended dose is 1 to 8 mg once daily. The usual starting dose is 1 or 2 mg daily.

DRUG INTERACTIONS: Medicines that can increase blood sugar can reverse the action of glimepiride. These drugs include diuretics, for example, hydrochlorothiazide (Hydrodiuril, Ezide, Hydro-Par, Microzide, and many combinations with other drugs), furosemide (Lasix), corticosteroids such as prednisone and methylprednisolone (Medrol), phenytoin (Dilantin), niacin, and sympathomimetics such as pseudoephedrine (Sudafed).

Beta blockers such as propranolol (Inderal) and atenolol (Tenormin) can cause low or high  blood sugar. Additionally, they can directly reverse the sugar-lowering effect of sulfonylureas and render them less effective. Beta blockers also can blunt some of the body's protective responses to low blood sugar, thus making it difficult for patients to recognize reactions due to low blood sugar (hypoglycemia). This notwithstanding, beta blockers have been used successfully in patients with diabetes and have been associated with improved survival in patients with diabetes and high blood pressure. Rifampin increases the breakdown of glimepiride by liver enzymes. This might reduce the effect of glimepiride and result in higher levels of sugar in the blood.

PREGNANCY: In animal studies, glimepiride and other sulfonylureas were associated with a higher risk of fetal death. However, there have been no good studies in women. On the other hand, abnormal blood sugar concentrations (high or low) during pregnancy increase the risk of abnormalities in the fetus. Therefore, physicians must carefully weigh the benefits and risks of sulfonylurea treatment during pregnancy. Insulin is the drug of choice for treating diabetes in pregnant women.



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