Tri tren side effects agent, III generation sulfonylurea derivative. Stimulates pancreatic beta cells, facilitating the mobilization and strengthening of endogenous insulin release, increases the amount of insulinchuvstvitelnyh receptors in target cells, inhibits the gluconeogenesis. Hyperglycemia without increasing the level of fasting insulin. Extrapancreatic effects are to increase peripheral tissue sensitivity to insulin.Glimepiride has antiagregatsionnym, anti-atherogenic and anti-oxidant effect. The maximum effect is achieved after 2-3 hours, the Tri tren side effects effect lasts more than 24 hours. Absorption high. When administered in a daily dose of 4 mg of the maximum blood concentration (309 ng / ml) is reached 2.5 hours. Provided with breast milk and crosses the placental barrier. The drug does not penetrate the blood-brain barrier.
Diabetes mellitus type 2, with poor diet and physical activity.
- type 1 diabetes;
- diabetic ketoacidosis, diabetic coma and precoma;
- hypersensitivity to glimepiride, or to components of the drug to other sulfonylureas or sulfanilamides;
- severe liver function;
- severe renal impairment;
- conditions requiring the patient’s transfer to insulin therapy (extensive burns, severe trauma, major surgery, as well as malabsorption in the gastrointestinal tract – intestinal obstruction, gastroparesis, etc.);
- Pregnancy and breast-feeding.
Be wary – feverish syndrome, alcoholism, adrenal insufficiency, thyroid disease (hypothyroidism or hyperthyroidism).
Use during pregnancy and lactation
Glimepiride is contraindicated in pregnant women. In the case of planned pregnancy or if pregnancy occurs it is recommended carrying out insulin.
Since glimepiride passes into breast milk, it should not be administered to women during breast-feeding. In this case, you need to conduct insulin or stop breastfeeding.
Dosage and administration
The dose of glimepiride is determined individually on the basis of regular monitoring of blood glucose.
The drug is taken orally, without chewing, with enough fluid to a hearty breakfast, at an initial dose of 1 mg 1 time a day. If necessary, the daily dose can be gradually increased (1 mg every 1-2 weeks) to 2, 3 or 4 mg / day. Only in individual patients treatment effect is achieved when receiving daily doses greater than 4 mg. The maximum daily dose – 6 mg. Treatment: long.
Side effect On the part of metabolism : in rare cases may develop Tri tren side effects reactions. These reactions primarily occur soon after ingestion, and not always easy to stop. From the side of view: during treatment (especially at the beginning) may experience transient blurred vision, caused by changes in the blood glucose concentration. On the part of the digestive system organs : sometimes may experience nausea, vomiting, a feeling of heaviness or discomfort in the epigastric abdominal pain , diarrhea, rarely leading to discontinuation of treatment; rarely – increased activity of “liver” enzymes, cholestasis, jaundice, hepatitis (until the development of liver failure). Hematopoietic system : rarely possible thrombocytopenia (moderate to severe), leukopenia, hemolytic or aplastic anemia, erythropenia, granuloditopeniya, . agranulocytosis and pancytopenia Allergic reactions : sometimes may cause symptoms of urticaria (itching, skin rash). Such reactions are usually moderately expressed, but may progress accompanied by a fall in blood pressure, dyspnea, until the development of anaphylactic shock. When urticaria symptoms should seek medical advice immediately. Possible cross-allergy with other sulfonylureas, sulfonamides, or the like substances, it is also possible the development of allergic vasculitis. Other side effects : in exceptional cases may develop photosensitivity, hyponatremia. If a patient finds himself in any of the above side effects, other undesirable effects, he should contact your doctor.
In case of overdose may develop hypoglycemia (symptoms: hunger, tachycardia, nausea, vomiting, lethargy, sleepiness, depression, sleep disturbances, severe weakness, anxiety, poor concentration, impaired speech (aphasia) and vision, tremor, sensitivity disorder, paresis , dizziness, convulsions, shallow breathing, impaired consciousness, Tri tren side effects coma). Treatment: If the patient is conscious – ingesting carbohydrates, carbohydrate intake at impossibility – dextrose injection (intravenous bolus – 40% solution, followed by infusion of 5.10% solution), 2.1 mg of glucagon subcutaneously or intramuscularly. It needs constant surveillance and maintenance of vital functions in the blood glucose concentration (at 5.5 mmol / L) for at least 24-48 hours (possible recurrent episodes of hypoglycemia).After regaining consciousness necessary to give the patient foods rich in carbohydrate (to avoid a recurrence of hypoglycemia).
Interaction with other drugs
increases the effect of glimepiride ACE inhibitors (captopril, enalapril), blockers H2-gistaminoretseptorov (cimetidine), antifungal drugs (miconazole, fluconazole), non-steroidal anti-inflammatory drugs (phenylbutazone, azapropazone, oxyphenbutazone), fibrates (clofibrate, bezafibrate) , TB (ethionamide), salicylates (acetaminophen), anticoagulants coumarin, anabolic steroids, beta-blockers, monoamoksidazy inhibitors, sulfonamides, Tri tren side effects agents (acarbose, biguanides, insulin), cyclophosphamide, chloramphenicol, fenfluramine, fluoxetine, guanethidine, pentoxifylline, tetracycline , theophylline, tubular secretion blockers, reserpine, bromocriptine, disopyramide, pyridoxine, allopurinol.
Loosen the effect of glimepiride barbiturates, steroids, adrenostimulyatorov (epinephrine, clonidine), antiepileptic drugs (phenytoin), blockers of the “slow” calcium channel blockers, carbonic anhydrase inhibitors (acetazolamide) thiazide diuretics, chlorthalidone, furosemide, triamterene, asparaginase, baclofen, danazol, diazoxide, isoniazid, morphine, ritodrine, salbutamol, terbutaline, glucagon, rifampicin, hormones, thyroid medications, lithium salts, in higher doses – nicotinic acid, chlorpromazine, oral contraceptives and estrogens.
glimepiride decreases (slightly) anticoagulation induced by warfarin. In an application with drugs, which suppress bone marrow blood, increases the risk of myelosuppression.
need for regular monitoring of blood glucose.
With the ineffectiveness of monotherapy with glimepiride, perhaps its use in combination therapy with metformin or with insulin.
In the case of surgical interventions or decompensated diabetes must take into account the possibility of insulin.
It should warn patients about the increased risk of hypoglycaemia cases of reception of ethanol (including possible development disulfiramopodobnyh reactions: abdominal pain, nausea, vomiting, headache), fasting. Need dosage adjustment in the physical and emotional strain, diet change.
Clinical manifestations of hypoglycemia may be masked when taking beta-blockers, clonidine, reserpine, guanethidine.
At the beginning of treatment, during dose adjustment to patients prone to hypoglycemia, you must be careful when driving vehicles and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.