#高警訊藥品

糖尿病 (Sulfonylurea / Metformin) Type 2 diabetes mellitus

Antidiabetic: 2nd Generation Sulfonylurea (Glimepiride)/ Biguanide (Metformiin)

1. Time to peak concentration: 4 h
2. Protein binding: extensively bound
3. Metabolism: Metabolites: 4-trans-hydroxy derivative and 3-cis-hydroxy derivative
4. Excretion: Renal and biliary, approximately 50% each
5. Elimination Half Life: 10 h

1. Hypersensitivity to glimepiride, metformin, any component of the formulation, or sulfonamides
2. Pregnancy; breastfeeding
3. Type 1 diabetes; diabetic ketoacidosis (with or without coma)
4. Severe renal or hepatic impairment

Agents other than glimepiride/metformin are currently recommended to treat diabetes mellitus in pregnancy.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk and benefits. Monitor the breastfed infant for signs of hypoglycemia.

Common:
Hypoglycemia, diarrhea, flatulence, nausea and vomiting
Others:
1. Central nervous system: Dizziness, headache, chills
2. Hepatic: Increased serum ALT
3. Respiratory: Dyspnea, flu-like symptoms, upper respiratory tract infection
4. Miscellaneous: Accidental injury
5. Cardiovascular: Chest discomfort, flushing, palpitations
6. Dermatologic: Diaphoresis, nail disease
7. Endocrine & metabolic: vitamin B12 deficiency
8. Neuromuscular & skeletal: Asthenia, myalgia

One tab once or twice a day before meals or with meals

Safety and effectiveness not established in pediatric patients.

1. eGFR >60 mL/minute/1.73 m2: No dosage adjustment necessary. Monitor renal function at least annually.
2. eGFR 45 to 60 mL/minute/1.73 m2: Consider initiating at a low dose and titrating cautiously
3. eGFR 30 to 45 mL/minute/1.73 m2: Use generally not recommended
4. eGFR <15 mL/minute/1.73 m2 or Scr ≥1.5mg/dL in male and ≥1.4mg/dL in female: Use is contraindicated

The manufacturer recommends avoiding metformin since liver disease is considered a risk factor for the development of lactic acidosis during metformin therapy.