Diamerid - instructions for use, dose, side effects, contraindications

active substance: glimepiride in terms of 100% of the substance - 1 mg, 2 mg, 3 mg or 4 mg; Excipients: lactose monohydrate 78.68 mg; 77.67 mg; 156.36 mg or 155.34 mg, povidone 2.5 mg; 2.5 mg; 5 mg or 5 mg, poloxamer 0.5 mg; 0.5 mg; 1 mg or 1 mg, croscarmellose sodium 4.7 mg; 4.7 mg; 9.4 mg or 9.4 mg, microcrystalline cellulose 12 mg; 12 mg; 24 mg or 24 mg, magnesium stearate 0.6 mg; 0.6 mg; 1.2 mg or 1.2 mg, iron oxide red oxide 0.02 mg or 0.04 mg (for tablets with a dosage of 1 mg and 3 mg), iron oxide dye oxide 0.03 mg or 0.06 mg (for tablets with with a dosage of 2 mg and 4 mg), respectively.

Description:

Ploskotsilindricheskie tablets with a facet. Tablets with a dosage of 1 mg and 3 mg of pink with a brownish hue; tablets with a dosage of 2 mg and 4 mg from cream to light yellow or yellow. Small inclusions are allowed.

Pharmacotherapeutic group: hypoglycemic agent for oral use of the sulfonylurea group of the third generation

ATX: & nbsp

A.10.B.B.12 Glimepiride

Pharmacodynamics:

Glimepiride reduces the concentration of glucose in the blood, mainly by stimulating the release of insulin from the running cells of the pancreas. Its effect is mainly associated with improving the ability of beta cells of the pancreas to respond to physiological stimulation with glucose.Compared to glibenclamide, taking low doses of glimeiroid induces the release of less insulin when the blood glucose concentration is approximately the same. This fact testifies in favor of the presence in glimeiirida extrapancreatic hypoglycemic effects (increased sensitivity of tissues to insulin and insulinemimetic effect).

Secretion of insulin

Like all other sulfonylureas, glimepiride regulates the secretion of insulin through interaction with ATP-sensitive potassium channels on the membranes of beta cells. Unlike other derivatives of sulfonylureas glimepiride selectively binds to a protein with a molecular weight of 65 kilodaltons (kDa), located in the membranes of beta cells of the pancreas. This interaction of glymeyride with its binding protein regulates the opening or closing of ATP-sensitive potassium channels.

Glimepiride closes potassium channels. This causes depolarization of beta cells and leads to the discovery of voltage-sensitive calcium channels and the intake of calcium into the cell.As a result, an increase in the intracellular calcium concentration activates the secretion of insulin by exocytosis.

Glimepiride much faster and, accordingly, more often enters into a bond and is released from the bond with the protein that binds it, than glibenclamide. It is suggested that this property of a high rate of exchange of glimeiiride with the protein binding to it causes its pronounced effect of the sensitization of beta cells to glucose and their protection against desensitization and premature exhaustion.

The effect of increasing the sensitivity of tissues to insulin

Glimepiride enhances insulin effects on glucose uptake by peripheral tissues.

Insulinomimetic effect

Glimepiride has effects similar to insulin effects on glucose uptake by peripheral tissues and glucose output from the liver.

Absorption of glucose by peripheral tissues is carried out by its transport inside the muscle cells and adipocytes. Glimepiride directly increases the amount of glucose-transporting molecules in the plasma membranes of muscle cells and adipocytes. Increasing the intake of glucose in the cells leads to the activation of glycosylphosphatidylinositol-specific phospholipase C.As a result, the intracellular concentration decreases, causing a decrease in the activity of protein kinase A, which in turn leads to stimulation of glucose metabolism. Glimepiride inhibits glucose output from the liver by increasing the concentration of fructose-2,6-bisphosphate, which inhibits gluconeogenesis.

Effect on platelet aggregation

Glimepiride reduces platelet aggregation in vitro and in vivo. This effect appears to be associated with selective inhibition of cyclooxygenase, which is responsible for the formation of thromboxane A, an important endogenous platelet aggregation factor.

Antiatherogenic action of the drug

Glimepiride promotes the normalization of lipid content, reduces the content of malonic aldehyde in the blood, which leads to a significant decrease in lipid peroxidation. In animals glimepiride leads to a significant decrease in the formation of atherosclerotic plaques.

Reducing the severity of oxidative stress, which is constantly present in patients with type 2 diabetes mellitus. Glimepiride increases the content of endogenous a-tocopherol, catalase activity, glutathione pen of ksidase and superoxide dismutase.

Cardiovascular Effects

Through ATP-sensitive potassium channels (see above), the sulfonylureas derivatives also affect the cardiovascular system. Compared with the traditional derivatives of sulfonylurea, glimepiride has a significantly smaller effect on the cardiovascular system, which can be explained by the specific nature of its interaction with the ATP-sensitive potassium channel binding to it.

In healthy volunteers, the minimum effective dose of glimepiride is 0.6 mg. The effect of glimepiride is dose-dependent and reproducible. Physiological response to physical activity (reduced secretion of insulin) with the intake of glimepiride is preserved.

There are no significant differences in the effect, depending on whether the drug was taken 30 minutes before meals or just before meals. In patients with sugar diabetes, sufficient metabolic control can be 24 hours with a single dose. In patients with renal insufficiency (creatinine clearance 4-79 ml / min), sufficient metabolic control can also be achieved.

Combined therapy with metformin

In patients with insufficient metabolic control with the maximum dose of glimepiride, combined therapy with glimepiride and metformin may be initiated. In two studies, combined therapy has been shown to improve metabolic control compared with that in the treatment of each of the drugs alone.

Combination therapy with insulin

In patients with insufficient metabolic control, maximal doses of glimepiride may be started, simultaneous therapy with insulin can be started. In two studies using this combination, the same improvement in metabolic control was achieved as with only one insulin; however, combined therapy requires a lower dose of insulin.

Use in children

There is insufficient data on the long-term efficacy and safety of the drug in children.

Pharmacokinetics:

Suction

With repeated administration of glimepiride in a daily dose of 4 mg, the maximum concentration in the blood serum (Сmах) is reached after about 2.5 hours and is 432 ng / ml; there is a linear relationship between dose and Сmах, as well as between the dose and AUC (area under the curve "concentration-time").When administered glimepiride, its bioavailability is about 100%. The intake of food does not have a significant effect on suction, with the exception of a slight slowing of the absorption rate.

Distribution

Glimepiride is characterized by a very low volume of distribution (about 8.8 liters), approximately equal to the volume of distribution of albumin, a high degree of binding to plasma proteins (more than 99%) and low clearance (about 48 ml / min).

Glimepiride penetrates into breast milk and through the placental barrier. The drug penetrates poorly through the blood-brain barrier.

Metabolism

13 urine and feces revealed two metabolites, formed as a result of metabolism in the liver (mainly by using CYP2C9), one of them is a hydroxy derivative, and the other is a carboxy derivative. After ingestion of glimepiride, the terminal half-life of these metabolites was 3-5 hours and 5-6 hours, respectively.

Excretion

The half-life at plasma concentrations of the drug in the serum, corresponding to a multiple dosing regimen, is 5-8 hours. After taking high doses, the elimination half-life increases slightly.After a single dose glimepirid dose in the kidneys is withdrawn 58% and through the intestine - 35%. An unchanged substance in the urine was not detected.

Pharmacokinetics in special clinical cases

In patients with impaired renal function (with low creatinine clearance), there is a tendency to increase the clearance of glimepiride and to reduce its average serum concentrations, which is likely due to a faster release of the drug due to its lower binding to plasma proteins. Thus, in this category of patients there is no additional risk of cumulation of the drug.

Indications:

Diabetes mellitus type 2 with ineffectiveness of a previously prescribed diet and exercise.

With the ineffectiveness of monotherapy with glimepiride, it is possible to use it in combination therapy with metformin or insulin.

Contraindications:

type 1 diabetes mellitus;
diabetic ketoacidosis, diabetic precoma and coma;
conditions, accompanied by a violation of food intake and development of hypoglycemia (including infectious diseases);
leukopenia;
severe violations of liver function;
severe dysfunction of the kidneys (including patients on hemodialysis);

hypersensitivity to glimepiride or to any inactivecomponent of the drug, to other derivatives of sulfonylureas or to sulfonamide preparations (risk of developing hypersensitivity reactions);

pregnancy and the period of breastfeeding;
lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
children's age till 18 years.

Carefully:

In the first stages of taking the drug (an increased risk of developing hypoglycemia); if there are risk factors for the development of hypoglycemia; when changing the lifestyle of patients (changing diet and eating time, increasing or decreasing physical activity); with intercurrent diseases and in the recovery period of the organism after stressful situations; insufficiency of glucose-6-phosphate dehydrogenase; conditions requiring the transfer of the patient to insulin therapy (extensive burns, severe multiple injuries, major surgical interventions, as well as impaired absorption of food and drugs in the gastrointestinal tract - intestinal obstruction,paresis of the stomach, etc.).

Pregnancy and lactation:

Glimepiride is contraindicated for use in pregnant women. In the case of a planned pregnancy or at the onset of pregnancy, a woman should be transferred to insulin therapy.

As glimepiride penetrates into breast milk, the drug is contraindicated in the period of breastfeeding. Breastfeeding should be discontinued when taking Diamerid® or switching the patient to insulin therapy.

Dosing and Administration:

As a rule, the dose of the preparation Diamerid® is determined by the target concentration of glucose in the blood. The lowest dose, sufficient to achieve the necessary metabolic control, should be used.

During treatment with the drug Diamerid®, the concentration of glucose in the blood should be regularly determined. In addition, regular monitoring of the level of glycosylated hemoglobin is recommended.

Incorrect drug intake, for example, skipping the next dose, never must be replenished by the subsequent administration of a higher dose.

The patient's actions in case of mistakes with the use of the preparation DiMerid® (in particular, missed receipt of the next dose or if you skipped the meal) or in situations where there is no possibility to take the drug, should be discussed by the patient and the doctor in advance.

Reception of the drug Diamerid®

Tablets of the preparation Diamidide are taken orally, without chewing, squeezed with a sufficient amount of liquid (about 0.5 cup).

Initial dose and dose selection

The initial dose is 1 mg glimepiride once a day. If necessary, the daily dose can be increased gradually (at intervals of 1-2 weeks). It is recommended that the dose be increased under regular control of blood glucose concentrations and in accordance with the following step of increasing the dose: 1 mg - 2 mg - 3 mg - 4 mg - b mg (-8 mg).

Dose range in patients with well-controlled diabetes mellitus

Usually, the daily dose in patients with well-controlled diabetes mellitus is 1-4 mg glimepiride. A daily dose of more than 6 mg is more effective only in a small number of patients.

Dosing regimen

The time of taking the drug Diamid and the distribution of doses during the day is set by the doctor, depending on the lifestyle of the patient at a given time (the time of taking the food, the amount of physical activity).

It is usually enough to take a single dose of the drug Diaperid during the day. It is recommended that in this case the entire dose of the preparation Diamidide® should be taken immediately before a full breakfast or, if it was not taken at this time, just before the first main meal.

It is very important not to skip meals after taking the drug Diaperid.

Since improvement in metabolic control is associated with an increase in insulin sensitivity, the need for glimepiride may decrease during treatment. In order to avoid the development of hypoglycemia, it is necessary to reduce the dose in a timely manner or stop taking the drug Diamidide.

Conditions in which glimepiride dose adjustment may also be required:

weight loss in the patient;
changing the lifestyle of the patient (changing diet, meal time, amount of exercise);
the occurrence of other factors that lead to a predisposition to the development of hypoglycemia or hyperglycemia (see section "Special instructions").

Duration of treatment

Treatment with glimepiride is usually carried out for a long time.

Transfer of the patient from taking another oral hypoglycemic preparation to taking Diaperid

There is no exact correlation between the doses of the drug Diameride and other hypoglycemic agents for oral administration. When another hypoglycemic agent for oral ingestion is replaced with a preparation of Diamidide®, it is recommended that the procedure for its administration be the same as for the initial administration of the preparation, that is, the treatment should start at an initial dose of 1 mg (even if the patient is transferred on the drug Diamid® from the maximum dose of another hypoglycemic drug for oral administration). Any increase in the dose should be carried out in stages, taking into account the reaction to glimepiride, in accordance with the above recommendations.

It is necessary to take into account the strength and duration of the effect of the previous hypoglycemic agent for oral administration. An interruption in treatment may be required in order to avoid any summation of effects that may increase the risk of developing hypoglycemia.

Use in combination with metformin

In patients with insufficiently controlled diabetes mellitustaking maximum daily doses or glimepiride or metformin can be started treatment with a combination of these two drugs. In this case, the previous treatment with either glimepiride or metformin continues at the same dose level, and additional metformin or glimepiride starts at a low dose, which is then titrated, depending on the target level of metabolic control, up to the maximum daily dose. Combination therapy should begin under close medical supervision.

Use in combination with insulin

Patients with insufficiently controlled diabetes mellitus at intake of the maximum daily doses of glimepiride can simultaneously be prescribed insulin administration. In this case, the last dose of glimepiride prescribed to the patient remains unchanged. In this case, treatment with insulin begins with low doses, which gradually increase under the control of the concentration of glucose in the blood. Combined treatment requires careful medical supervision.

Use in patients with renal insufficiency

There is a limited amount of information on the use of the drug Diamid® in patients with renal insufficiency.Patients with impaired renal function may be more sensitive to the hypoglycemic effect of glimepiride (see the sections "Pharmacokinetics", "Contraindications"),

Use in patients with hepatic impairment

There is a limited amount of information on the use of the drug for liver failure (see "Contraindications"),

Use in children

Data on the use of the drug in children is not enough.

Side effects:

Metabolic disorders

As a result of the hypoglycemic action of the drug Diamidide®, hypoglycemia may develop, which, like with other sulfonylurea derivatives, can be prolonged.

Symptoms of hypoglycemia are: headache, hunger, nausea, vomiting, fatigue, drowsiness, sleep disorders, anxiety, aggressiveness, impaired concentration, alertness and reaction speed, depression, confusion, speech disorders, aphasia, visual disorders, tremor, paresis, sensory disturbances, dizziness, loss of self-control, delirium, cerebral cramps, doubt or loss of consciousness right up to coma, shallow breathing, bradycardia.In addition, there may occur adrenergic counterregulation in response to hypoglycemia, such as the appearance of cold sticky sweat, anxiety, tachycardia, increased blood pressure, angina pectoris, palpitations and heart rhythm disturbances.

The clinical picture of severe hypoglycemia may be similar to a stroke.

Symptoms of glycemia almost always disappear after its elimination.

Disturbances on the part of the organ of sight

During treatment (especially at the beginning), there may be a visual disability caused by a change in the concentration of glucose in the blood. Their cause is a temporary change in the swelling of the lens, depending on the concentration of glucose in the blood, and due to this the change in the refractive index of the lens.

Disorders from the gastrointestinal tract

In rare cases: nausea, vomiting, a feeling of heaviness or overflow in the epigastrium, abdominal pain, diarrhea.

In some cases: hepatitis, increased activity of "liver" enzymes and / or cholestasis and jaundice, which can progress to life threatening liver failure, but may undergo reverse development if the drug is withdrawn.

Violations of the blood and lymphatic system

Rarely - thrombocytopenia.In some cases: leukopenia, hemolytic anemia, erythrocytopenia, granulocytopenia, agranulocytosis and pancytopenia.

In the postmarketing application of the drug, cases of severe thrombocytopenia with a platelet count of less than 10,000 / μl and thrombocytopenic purpura were reported (the frequency is unknown).

Immune system disorders

In rare cases, allergic and non-allergic reactions are possible, such as itching, hives, skin rashes. Such reactions are almost always of an easy form, however, they can turn into severe reactions with shortness of breath, a sharp decrease in blood pressure, which sometimes progresses down to anaphylactic shock. When symptoms of urticaria appear, consult a doctor immediately. In some cases, there may be a decrease in serum sodium concentrations, allergic vasculitis, photosensitivity.

Overdose:

After ingestion of a large dose of glimepiride, the development of hypoglycemia, lasting from 12 to 72 hours, may occur, which may recur after the initial restoration of the glucose concentration in the blood.Acute overdose, as well as long-term treatment with too high doses of glimepiride, can lead to the development of severe life-threatening hypoglycemia.

Symptoms of hypoglycemia: increased sweating, anxiety, tachycardia, increased blood pressure, palpitations, pain in the heart, arrhythmia, headache, dizziness, a sharp increase in appetite, nausea, vomiting, apathy, snotty, anxiety, aggressiveness, impaired concentration, depression, tremor , paresis, a sensitivity disorder, convulsions of the central genesis. In addition, such symptoms as cold sticky sweat, shallow breathing, bradycardia, verbal and visual disorders, aphasia, delirium, violation of self-control, vigilance and reaction speed, impairment of consciousness or loss of consciousness, including coma, may occur. Sometimes the clinical picture of hypoglycemia may resemble a stroke.

Treatment: hypoglycemia can be stopped by the immediate intake of carbohydrates (glucose or a piece of sugar, sweet fruit juice or tea). In most cases, monitoring in a hospital is recommended.

Treatment includes the induction of vomiting, a plentiful drink with activated charcoal (adsorbent) and sodium picosulfate (laxative). When receiving a large amount of the drug shows gastric lavage, followed by sodium picosulfate and activated carbon. As soon as possible, start the injection of dextrose, if necessary in the form of intravenous jet injection of 50 ml of a 40% solution, followed by infusion of 10% solution, with careful monitoring of the concentration of glucose in the blood. As an alternative to adults, intravenous, subcutaneous or intramuscular administration of glucagon in a dose of 0.5-1 mg is possible. In the future, treatment should be symptomatic.

In the treatment of hypoglycemia due to the occasional intake of glimepiride by infants or young children, the dose of dextrose administered should be carefully adjusted in terms of the potential for dangerous hyperglycemia; The administration of dextrose should be carried out under constant control of the concentration of glucose in the blood.

After a rapid recovery of the blood glucose concentration, an intravenous infusion of dextrose solution at a lower concentration is necessary to prevent the resumption of hypoglycemia.The concentration of glucose in the blood in these patients should be constantly monitored within 24 hours. In severe cases with prolonged course of hypoglycemia, the risk of lowering blood glucose levels to the hypoglycemic level may persist for several days.

Interaction:

The simultaneous use of glimepiride with certain drugs can cause both an increase and a decrease in the hypoglycemic effect of the drug. Therefore, other medications can be taken only after consultation with the doctor.

Increased hypoglycemic action and, associated with this, the possible development of hypoglycemia can be observed with the simultaneous use of glimepiride with insulin, metformin or other oral hypoglycemic agents, angiotensin converting enzyme (ACE) inhibitors, allopurinol, anabolic steroids and male sex hormones, chloramphenicol, coumarin derivatives, cyclophosphamide, trophosphamide and isophosphamide, disopyramide, fenfluramine, fibrates, fluoxetine, sympatholytics (guanethidine), monoamine oxidase (MAO) inhibitors.miconazole, pentoxifylline (when administered parenterally in high doses), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, hinoloiovymi antibiotics and salicylates aminosalicylic acid, sulfinpyrazone, clarithromycin, some sulfonamides prolonged action, tetracyclines, tritokvalinom, fluconazole.

Weakening of hypoglycemic action, and associated with this, an increase in the concentration of glucose in the blood can be observed with the simultaneous use of glimenide with acetazolamide, barbiturates, glucocorticosteroids, diazoxide, saluretic, thiazide diuretics, epinephrine and other sympathomimetic agents, glucagon, laxatives (for prolonged use), nicotinic acid high doses) and its derivatives, estrogens and progestogens, phenothiazine derivatives, including chlorpromazine, fepitoin, rifampicin, thyroid hormones lezy, lithium salts.

The blockers of H2-histamine receptors, clonidine and reserpine are able both to potentiate and weaken the hypoglycemic action of glimenide.

Under the action of beta adrenoblockers, clonidine, guaetidine and reserpine, it is possible that the clinical signs of hypoglycemia are weakened or absent.

Against the background of taking glimepiride, there may be an increase or decrease in the action of coumarin derivatives.

When used simultaneously with drugs that depress the bone marrow hematopoiesis, the risk of mis-expression increases.

A single or chronic use of alcohol can both enhance and weaken the hypoglycemic effect of glimenide.

Sequestration of bile acids: kolesevelam binds with glimepiride and reduces absorption of glimepiride from the gastrointestinal tract. In the case of using glimepiride, at least 4 hours before the administration of colesevelum, no interaction is observed. therefore glimepiride must be taken at least 4 hours prior to taking kolesevelam.

Special instructions:

Glimepiride should be taken at recommended doses and at the appointed time. The patient should immediately inform the doctor if too high a dose is taken.

The development of hypoglycemia in a patient after taking 1 mg of glimepiride per day means the possibility of controlling glycemia solely with the help of a diet.

When you reach the compensation of type 2 diabetes, the sensitivity to insulin increases. In this connection, the need for glnmepyride may decrease during the treatment. To avoid the development of hypoglycemia, it is necessary to temporarily reduce the dose or cancel glimepiride. Correction of the dose should also be carried out with a change in the body weight of the patient, his lifestyle, or with the appearance of other factors contributing to an increased risk of hypo- or hyperglycaemia.

Adequate diet, regular and sufficient physical exercise and, if necessary, weight loss are just as important for achieving optimal control of blood glucose, as is the regular intake of glimepiride.

Clinical symptoms hyperglycemia are: increasing the frequency urination, severe thirst, dry mouth and dry skin.

In the first weeks of treatment, the risk of developing hypoglycemia may increase, which requires particularly careful monitoring of the patient. On the background of treatment with glimepiride with irregular intake of food or skipping meals can develop hypoglycemia. Factors contributing to the development of hypoglycemia include:

reluctance or (especially in old age) the patient's inadequate ability to cooperate with a doctor;
inadequate, irregular meals, skipping meals, fasting, changing a habitual diet;
an imbalance between exercise and carbohydrate intake;
alcohol consumption, especially when combined with a skipping meal;
violation of the function of the nights;
severe liver dysfunction;
an overdose of glimepiride;
Some uncompensated diseases of the endocrine system that provide influence on carbohydrate metabolism (eg, thyroid dysfunction and anterior pituitary gland or adrenocortical insufficiency);

simultaneous use of some other medicines (see section "Interaction with other drugs").

The doctor should be informed of the above factors and episodes of hypoglycemia, because they require very strict monitoring of the patient. When presence of such factors, increasing the risk of hypoglycemia, should adjust the dose of glimepiride or the entire treatment regimen. This must also be done in the case of an intercurrent disease or a change in the patient's lifestyle.Symptoms of hypoglycemia can be smoothened or completely absent in the elderly, in patients with autonomic neuropathy or receiving simultaneous treatment with beta-blockers, clonidine, reserpine, guanethidine. Hypoglycemia can almost always be quickly stopped by the immediate intake of carbohydrates (glucose or sugar, for example, in the form of a piece of sugar, sweet fruit juice or tea). In this regard, the patient should always have at least 20 grams of glucose (4 pieces of sugar). Sugary substitutes are ineffective in the treatment of hypoglycemia.

From experience with the use of other sulfonylurea drugs, it is known that, despite the initial success of stopping hypoglycemia, it is possible to relapse. In this regard, continuous and careful monitoring of the patient is necessary. Severe hypoglycemia requires immediate treatment under the supervision of a doctor, and under certain circumstances and hospitalization of the patient.

If a patient with diabetes mellitus is treated by different doctors (for example, during a hospital stay after an accident, during a weekend illness), he must necessarily inform them about his illness and about the previous treatment.

Treatment with sulfonylurea derivatives, which includes glimepiride, can lead to the development of hemolytic anemia, therefore, patients with glucose-6-phosphate dehydrogenase deficiency should be especially careful in the appointment of glimepiride, and it is better to use hypoglycemic agents that are not derivatives of sulfonylurea.

During treatment with glimepiride, regular monitoring of liver function and peripheral blood pattern (especially the number of leukocytes and platelets) is required.

In stressful situations (for example, with trauma, surgical intervention, infectious diseases accompanied by fever), there may be a need for a temporary transfer of the patient to insulin therapy.

There is no experience with glimepiride in patients with severe impairment of liver and kidney function or patients on hemodialysis. Patients with severe impairment of kidney and liver function are indicated by a transfer to insulin therapy. During treatment with glimepiride, regular monitoring of blood glucose concentration as well as the concentration of glycosylated hemoglobin is necessary.

Some side effects (severe hypoglycemia, serious changes in the picture blood, severe allergic reactions, liver failure), can in certain circumstances, constitute a threat to the life of the patient. In case of unwanted or severe reactions, the patient should immediately inform the attending physician about them and in no case should continue taking the drug without his recommendation.

Effect on the ability to drive transp. cf. and fur:

At the beginning of treatment, when switching from one drug to another, or with an irregular intake of glimepiride, hypoglycemic or hyperglycemia may occur, a decrease in the concentration and speed of the psychomotor reactions of the patient. This can adversely affect the ability to drive vehicles or to manage various machines and mechanisms. Patients should be advised to take measures to prevent the development of hypoglycemia and hyperglycemia when driving vehicles and working with mechanisms. This is especially important for patients with a lack or decrease in the severity of symptoms-precursors of developing hypoglycemia or suffering from frequent episodes of hypoglycemia.In these cases, you should consider the feasibility of doing such work.

Form release / dosage:

Tablets 1 mg, 2 mg, 3 mg and 4 mg.

Packaging:

For 10 tablets in a contour mesh package made of a polyvinylchloride film or a combined three-layer material for the packaging of medicines and foils of aluminum printed lacquered.

3 or 6 contour mesh packages together with the instruction but are placed in a pack of cardboard.

Storage conditions:

In a dry, the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

2 years.

Do not use after the expiration date.

Terms of leave from pharmacies:Without recipe

Registration number:LP-000029

Date of registration:10.11.2010 / 27.11.2015

The owner of the registration certificate:AKRIKHIN HFK, JSC AKRIKHIN HFK, JSC Russia

Manufacturer: & nbsp

AKRIKHIN HFK, JSC Russia

Representation: & nbspAKRIKHIN OJSC AKRIKHIN OJSC Russia

Information update date: & nbsp28.01.2016

Illustrated instructions

Instructions

DiMerid® (Diamerid)