Meglimate should be taken at recommended doses and at the appointed time. Errors in the use of the drug, for example, admission, can never be eliminated by the subsequent administration of a higher dose. The doctor and the patient should discuss in advance the measures that should be taken in case of such mistakes (for example, skipping a drug or eating a meal) or in situations when it is not possible to take a regular dose of the drug at the set time. The patient should immediately inform the doctor if too high a dose is taken.
If the patient develops a hypoglycemic reaction with taking 1 mg of glimepiride per day, this indicates that in this patient the normalization of the blood glucose level can be achieved with a single diet.
At achievement of indemnification of a diabetes of type 2 sensitivity to an insulin raises. In this regard, the treatment process may reduce the need for glimepiride. To avoid the development of hypoglycemia, it is necessary to temporarily reduce the dose or cancel glimepiride, Dose correction should also be carried out when the patient's body weight changes, if his lifestyle changes, or if other factors contribute to an increased risk of developing hypo- or hyperglycemia.
Adequate diet, regular and sufficient physical exercise and, if necessary, weight loss are just as important for achieving optimal control of blood glucose levels, as is the regular intake of glimepiride. Clinical symptoms hyperglycemia (insufficient reduction in blood glucose) are: increased frequency of 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. Its possible symptoms are: headache, hunger, nausea, vomiting, tiredness, sleepiness, sleep disturbances, restlessness, aggressiveness, impaired concentration, attention and reaction, depression, confusion, speech and visual disorders, aphasia, tremor, paresis, sensory disturbances,
dizziness, helpless state, the loss of self-control, delirium, cerebral convulsions, confusion or loss of consciousness including coma, shallow breathing, bradycardia. In addition, as a result of the adrenergic feedback mechanism, symptoms such as cold, sticky sweat, anxiety, tachycardia, increased blood pressure, angina and heart rhythm disturbances can occur.
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, starvation, changes in the habitual diet;
an imbalance between exercise and consumption, carbohydrates;
alcohol consumption, especially when combined with a skipping meal;
impaired renal function;
severe liver dysfunction;
an overdose of glimepiride;
Some uncompensated diseases of the endocrine system affecting the carbohydrate metabolism (for example, thyroid dysfunction, pituitary insufficiency 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. In the presence of such factors that increase the risk of hypoglycemia, the dose of glimepiride or the entire treatment regimen should be adjusted. 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 elderly patients, in patients suffering from autonomic neuropathy or receiving simultaneous treatment padrenoblockers, clonidine, reserpine, guanethidine, or other immunopathy.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 other sulfonylureas, 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 suffering from 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.
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), it may be necessary to transfer the patient to insulin therapy in a timely manner.
There is no experience with glimepiride in patients with severe impairment of liver and kidney function or patients on hemodialysis. Patients with severe "impaired renal and hepatic 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.
At the beginning of treatment, when switching from one drug to another, or with an irregular intake of glimepiride, there may be a hypoglycemic or hyperglycemia-induced decrease in the concentration of attention and speed of the patient's psychomotor reactions. This can adversely affect the ability to drive vehicles or to manage various machines and mechanisms.
Meglimate 6 mg tablets contain a sunny yellow sunset dye (E110), which can cause allergic reactions.
Meglimate contains lactose, therefore the drug is not recommended for patients with hereditary intolerance to galactose and with lactase deficiency of Lappa or glucose-galactose malabsorption.