Description of the dosage form Glyburide Metformin:
Tablets of 500 mg / 2,5 mg: Valium biconvex, film-coated, light-orange color with an engraved “2.5″ on one side.
Tablets of 500 mg / 5 mg: Valium biconvex, film-coated, yellow colored engraved with “5″ on one side.
Feature:
Combined oral hypoglycemic agent.
Pharmacological action Glyburide Metformin:
hypoglycemic. Glyburide Metformin belongs to the biguanide and reduces the level of glucose in the blood serum by increasing the sensitivity of peripheral tissues to the action of insulin and increased glucose uptake. Metformin reduces the absorption of carbohydrates in the gastrointestinal tract and inhibits hepatic gluconeogenesis. Also has a beneficial effect on blood lipids lowering total cholesterol, LDL and triglycerides.
Glyburide belongs to the sulfonylurea derivatives II generation. Glucose levels while taking Glyburide decreases as a result of stimulation of insulin secretion of beta-cells in the pancreas.
Indications Glyburide Metformin:
type 2 diabetes mellitus in adults: as second-line drugs in cases where the diet therapy, exercise, and previous therapy Metformin, or Glyburide was not allowed to control diabetes; to replace the previous therapy with two drugs (Metformin and Glyburide) in patients with stable and well-controlled blood glucose levels.
Contra Glyburide / Metformin Glyburide Metformin:
Hypersensitivity to Metformin, Glyburide, or other sulfonylureas, as well as auxiliary substances, type 1 diabetes, diabetic ketoacidosis, diabetic precoma, coma, renal failure or renal dysfunction (creatinine level above 135 mg / dL for men and 110 mmol / L for women), acute conditions that may lead to changes in renal function: dehydration, severe infection, shock, intravascular introduction of iodinated contrast media, acute or chronic diseases accompanied by tissue hypoxia: cardiac or respiratory failure, recent myocardial infarction, hepatic insufficiency, acute alcohol intoxication, alcoholism, porphyria, pregnancy, lactation, concomitant use of miconazole, lactic acidosis (including history), compliance with a hypocaloric diet (1000 kcal / day), the holding of radioisotope or radiology Studies with the introduction of iodinated contrast material (no less than 48 hours before and after the procedure).
The use of Glyburide / Metformin during pregnancy and lactation:
Contraindicated during pregnancy. At the time of treatment should stop breastfeeding (there are no data on the ability of the drug passes into breast milk).
During treatment Glucovance should inform the doctor about planned pregnancy and the onset of pregnancy. When planning a pregnancy, as well as in the case of pregnancy while taking Glucovance, the drug should be withdrawn and assigned to treatment with insulin.
Side effects Glyburide Metformin
From the digestive tract: nausea, vomiting, abdominal pain, loss of appetite. Are frequent symptoms at baseline and in most cases are their own and do not require special treatment. For the prevention of these symptoms are advised to take the drug in 2 or 3 times, slowly increasing the dose of the drug also improves its portability.
For the skin: erythema.
From the hemopoietic system: megaloblastic anemia.
From a metabolism: lactic acidosis.
Other: “metallic” taste in the mouth.
Associated with Glyburide.
From a metabolism: hypoglycaemia.
For the skin: hives, rashes, itchy skin.
From the digestive tract: nausea, vomiting, epigastric pain and elevated liver enzymes.
From the hemopoietic system: leucopenia, thrombocytopenia, rare – agranulocytosis, hemolytic anemia, pancytopenia.
Other:
antabusny effect “when taking alcohol.
Interaction Glyburide Metformin:
Miconazole may provoke the development of hypoglycemia (down to the development of coma). Danazol, chlorpromazine at high doses (100 mg / day), beta 2-agonists have a hyperglycemic effect. If necessary, treatment with danazol and stopped taking the last dose of Glucovance is required correction under the control of glucose levels.
Drinking alcohol increases the risk of hypoglycemic reactions, including cases of coma. During treatment Glucovance should avoid alcohol and drugs containing alcohol.
Glucocorticoids increase blood glucose levels and may lead to the development ketotsidoza.
Diuretics (particularly “loop”) provoke the development of ketoacidosis due to the development of functional renal failure.
In the intravenous iodinated contrast media can lead to kidney failure, which in turn leads to the accumulation of the drug in the body and the development of lactic acidosis.
All beta-blockers mask the symptoms of hyperglycemia such as tachycardia. Most of the nonselective beta-blockers increase the frequency and severity of hypoglycemia.
Fluconazole increases the T1 / 2 of sulfonylurea derivatives and increases the risk of hypoglycemic reactions. Sharing of ACE inhibitors (captopril, enalapril) in patients with diabetes increases the risk of hypoglycemic reactions due to improvement in glucose tolerance and lower insulin requirements.
Overdose Glyburide Metformin:
Symptoms: The development of lactic acidosis (due to the presence of Metformin); the development of hypoglycemia (due to the presence of the drug Glyburide).
Treatment:
with lactic acidosis – hemodialysis, with hypoglycemia if the patient is conscious, the appointment of glucose inside, with loss of consciousness – in the intravenous glucose or 1-2 ml of glucagon. After recovery of consciousness is necessary to give the patient foods rich in carbohydrate (to avoid recurrence of hypoglycemia).
Glyburide clearance in plasma may be increased in patients with liver disease. Since Glyburide is actively associated with blood proteins, the drug is not eliminated by dialysis.
Dosing and dose Glyburide Metformin:
Inside, during a meal. Dose is determined by the physician for each patient depending on the level of glycemia. Typically, the initial dose is 1 tablet. Glucovance 500 / 2,5 mg a day.
When replacing the previous combination therapy of Metformin and Glyburide – 1-2 Table. Glucovance 500 / 2,5 mg depending on the previous dose levels. Every 1-2 weeks after starting treatment dose correcting depending on the level of glucose.
The maximum daily dose is 4 tablets. Glucovance 500 / 2,5 mg or 2 tablets. Glucovance 500 / 5 mg.
Special instructions:
When you are vomiting, abdominal pain, accompanied by muscle cramps or general malaise should discontinue the drug and seek medical advice immediately (possibly the development of lactic acidosis).
For 48 h prior to surgery or intravenous injection iodinated radiopaque means taking Glucovance should be discontinued. Treatment Glucovance recommended resume in 48 hours
During the treatment should not take alcohol.
In the treatment of drug should be avoided broncho-pulmonary infections and urinary tract infection.
