Glimepiride drug interactions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

List of drug interactions

Highly protein bound drugs

Drugs tending to produce hyperglycemia

Aspirin

Cimetidine/ranitidine

Propranolol

Warfarin

Serum glucose/insulin/C-peptide/plasma glucagon

Oral miconazole

Other drugs



Highly protein bound drugs

The hypoglycemic action of sulfonylureas may be potentiated by certain drugs, including nonsteroidal anti-inflammatory drugs and other drugs that are highly protein bound, such as salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, monoamine oxidase inhibitors, and beta adrenergic blocking agents. When these drugs are administered to a patient receiving Glimepiride, the patient should be observed closely for hypoglycemia. When these drugs are withdrawn from a patient receiving Glimepiride, the patient should be observed closely for loss of glycemic control. Return to top

Drugs tending to produce hyperglycemia

Certain drugs tend to produce hyperglycemia and may lead to loss of control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, and isoniazid. When these drugs are administered to a patient receiving Glimepiride, the patient should be closely observed for loss of control. When these drugs are withdrawn from a patient receiving Glimepiride, the patient should be observed closely for hypoglycemia. Return to top

Aspirin

Coadministration of aspirin (1 g tid) and Glimepiride led to a 34% decrease in the mean Glimepiride AUC and, therefore, a 34% increase in the mean CL/f. The mean Cmax had a decrease of 4%. Blood glucose and serum C-peptide concentrations were unaffected and no hypoglycemic symptoms were reported. Pooled data from clinical trials showed no evidence of clinically significant adverse interactions with uncontrolled concurrent administration of aspirin and other salicylates. Return to top

Cimetidine/ranitidine

Coadministration of either cimetidine (800 mg once daily) or ranitidine (150 mg bid) with a single 4 mg oral dose of Glimepiride did not significantly alter the absorption and disposition of Glimepiride, and no differences were seen in hypoglycemic symptomatology. Pooled data from clinical trials showed no evidence of clinically significant adverse interactions with uncontrolled concurrent administration of H2-receptor antagonists. Return to top

Propranolol

Concomitant administration of propranolol (40 mg tid) and Glimepiride significantly increased Cmax, AUC, and T1/2 of Glimepiride by 23%, 22%, and 15%, respectively, and it decreased CL/f by 18%. The recovery of M1 and M2 from urine, however, did not change. The pharmacodynamic responses to Glimepiride were nearly identical in normal subjects receiving propranolol and placebo. Pooled data from clinical trials in patients with Type 2 diabetes showed no evidence of clinically significant adverse interactions with uncontrolled concurrent administration of beta-blockers. However, if beta-blockers are used, caution should be exercised and patients should be warned about the potential for hypoglycemia. Return to top

Warfarin

Concomitant administration of Glimepiride tablets (4 mg once daily) did not alter the pharmacokinetic characteristics of R- and S-warfarin enantiomers following administration of a single dose (25 mg) of racemic warfarin to healthy subjects. No changes were observed in warfarin plasma protein binding. Glimepiride treatment did result in a slight, but statistically significant, decrease in the pharmacodynamic response to warfarin. The reductions in mean area under the prothrombin time (PT) curve and maximum PT values during Glimepiride treatment were very small (3.3% and 9.9%, respectively) and are unlikely to be clinically important. Return to top

Serum glucose/insulin/C-peptide/plasma glucagon

The responses of serum glucose, insulin, C-peptide, and plasma glucagon to 2 mg Glimepiride were unaffected by coadministration of ramipril (an ACE inhibitor) 5 mg once daily in normal subjects. No hypoglycemic symptoms were reported. Pooled data from clinical trials in patients with Type 2 diabetes showed no evidence of clinically significant adverse interactions with uncontrolled concurrent administration of ACE inhibitors. Return to top

Oral miconazole

A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known. There is a potential interaction of Glimepiride with inhibitors (e.g. fluconazole) and inducers (e.g. rifampicin) of cytochrome P450 2C9. Return to top

Other drugs

Although no specific interaction studies were performed, pooled data from clinical trials showed no evidence of clinically significant adverse interactions with uncontrolled concurrent administration of calcium-channel blockers, estrogens, fibrates, NSAIDS, HMG CoA reductase inhibitors, sulfonamides, or thyroid hormone. Return to top

Complete List of Drug Interactions

Major Interactions

Moderate Interactions

Minor Interactions




Adapted from the FDA Package Insert.


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