glimepiride Nursing Considerations & Management

Drug Name

Generic Name : glimepiride

Brand Name:  Amaryl

Classification: Antidiabetic, Sulfonylurea (second generation)

Pregnancy Category C

Dosage & Route
  • Available forms : Tablets—1, 2, 4 mg
  • Usual starting dose is 1–2 mg PO once daily with breakfast or first meal of the day; usual maintenance dose is 1–4 mg PO once daily, depending on patient response and glucose levels. Do not exceed 8 mg/day.
    • Combination with insulin therapy: 8 mg PO daily with first meal of the day with low-dose insulin.
    • Transfer from other hypoglycemics: No transition period is necessary.
  • Safety and efficacy not established.
  • Usual starting dose is 1 mg PO once daily; titrate dose carefully, lower maintenance doses may be sufficient to control blood sugar.
Therapeutic actions
  • Glimepiride stimulates the insulin release from functioning pancreatic β-cells and inhibits gluconeogenesis at hepatic cells. It also increases insulin sensitivity at peripheral target sites.
  • As an adjunct to diet to lower blood glucose in patients with type 2 diabetes mellitus whose hypoglycemia cannot be controlled by diet and exercise alone
  • In combination with metformin or insulin to better control glucose as an adjunct to diet and exercise in patients with type 2 diabetes mellitus
Adverse effects
  • Vomiting, GI pain, diarrhoea; pruritus, erythema, urticaria, morbilliform, maculopapular eruptions; leukopenia, agranulocytosis, thrombocytopenia, haemolytic anaemia, aplastic anaemia and pancytopenia; hyponatraemia; changes in accommodation, blurred vision, jaundice.
  • Diabetic ketoacidosis with or without coma.
Nursing considerations
  • History: Allergy to sulfonylureas; diabetes complicated by fever, severe infections, severe trauma, major surgery, ketosis, acidosis, coma (insulin is indicated in these conditions); type 1 or juvenile diabetes, serious hepatic or renal impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia associated with primary renal disease; pregnancy
  • Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum creatinine, LFTs, blood glucose, CBC
  • Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage being used.
  • WARNING: Transfer to insulin therapy during periods of high stress (eg, infections, surgery, trauma).
  • Use IV glucose if severe hypoglycemia occurs as a result of overdose.
  • Arrange for consultation with dietitian to establish weight-loss program and dietary control.
  • Arrange for thorough diabetic teaching program, including disease, dietary control, exercise, signs and symptoms of hypoglycemia and hyperglycemia, avoidance of infection, hygiene.
Teaching points
  • Take this drug once a day with breakfast or the first main meal of the day.
  • Do not discontinue this drug without consulting your health care provider; continue with diet and exercise program for diabetes control.
  • Monitor urine or blood for glucose and ketones as prescribed.
  • Do not use this drug if you are pregnant.
  • Avoid alcohol while using this drug.
  • Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-colored stools, hypoglycemic or hyperglycemic reactions.