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The patient's fasting blood glucose and HbA1c must be measured periodically to determine the minimum effective dose for the patient; to detect primary failure, ie, inadequate lowering of blood glucose at the maximum recommended dose of medication; and to detect secondary failure, ie, loss of adequate blood glucose lowering response. After an initial period of effectiveness glycosylated hemoglobin levels should be performed to monitor the patient's response to therapy.
Hypoglycemia: All sulfonylurea drugs are capable of producing severe hypoglycemia. Proper patient selection, dosage and instructions are important to avoid hypoglycemic episodes.
Debilitated patients, malnourished patients and patients with adrenal, pituitary, renal or hepatic insufficiency are paticularly susceptible to the hypoglycemic action of sulfonylureas and should therefore be carefully monitored. The dosage of glimepiride should be carefully adjusted in these patients.
Hepatic insufficiency may cause increased serum concentrations of glimepiride and may diminish gluconeogenic capacity, both of which increase the risk of severe hypoglycemic reactions.
Alcohol ingestion, severe or prolonged exercise, deficient caloric intake or use of >1 antidiabetic agent may predispose patients to the development of hypoglycemia.
Loss of Control of Blood Glucose: When a patient stabilized on any diabetic regimen is exposed to stress eg, fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to add insulin in combination with glimepiride or even use insulin monotherapy.
Use in pregnancy: Glimepiride is not recommended for use during pregnancy.
Use in lactation: It is not known whether glimepiride is distributed into human breast milk. However, some sulfonylureas are distributed into human breast milk. Because of its potential to cause hypoglycemia in nursing infants, glimepiride is not recommended for use by nursing mothers.
Use in children: Glimepiride is not recommended for use in children.
