Glimepiride Pioglitazone Brand Name– Duetact
What is Glimepiride Pioglitazone
Glimepiride pioglitazone is a combination product containing 2 oral antidiabetic agents.
Glimepiride is a second-generation, long-acting sulfonylurea. Pioglitazone is a member of the thiazolidinedione (TZD) class.
The combination is used as an adjunct to diet and exercise to lower blood glucose concentrations in patients with type 2 diabetes mellitus (DM). The addition of pioglitazone to a sulfonylurea further reduces fasting plasma glucose and hemoglobin A1C vs. monotherapy; A1C reductions range from 0.88% to 1.67% depending on the dose of pioglitazone used.
Metformin is first-line in the treatment of type 2 DM. In patients with established cardiovascular (CV) disease, heart failure (HF), or chronic kidney disease (CKD), a sodium-glucose co-transporter 2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with proven CV benefit and reduction of CKD progression is recommended for add-on therapy, independent of baseline A1C or individualized A1C target.
In patients without indicators of high-risk or established CVD, HF, or CKD, pioglitazone and other TZDs are associated with glycemic durability; however, the benefits must be balanced with the risk of adverse effects such as heart failure, edema, decreased bone mineral density, and weight gain.
Sulfonylureas are generally considered to have equivalent efficacy in the treatment of type 2 DM with an expected 1% to 2% decrease in hemoglobin A1C; however, second-generation agents, like glimepiride, are preferred over first-generation agents due to a lower risk of hypoglycemia and favorable cost, efficacy, and safety profiles.
Disadvantages of sulfonylurea therapy include hypoglycemia (especially in the elderly), weight gain, and frequent loss of efficacy over time; however, the weight gain is relatively modest in large cohort studies and the incidence of severe hypoglycemia is lower than with insulin
Indications
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus uncontrolled by diet and exercise alone
for use when initial treatment with a sulfonylurea alone does not result in adequate glycemic control
Side Effects
- abdominal pain
- agranulocytosis
- alopecia
- anaphylactoid reactions
- anemia
- angioedema
- anorexia
- aplastic anemia
- asthenia
- blurred vision
- bone fractures
- cholestasis
- diarrhea
- dizziness
- dyspnea
- edema
- elevated hepatic enzymes
- erythema
- fluid retention
- flushing
- headache
- heart failure
- hemolytic anemia
- hepatic failure
- hepatitis
- hyperbilirubinemia
- hypoglycemia
- hyponatremia
- infection
- jaundice
- leukopenia
- macular edema
- maculopapular rash
- menstrual irregularity
- myalgia
- nausea
- new primary malignancy
- osteopenia
- pancytopenia
- peripheral edema
- pharyngitis
- photosensitivity
- porphyria
- pruritus
- rhabdomyolysis
- SIADH
- sinusitis
- Stevens-Johnson syndrome
- thrombocytopenia
- urticaria
- visual impairment
- vomiting
- weight gain
Monitoring Parameters
- blood glucose
- glucose-6-phosphate dehydrogenase (G6PD) activity
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- serum bilirubin
- weight
Contraindications
- acute heart failure
- adrenal insufficiency
- anemia
- autonomic neuropathy
- bladder cancer
- bone fractures
- breast-feeding
- cardiac disease
- children
- contraception requirements
- diabetic ketoacidosis
- edema
- fever
- G6PD deficiency
- geriatric
- heart failure
- hemolytic anemia
- hepatic disease
- hypoglycemia
- infection
- menstrual irregularity
- neonates
- new primary malignancy
- obstetric delivery
- osteoporosis
- peripheral edema
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- pulmonary edema
- renal failure
- renal impairment
- sulfonamide hypersensitivity
- sulfonylurea hypersensitivity
- surgery
- thyroid disease
- trauma
- type 1 diabetes mellitus
Interactions
- Abiraterone
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetazolamide
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- Alogliptin; Metformin
- Alpelisib
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- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
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- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
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- Hydrocodone; Phenylephrine
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