Glimepiride Pioglitazone

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

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. anaphylactoid reactions
  5. anemia
  6. angioedema
  7. anorexia
  8. aplastic anemia
  9. asthenia
  10. blurred vision
  11. bone fractures
  12. cholestasis
  13. diarrhea
  14. dizziness
  15. dyspnea
  16. edema
  17. elevated hepatic enzymes
  18. erythema
  19. fluid retention
  20. flushing
  21. headache
  22. heart failure
  23. hemolytic anemia
  24. hepatic failure
  25. hepatitis
  26. hyperbilirubinemia
  27. hypoglycemia
  28. hyponatremia
  29. infection
  30. jaundice
  31. leukopenia
  32. macular edema
  33. maculopapular rash
  34. menstrual irregularity
  35. myalgia
  36. nausea
  37. new primary malignancy
  38. osteopenia
  39. pancytopenia
  40. peripheral edema
  41. pharyngitis
  42. photosensitivity
  43. porphyria
  44. pruritus
  45. rhabdomyolysis
  46. SIADH
  47. sinusitis
  48. Stevens-Johnson syndrome
  49. thrombocytopenia
  50. urticaria
  51. visual impairment
  52. vomiting
  53. 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

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