Glimepiride Rosiglitazone Brand Name– Avandaryl
What is Glimepiride Rosiglitazone
Glimepiride rosiglitazone is a combination product containing 2 oral antidiabetic agents.
Glimepiride is a second-generation, long-acting sulfonylurea. Rosiglitazone 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 adult patients with type 2 diabetes mellitus (DM). The addition of rosiglitazone (4 or 8 mg/day) to a sulfonylurea further reduces fasting plasma glucose and A1C compared to monotherapy.
A meta-analysis of mostly short-term trials suggested an increased risk for myocardial infarction (MI) with rosiglitazone vs. placebo. However, data from long-term clinical trials of rosiglitazone vs. other antidiabetic agents, including a cardiovascular (CV) outcome trial (RECORD), observed no difference in overall mortality or major adverse CV events (MACE).
Some uncertainty over the CV safety of rosiglitazone nevertheless remains, and thus close monitoring is prudent, especially among patients with greater CV risk factors.
Metformin is first-line in the treatment of type 2 DM. In patients with established 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, rosiglitazone 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 when treatment with a sulfonylurea or rosiglitazone alone does not result in adequate glycemic control
Side Effects
- abdominal pain
- agranulocytosis
- alopecia
- anaphylactoid reactions
- anemia
- angina
- angioedema
- aplastic anemia
- arthralgia
- asthenia
- back pain
- blurred vision
- bone fractures
- cholestasis
- diarrhea
- dizziness
- dyspnea
- edema
- elevated hepatic enzymes
- erythema
- fatigue
- flushing
- headache
- heart failure
- hemolytic anemia
- hepatic failure
- hepatitis
- hyperbilirubinemia
- hypercholesterolemia
- hypertension
- hypoglycemia
- hyponatremia
- infection
- jaundice
- leukopenia
- macular edema
- maculopapular rash
- menstrual irregularity
- myocardial infarction
- nausea
- osteopenia
- pancytopenia
- peripheral edema
- pharyngitis
- photosensitivity
- pleural effusion
- porphyria
- pruritus
- pulmonary edema
- rash
- SIADH
- sinusitis
- Stevens-Johnson syndrome
- thrombocytopenia
- urticaria
- vasculitis
- visual impairment
- vomiting
- weight gain
Monitoring Parameters
- blood glucose
- glucose-6-phosphate dehydrogenase (G6PD) activity
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- weight
Contraindications
- acute heart failure
- adrenal insufficiency
- anemia
- angina
- bone fractures
- breast-feeding
- cardiac disease
- children
- contraception requirements
- diabetic ketoacidosis
- edema
- G6PD deficiency
- geriatric
- heart failure
- hemolytic anemia
- hepatic disease
- hypercortisolism
- hyperglycemia
- hyperthyroidism
- hypoglycemia
- hypothyroidism
- jaundice
- menstrual irregularity
- myocardial infarction
- neonates
- obstetric delivery
- osteoporosis
- peripheral edema
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- pulmonary edema
- renal failure
- renal impairment
- sulfonamide hypersensitivity
- sulfonylurea hypersensitivity
- type 1 diabetes mellitus
Interactions
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