Glimepiride Rosiglitazone

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

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. anaphylactoid reactions
  5. anemia
  6. angina
  7. angioedema
  8. aplastic anemia
  9. arthralgia
  10. asthenia
  11. back pain
  12. blurred vision
  13. bone fractures
  14. cholestasis
  15. diarrhea
  16. dizziness
  17. dyspnea
  18. edema
  19. elevated hepatic enzymes
  20. erythema
  21. fatigue
  22. flushing
  23. headache
  24. heart failure
  25. hemolytic anemia
  26. hepatic failure
  27. hepatitis
  28. hyperbilirubinemia
  29. hypercholesterolemia
  30. hypertension
  31. hypoglycemia
  32. hyponatremia
  33. infection
  34. jaundice
  35. leukopenia
  36. macular edema
  37. maculopapular rash
  38. menstrual irregularity
  39. myocardial infarction
  40. nausea
  41. osteopenia
  42. pancytopenia
  43. peripheral edema
  44. pharyngitis
  45. photosensitivity
  46. pleural effusion
  47. porphyria
  48. pruritus
  49. pulmonary edema
  50. rash
  51. SIADH
  52. sinusitis
  53. Stevens-Johnson syndrome
  54. thrombocytopenia
  55. urticaria
  56. vasculitis
  57. visual impairment
  58. vomiting
  59. 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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