Buy Generic Amaryl (Glimepiride) 1, 2, 4 mg online

Dosage and administration:
The initial and maintenance dose of glimepiride are determined on the basis of regular monitoring of glucose levels in blood and urine. A monitor for monitoring blood sugar levels in the urine and also helps to detect primary or secondary resistance to glimepiride.
Glimepiride Tablets taken orally as a whole, without chewing, with a sufficient amount of liquid (about 0.5 cups).
The starting dose and titration of glimepiride:
Usually, at the beginning of treatment prescribed 1 mg glimepiride once daily. the daily dose can be increased if necessary. Any increase in the dose of glimepiride should be conducted at regular control of blood sugar levels gradually (e.g., at intervals of 1 – 2 weeks) and as follows: 1 mg – 2 mg – 3 mg – 4 mg – 6 mg, and (exceptionally ) – 8 mg.
The range of daily doses of glimepiride in patients with well-controlled diabetes:
A typical daily dose range of glimepiride in patients with well-controlled diabetes is 1 to 4 mg. Only individual patients sufficient effect is achieved by the daily doses of more than 6 mg.
The distribution of the daily dose of glimepiride:
Time and allocation of receiving a daily dose of glimepiride is determined by a physician taking into account the way of life of the patient. Usually it is enough to take the daily dose once a day. This should be done immediately before a hearty breakfast, or if the daily dose has not been accepted, immediately before the first abundant meal. It is very important not to skip meals after taking glimepiride.
The secondary correction dose of glimepiride:
In the case of improvement of diabetes compensation increases insulin sensitivity in this regard, in the course of treatment may decrease the need for glimepiride. In order to avoid the development of hypoglycemia should be considered for temporary dose reduction or cancellation of glimepiride.
dose adjustment should be carried out as in patient weight change or change his way of life, or the appearance of other factors that contribute to increased susceptibility to the development of hypo – or hyperglycaemia.
The duration of treatment glimepiride:
Typically, glimepiride treatment is long, under the control of glucose in the blood and urine.
Translation patients with other oral antidiabetic drugs to glimepiride:
There is no exact correlation between the dose of glimepiride and other oral sugar-reducing drugs. When replacing such other drugs glimepiride initial daily dose of the latter should be 1 mg (even if the patient is transferred to a maximum dosage of glimepiride other oral hypoglycemic drug). Any increase in the dose of glimepiride should be carried out in accordance with the recommendations given above.
It is necessary to take into account the degree and duration of effect of prior hypoglycemic agents. It may be necessary during the temporary cessation of treatment in order to avoid an additive effect, which increases the risk of hypoglycemia.

Overdose:
Symptoms: hypoglycemia (hunger, nausea, vomiting, sweating, anxiety, tachycardia, hypertension, palpitations, pain in the heart, arrhythmia, headache , dizziness, lethargy, drowsiness, restlessness, aggressiveness, impaired concentration, depression, confusion, tremor, paresis, sensory disorder, seizures of central origin). The clinical picture may resemble a stroke; may develop coma.
Treatment: If the patient is conscious – administered glucose by mouth or I / O. In severe cases, the patient should be hospitalized. When carried hypoglycemic coma infusion therapy 50% glucose solution, followed by infusion of a dilute (10%) glucose solution to maintain a blood glucose level of 100 mg% (5.5 mmol / L); possible introduction of 1 – 2 mg of glucagon or epinephrine and. Constant monitoring and maintenance of vital functions, the concentration of glucose in the blood for at least 24 – 48 hours (subject to repeated episodes of hypoglycemia). After recovery of consciousness is necessary to give the patient foods rich in easily digestible carbohydrates (to avoid a recurrence of hypoglycemia). When cerebral edema prescribed mannitol and dexamethasone.

Contraindications:

Use during pregnancy and lactation:
Glimepiride is contraindicated during pregnancy. In order to avoid adverse effects on the child Glimepiride should not be administered to pregnant women; the patient should be transferred to insulin. Sick women should inform their doctor about the plans for pregnancy and go on insulin.
In experimental studies have shown that glimepiride is excreted in breast milk. Getting glimepiride with the breast milk can be harmful to the child. Therefore, glimepiride should not be given to women in lactation period. The patient should go on insulin or completely abandon breastfeeding.

Side effects:
Based on the experience with glimepiride and other sulfonylureas, you must take into account the possibility of the following side effects:
From the Metabolic: hypoglycemia (headache, “wolfish “appetite, nausea, vomiting, lethargy, sleepiness, sleep disturbances, restlessness, aggressiveness, impaired concentration, reduced alertness and reactive ability, depression, confusion, speech disorders, aphasia, disorders of vision, tremor, paresis, sensory disturbances, dizziness, loss of self-control, delirium, convulsions central origin, drowsiness and loss of consciousness up to coma, shallow respiration and bradycardia, signs of adrenergic kontrregulyatsii: sweating, anxiety, tachycardia, hypertension, palpitations, angina pectoris and cardiac arrhythmias), sodium reduction in blood (hyponatremia).
From the digestive system: sometimes nausea, vomiting, epigastric discomfort, abdominal pain, diarrhea, increase in liver transaminases. In exceptional cases, cholestasis, jaundice, hepatitis, which may lead to liver failure.
From the hematopoietic system: there may be severe disorders of the blood picture; A rare opportunity to thrombocytopenia, leykotsitopeniya, hemolytic anemia or erythropenia, granulocytopenia, agranulocytosis, and pancytopenia (due mielosupresii).
From the side of view: especially at the beginning of treatment may experience transient vision disturbances caused by changes in blood sugar levels.
Allergic reactions: sometimes there may be allergic or pseudoallergy reactions: itching, hives, rash, dyspnoea, fall in blood pressure up to anaphylactic shock. In some cases there may be allergic vasculitis or photosensitivity.
If you check at any – any side effects of those listed, any – any other undesired effects or unexpected changes, please consult your physician. Since some side effects such as severe hypoglycemia, serious changes in the blood picture, severe allergic reaction and pseudoallergy or liver failure, can under certain circumstances pose a threat to life, in the case of sudden or severe reactions. You need to immediately inform them of your doctor and in no case do not continue taking the drug without his strong recommendation.

Special warnings and precautions:
The doses of glimepiride determined by the level of glucose in blood. Glimepiride should be appointed in doses and in due time, before a heavy meal (usually before breakfast). It is very important not to skip meals after taking glimepiride. Skip reception can never be corrected by subsequently receiving higher doses. The patient should inform the doctor immediately if you receive too high a dose of glimepiride.
glimepiride treatment is carried out in conjunction with a low calorie diet low in carbohydrates. Proper diet, regular and sufficient physical exercise and, if necessary, reduction of body weight are just as important to achieve optimal control of blood sugar levels, as well as regular intake of glimepiride.
During the blood treatment glimepiride requires regular monitoring of glucose levels in the urine, and glycated hemoglobin concentrations. Performance monitor for monitoring blood glucose levels in urine and makes the detection of primary or secondary resistance to the drug. Upon reaching
compensation of diabetes increases insulin sensitivity in this regard, in the course of treatment can decrease the need for glimepiride. To avoid hypoglycaemia timely necessary to reduce the dose or cancel glimepiride. Need dosage adjustment glimepiride with the physical and emotional strain, diet change or when other factors contributing to the development of hypo – or hyperglycaemia.
The clinical symptoms of inadequate lowering of blood sugar levels (hyperglycemia) include: increased frequency of urination, excessive thirst, dry mouth and dry skin.
In the first weeks of treatment Glimepiride may increase the risk of hypoglycemia, which requires very strict monitoring of patients. Factors contributing to the development of hypoglycemia include: irregular, poor nutrition, change of dietary habits, alcohol consumption, especially in combination with skipping meals, changing the usual regime of physical activity, the simultaneous use of other drugs. Almost always, hypoglycemia can quickly be cupped instant intake of carbohydrates (glucose, or sugar, such as sugars, sweetened fruit juice or tea). Therefore, the patient must always carry at least 20 g. glucose. It may also be required to assist other patients. Artificial sweeteners are not effective in treating hypoglycemia. Severe hypoglycemia requiring immediate medical treatment under the supervision of a physician, and under certain circumstances, and hospitalization.
Precautions should be prescribed glimepiride in patients with concomitant diseases of the endocrine system affecting carbohydrate metabolism (including thyroid dysfunction, adenogipofizarnaya or adrenocortical insufficiency).
When you go to glimepiride with other drugs should take into account the degree and duration of effect of prior hypoglycemic agents. It may be necessary during the temporary cessation of treatment in order to avoid an additive effect.
In exceptional stress situations (eg trauma, surgery, infectious disease with fever) may be impaired control of blood sugar levels and may need to be in a temporary transfer of the patient to insulin.
With little effect of glimepiride or reduction steps during long-term monotherapy (secondary resistance), we recommend a combination with insulin.
It is necessary to warn patients about the increased risk of hypoglycemia when receiving NSAIDs (indomethacin. diclofenac. ibuprofen, etc..), fasting.
Alcohol can strengthen or weaken the hypoglycaemic action of glimepiride; possible development of disulfiram onopodobnogo syndrome: abdominal pain, nausea, vomiting, headache.
The clinical manifestations of hypoglycemia may be masked when taking beta – blockers (propranolol, etc.), clonidine, reserpine, guanethidine or other sympatholytic.
In the treatment of tolbutamide (1.5 g / day) for 5 – 8 years, there was an increase cardio – vascular mortality by 2.5 times.
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