Glucovance

2nd-line therapy in patients w/ type 2 diabetes when diet, exercise & initial treatment w/ sulphonylurea or metformin results in inadequate glycaemic control.

Individualized dose. Previously-treated patient (2nd-line therapy) Recommended starting dose: 500 mg/2.5 mg or 500 mg/5 mg bd. Max: 2,000 mg/20 mg daily. Geriatric population Adjust dosage depending on renal function parameters (start w/ 1 tab of Glucovance 500 mg/2.5 mg), ≥65 yr Start w/ lowest available dose.

Should be taken with food: Take w/ meals.

Hypersensitivity to metformin HCl, glibenclamide, other sulphonylureas or sulphonamides. Type 1 diabetes, diabetic pre-coma; any type of acute metabolic acidosis eg, lactic acidosis, diabetic ketoacidosis; acute conditions w/ potential to alter renal function eg, dehydration, severe infection, shock; disease causing tissue hypoxia eg, cardiac or resp failure, recent MI. Acute alcohol intoxication, alcoholism; porphyria. Concomitant use w/ miconazole. Severe renal failure (GFR <30 mL/min), hepatic insufficiency. Lactation.

Temporarily discontinue use if dehydration occurs; in presence of conditions altering renal function. Not recommended in patients w/ known or suspected mitochondrial diseases eg, mitochondrial encelopathy w/ lactic acidosis & stroke-like episodes (MELAS) syndrome, maternal inherited diabetes & deafness (MIDD). Lactic acidosis. Hypoglycaemia in case of energy-restricted diet, after intensive or prolonged exercise, alcohol intake; malnutrition, irregular & missed meals, fasting or diet changes, poor balance between physical exercise & carbohydrate intake, thyroid, pituitary & adrenal gland insufficiency. Blood-sugar imbalance; stable chronic heart failure. May reduce vit B₁₂ levels. Perform prompt diagnostic evaluation in case of signs & symptoms suggestive of MELAS syndrome or MIDD. Assess renal function prior to initiation & regularly thereafter. Regularly perform usual lab tests for diabetes monitoring. G6PD deficiency. Overwt patients should continue energy-restricted diet. Discontinue use prior to, during or 48 hr after use of intravascular iodinated contrast agents & surgery under general, spinal or peridural anaesth. Not to be used in congenital galactosemia, glucose-galactose malabsorption syndrome or lactase deficiency. Not recommended in concomitant use w/ alcohol, phenylbutazone or danazol. Concomitant use w/ antihypertensives, diuretics, NSAIDs. May affect ability to drive & use machines. Hepatic failure or severe renal failure. Pregnancy. Not recommended in childn. Elderly ≥65 yr.

GI disorders eg, nausea, vomiting, diarrhoea, abdominal pain & loss of appetite. Vit B₁₂ decrease/deficiency; taste disturbance; transient visual disturbances.

Increased hypoglycaemic effect w/ miconazole. Antabuse effect & increased risk of lactic acidosis w/ alcohol. Increased hypoglycaemic effects w/ phenylbutazone; danazol. Elevated blood glucose w/ chlorpromazine, corticosteroids (glucocorticoids), systemic & local tetracosactides, β₂-agonists. Decreased blood glucose levels w/ ACE inhibitors. Triggered lactic acidosis w/ diuretics. Renal failure w/ iodinated contrast agents. Reduced efficacy w/ organic cation transporters (OCT) 1 substrates/inhibitors eg, verapamil. Increased GI absorption & efficacy w/ OCT1 inducers eg, rifampicin. Increased plasma conc w/ OCT2 substrates/inhibitors eg, cimetidine, dolutegravir, crizotinib, olaparib, daclatasvir, vandetanib. Masked some hypoglycaemic symptoms by β-blockers. Increased sulphonylurea t_½ w/ fluconazole. Reduced plasma conc w/ bosentan. Reduced antidiuretic activity w/ desmopressin. Reduced hypoglycaemic effect w/ bile acid sequestrants, colesevelam.

Antidiabetic Agents

A10BD02 - metformin and sulfonylureas ; Belongs to the class of combinations of oral blood glucose lowering drugs. Used in the treatment of diabetes.

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