General Considerations
Dosage of Glimet must be individualized on the basis of both effectiveness and tolerance while not exceeding the maximum recommended daily dose of 2000 mg Metformin HCI / 20 mg Glibenclamide.
Glimet (Metformin HCI and Glibenclamide) Tablets should be given with meals and should be initiated at a low dose, with gradual dose escalation, in order to avoid hypoglycemia (largely due to Glibenclamide), to reduce Gl side effects (largely due to Metformin), and to permit determination of the minimum effective dose for adequate control of blood glucose for the individual patient.
Glimet As Initial Therapy
Recommended starting dose: Glimet 1.25 once or twice daily with meals.
For patients with type 2 diabetes whose hyperglycemia cannot be satisfactorily managed with diet and exercise alone, the recommended starting dose of Glimet is 1.25 once a day with a meal. As initial therapy in patients with baseline HbA10 > 9% or an FPG > 200 mg/dL, a starting dose of Glimet 1.25 twice daily with the morning and evening meals may be used. Dosage increases should be made in increments of Glimet 1.25 per day every twc weeks up to the minimum effective dose necessary to achieve adeguate control of blood glucose. In clinical trials of Glimet as initial therapy, there was no experience with total daily doses greater than 2000mg/10mg per day. Glimet 5 should not be used as initial therapy due to an increased risk of hypoglycemia.
Glimet Use in Previously Treated Patients (Second-Line Therapy)
Recommendedstartingdose: Glimet 2.5 or 5 twice daily with meals.
For patients not adeguately controlled on either Glibenclamide (or another sulfonylurea) or Metformin alone, the recommended starting dose of Glimet is 2.5 or 5 twice daily with the morning and evening meals. In order to avoid hypoglycemia, the starting dose of Glimet should not exceed the daily doses of Glibenclamide or Metformin already being taken. The daily dose should be titrated in increments of no more than Glimet 5 up to the minimum effective dose to achieve adeguate control of blood glucose or to a maximum dose of 2000 mg/20 mg per day.
For patients previously treated with combination therapy of Metformin plus Glibenclamide (or another sulfonylurea), if switched to Glimet, the starting dose should not exceed the daily dose of Metformin and Glibenclamide (or equivalent dose of another sulfonylurea) already being taken.
