The dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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In principle, the dosage of Ziglim-M is governed by the desired blood glucose level. The starting dose of Ziglim-M is 1 tab once a day before or with breakfast or first main meal. The dosage of Ziglim-M must be the lowest which is sufficient to achieve the desired metabolic control.
During treatment with Ziglim-M, glucose levels in blood and urine must be measured regularly. In addition, it is recommended that regular determinations of the proportion of glycated haemoglobin be carried out.
Mistakes eg, forgetting to take a dose, must never be corrected by subsequently taking a larger dose.
Measures for dealing with such mistakes (in particular, forgetting a dose or skipping a meal) or situations where a dose cannot be taken at the prescribed time must be discussed and agreed between physician and patient beforehand.
As an improvement in control of diabetes is, in itself, associated with higher insulin sensitivity, Glimepiride (Ziglim-M) requirements may fall as treatment proceeds. To avoid hypoglycaemia, timely dose reduction or cessation of Ziglim-M therapy must therefore be considered.
The highest recommended dose per day should be Glimepiride (Ziglim-M) 8 mg and Metformin (Ziglim-M) 2000 mg.
Daily doses of Glimepiride (Ziglim-M) of >6 mg are more effective only in a minority of patients.
In order to avoid hypoglycaemia, the starting dose of Ziglim-M should not exceed the daily doses of Glimepiride (Ziglim-M) or Metformin (Ziglim-M) already being taken.
When switching from combination therapy of Glimepiride (Ziglim-M) plus Metformin (Ziglim-M) as separate tablets, Ziglim-M should be administered on the basis of dosage currently being taken.
Titration: The daily dose should be titrated in increments of 1 tab only, corresponding to the lowest strength (in case various strengths are available).
Duration of Treatment: Treatment with Ziglim-M is normally a long-term therapy.
Administration: Ziglim-M should be administered once per day during breakfast or at the first main meal. Due to the sustained-release formulation, Ziglim-M must be swallowed whole and not crushed or chewed.
Ziglim-M interactions
Interactions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Ziglim-M, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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Glimepiride (Ziglim-M): Based on experience with Glimepiride (Ziglim-M) and on what is known of other sulfonylureas, the following interactions must be considered:
Glimepiride (Ziglim-M) is metabolized by cytochrome P-450 2C9 (CYP2C9). This should be taken into account when Glimepiride (Ziglim-M) is co-administered with inducers (eg, rifampicin) or inhibitors (eg, fluconazole) of CYP2C9.
Potentiation of the blood glucose-lowering effect and, thus, in some instances, hypoglycaemia may occur when one of the following drugs is taken eg, insulin and other oral antidiabetics, angiotensin-convering enzyme (ACE) inhibitors, anabolic steroids and male sex hormones, chloramphenicol, coumarin derivatives, cyclophosphamide, disopyramide, fenfluramine, fenyramidol, fibrates, fluoxetine, guanethidine, ifosfamide, MAO inhibitors, miconazole, fluconazole, para-aminosalicylic acid, pentoxifylline (high dose parenteral), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolones, salicylates, sulfinpyrazone, clarithromycin, sulfonamide antibiotics, tetracyclines, tritoqualine, trofosfamide.
Weakening of the blood glucose-lowering effect and, thus, raised blood glucose levels may occur when one of the following drugs is taken eg, acetazolamide, barbiturates, corticosteroids, diazoxide, diuretics, epinephrine (adrenaline) and other sympathomimetic agents, glucagon, laxatives (after protracted use), nicotinic acid (in high doses), oestrogens and progestogens, phenothiazines, phenytoin, rifampicin, thyroid hormones.
H2-receptor antagonists, β-blockers, clonidine and reserpine may lead to either potentiation or weakening of the blood glucose-lowering effect.
Under the influence of sympatholytic drugs eg, β-blockers, clonidine, guanethidine and reserpine, the signs of adrenergic counter-regulation to hypoglycaemia may be reduced or absent.
Both acute and chronic alcohol intake may potentiate or weaken the blood glucose-lowering action of Glimepiride (Ziglim-M) in an unpredictable fashion.
The effect of coumarin derivatives may be potentiated or weakened.
Metformin (Ziglim-M): Inadvisable Combinations: Alcohol: Increased risk of lactic acidosis in acute alcohol intoxication, particularly in case of fasting or malnutrition and hepatic insufficiency.
Avoid consumption of alcohol and alcohol-containing medications.
Iodinated Contrast Agents: Intravascular administration of iodinated contrast agents may lead to renal failure, resulting in Metformin (Ziglim-M) accumulation and a risk of lactic acidosis.
Metformin (Ziglim-M) should be discontinued prior to, or at the time of the test and not reinstituted until 48 hrs afterwards, and only after renal function has been re-evaluated and found to be normal.
Associations Requiring Precautions for Use: Glucocorticoids (systemic and local routes), β-agonists (salbutamol, formoterol) and diuretics have intrinsic hyperglycaemic activity. Inform the patient and perform more frequent blood glucose monitoring, especially at the beginning of treatment. If necessary, adjust the dosage of the antidiabetic drug during therapy with the other drug and upon its discontinuation.
ACE inhibitors may decrease the blood glucose levels. If necessary, adjust the dosage of the antidiabetic drug during therapy with the other drug and upon its discontinuation.
Incompatibilities: None.
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References
DailyMed. "GLIMEPIRIDE; PIOGLITAZONE HYDROCHLORIDE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
FDA/SPL Indexing Data. "9100L32L2N: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
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