In principle, the dosage of Glimepiride is determined by the desired blood glucose level. The dosage of Glimepiride must be lowest which is sufficient to achieve the desired metabolic treatment with Glimepiride must be initiated and monitored by a doctor. Glimepiride must be taken at the times and in the doses prescribed. During treatment with Glimepiride 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.
If a patient forgets to take a dose, this must never be corrected by subsequently taking a larger dose. Measure for dealing with such situations (in particular forgetting a dose or skipping a meal) where a dose cannot be taken at the prescribed time must be discussed and agreed between physician and patient beforehand.
If it is discovered that too high a dose or an extra dose of Glimepiride has been taken, a physician must be notified immediately.
Initial Dose and Dose Titration: The usual initial dose is 1 mg Glimepiride once daily. If necessary, the daily dose can be increased. It is recommended that the increase be guided by regular blood glucose monitoring and that the dose be increased gradually, i.e. at intervals of one to two weeks and according to the following dose steps: 1 mg-2 mg-3 mg-4 mg-6 mg, daily doses of more than 6 mg are more effective only in a minority of patients. A maximum of 8 mg per day may not be exceeded.
Dose range in patients with well controlled diabetes: Usual daily doses in patients with well controlled diabetes are 1 to 4 mg Glimepiride.
Distribution of doses: Timing and distribution of doses are to be decided by the physician, taking into consideration the patient's current life-style.
Normally a single daily dose of Glimepiride is sufficient. It is recommended that this dose be taken immediately before a substantial breakfast or if none is taken-immediately before the first main meal.
It is very important not to skip meals after the tablet(s) have been taken.
Secondary dosage adjustment: An improvement in the control of diabetes is associated with higher insulin sensitivity, therefore Glimepiride requirements may fall as treatment proceeds. To avoid hypoglycaemia, dose reduction or cessation of Glimepiride therapy must therefore be considered, in time correction of dosage must also be considered, whenever the patient's weight changes the patient's lifestyle changes or other factors arise which cause an increased susceptibility to hypoglycaemia or hyperglycaemia (refer to Precautions).
Duration of Treatment: Treatment with Glimepiride is normally long-term therapy.
Change over from other oral diabetics to Glimepiride: There is no exact dosage relationship between Glimepiride and other oral antidiabetics. When substituting glimepiride for other oral antidiabetics. It is recommended that the procedure be the same as for initial dosage, starting with daily doses of 1 mg. This applies even in cases where the patient is being switched from the maximum dose of another oral antidiabetic.