Gliclazide: indications, side effects of single and combined metformin delivery

Indications of Gliclazide

Gliclazide is a sulfonylurea hypoglycaemic drug. Sulfonylureas work by increasing the amount of insulin and thus lowering blood sugar levels in the body. This corresponds to the insufficient insulin levels caused by type 2 diabetes, making Gliclazide one of the most commonly prescribed medications for the clinical treatment of type 2 diabetes.

Gliclazide is often administered orally as tablets and is available in both standard (80 mg) and extended-release (30 mg) tablet sizes. Adults: The recommended dose for standard tablets is 40-80 mg per day; this may be increased if necessary until adequate control is achieved. The maximum daily dose used is 320 mg. Doses >160 mg given in 2 divided doses daily. Extended-release tablets are 30 mg daily; may be increased by 30 mg at intervals of at least 1 month (after 2 weeks if no reduction in blood glucose is observed). Maximum daily dose is 120 mg. Optimal treatment during use of Gliclazide may be achieved by use of proper diet and exercise and close monitoring of blood glucose levels.

To better treat patients with type 2 diabetes, Gliclazide is being developed for use in combination to promote therapeutic efficacy. Metformin is the most widely used drug in the clinical treatment of type 2 diabetes. It lowers sugar by reducing glucose production in the liver and improving insulin sensitivity. This is synergistic with the mechanism of action of Gliclazide and is therefore indicated for the treatment of type 2 diabetes and is not effective in type 1 diabetes. Clinical studies have shown that the combined Gliclazide/Metformin tablets (at a dose of 80/500 mg) are bioequivalent to the tablets alone. And it can be exchanged with co-administration of individual tablets. In addition, the combination tablets are expected to improve convenience and adherence to prescribed therapy and contribute to better glycaemic control in patients with type 2 diabetes.

Side Effects

Alone: Common side effects of Gliclazide include: stomach pain or indigestion; nausea, vomiting, diarrhoea, constipation.Gliclazide is also sometimes associated with hypoglycaemia, which manifests itself as hunger, trembling, sweating, confusion, and difficulty concentrating. Serious side effects are relatively rare and include: Hepatobiliary disorders (jaundice, cholestasis, hepatitis), eye disorders (transient visual disturbances), haematological and lymphatic disorders (reversible anaemia, leucopenia, thrombocytopenia, granulocyte deficiency), and severe allergic reactions.

Common side effects of the Gliclazide/Metformin combination tablets include low blood sugar, taste changes, nausea, vomiting, dizziness, stomach pain, diarrhoea, headache and upper respiratory tract infections. It can be associated with severe lactic acidosis and death from kidney failure compared to gliclazide alone, but is relatively rare. It can also lead to vitamin B12 deficiency if used for a long time.

References:

[1] H Y CHO. Pharmacokinetics and bioequivalence evaluation of gliclazide/metformin combination tablet and equivalent doses of gliclazide and metformin in healthy Korean subjects.[J]. International journal of clinical pharmacology and therapeutics, 2009. DOI:10.5414/cpp47770.

[2] JIAN L Q. A Fatal Case of Metformin and Gliclazide Poisoning and its Management[J]. Borneo Journal of Medical Sciences (BJMS), 2017. DOI:10.51200/bjms.v11i3.978.