Canada-Approved Medicine

This monograph describes a medication approved for use in Canada by the Therapeutic Products Directorate, a division of Health Canada’s Health Products and Food Branch. The medication is not approved by the United States Food and Drug Administration; however, a similar formulation carrying a different generic or brand name might be available in the US.

• Control of blood sugar in type 2 diabetes mellitus when control of diet and exercise fails or when insulin is not an option. Requires some pancreatic function.

Contraindicated in:

• Hypersensitivity; cross-sensitivity with other sulfonylureas may occur
• Unstable diabetes, type 1 diabetes mellitus, diabetic ketoacidosis, diabetic coma or pre-coma
• Severe hepatic or renal impairment
• Concurrent use of oral/oromucosal miconazole, alcohol or alcohol-containing medications, or systemic phenylbutazone
• OB: Should not be used during pregnancy, insulin is preferred
• Lactation: Should not be used during lactation, insulin is perferred.

Use Cautiously in:

• Glucose 6-phosphate dehydrogenase deficiency (↑ risk of hemolytic anemia)
• Infection, stress, or changes in diet may alter requirements for control of blood sugar or require use of insulin
• Impaired thyroid, pituitary, or adrenal function
• Malnutrition, high fever, prolonged nausea, or vomiting
• Pedi: Safety and effectiveness not established.

Endo: hypoglycemia.

GI: abdominal pain, diarrhea, dyspepsia, ↑ liver enzymes, nausea, vomiting.

Derm: photosensitivity, rash.

Drug-Drug:

• Concurrent use of alcohol, angiotensin converting-enzyme inhibitors, antituberculars, azole antifungals, beta-blockers, clarithromycin, clofibrate, disopyramide, H2–receptor antagonists, MAO inhibitors, NSAIDs, phenylbutazone, salicylates, long-acting sulfonamides, warfarin, may ↑ risk of hypoglycemia.
• ↑risk of hypoglycemia with other antidiabetic agents including alpha glucosidase inhibitors, biguanides, and insulin.
• Concurrent use of chlorpromazine, corticosteroids, danazol, diuretics (including thiazides, and furosemide), hormonal contraceptives (estrogen and progestogen), nicotinic acid (pharmacologic doses), ritodrine, salbutamol, terbutaline, or tetracosactrin may ↑ risk of hyperglycemia and lead to loss of diabetic control.
• May ↑ risk of bleeding with warfarin.
• Concurrent use with alcohol may result in a disulfiram-like reaction and should be avoided.
• Beta-blockers may ↓ some symptoms of hyperglycemia.

• Tablets (contain lactose): 80 mg;
• Modified-release tablets: 30 mg; 60 mg;

• PO (Adults): Tablets — 80–320 mg/day, doses >160 mg/day should be divided and given twice daily; modified-release tablets — 30 mg daily, may be ↑ in 30 mg increments every 2 wk until blood sugar is controlled up to 120 mg/day.

• Lowers blood glucose by stimulating the release of insulin from the pancreas and increasing sensitivity to insulin at receptor sites.

• Lowering of blood glucose in diabetic patients.

Therapeutic Classification: antidiabetics

Pharmacologic Classification: sulfonylureas

Absorption: Well absorbed following oral administration (97%).

Distribution: Unknown.

Protein Binding: 95%.

Metabolism/Excretion: Extensively metabolized, metabolites are mostly eliminated (60–70%) in urine, 10–20% in feces; <1% excreted unchanged in urine.

Half-life: Tablets — 10.4 hr; modified-release tablets — 16 hr.

Diamicron MR

(effect on blood sugar)

• Instruct patient to take gliclazides as directed at the same time every day.
• Explain to patient that this medication does not cure diabetes and must be used in conjunction with a prescribed diet, exercise regimen, to prevent hypoglycemic and hyperglycemic events.
• Instruct patient on proper technique for home glucose monitoring. Monitor closely during periods of stress or illness and notify health care professional if significant changes occur.
• Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to drink a glass of orange juice or ingest 2–3 tsp of sugar, honey, or corn syrup dissolved in water or an appropriate number of glucose tablets and notify health care professional.
• Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
• Concurrent use of alcohol may cause a disulfiram-like reaction (abdominal cramps, nausea, flushing, headaches, and hypoglycemia).
• Instruct patient to avoid sun exposure and to wear protective clothing and sunscreen when outdoors.
• Caution patient to avoid other medications, especially aspirin and alcohol, while on this therapy without consulting health care professional.
• Advise patient to notify health care professional promptly if unusual weight gain, swelling of ankles, drowsiness, shortness of breath, muscle cramps, weakness, sore throat, rash, or unusual bleeding or bruising occurs.
• Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
• Advise patient to carry sugar packets or candy, and identification describing diabetes diagnosis and medication regimen.
• Insulin is the recommended method of controlling blood sugar during pregnancy. Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected.
• Emphasize the importance of routine follow-up exams.

GLIK-la-zide