A fixed-dose combination (FDC) oral anti-diabetic drug (OAD) containing a sulfonylurea (Glimepiride), a biguanide (Metformin), and an alpha-glucosidase inhibitor (Voglibose). This triple-drug combination targets multiple pathophysiological defects of type 2 diabetes mellitus (T2DM) - insulin resistance, insulin deficiency, and postprandial hyperglycemia - providing synergistic glycemic control. It is indicated for patients inadequately controlled on dual therapy.
Adult: Usually one tablet twice daily, with the first bite of the two main meals (breakfast and dinner). The dose must be individualized based on glycemic control. Starting dose is often one tablet once daily with the main meal.
Note: Take with the first bite of the main meals (usually breakfast and dinner). Swallow the tablet whole with a glass of water. Do not crush or chew. Adherence to a regular meal schedule is crucial to avoid hypoglycemia. Avoid excessive intake of complex carbohydrates at once.
This combination acts synergistically via three distinct mechanisms: 1) Glimepiride stimulates insulin secretion from pancreatic beta-cells. 2) Metformin decreases hepatic glucose production (gluconeogenesis) and improves peripheral insulin sensitivity. 3) Voglibose delays the digestion and absorption of complex carbohydrates in the small intestine, flattening the postprandial glucose spike.
Pregnancy: Category C (US FDA). Contraindicated. Insulin is the preferred treatment for glycemic control in pregnant women with diabetes. Glimepiride may cross the placenta and cause neonatal hypoglycemia. Metformin may be used in some cases (Category B) but not in this FDC.
Driving: Caution advised. The drug can cause dizziness and hypoglycemia, which may impair the ability to concentrate and react. Patients should be aware of hypoglycemia symptoms and carry a fast-acting sugar source.
| Other Anti-diabetic Agents (Insulin, other SUs, GLP-1 RAs) | Additive hypoglycemic effect, increased risk of hypoglycemia. | Major |
| Beta-blockers (e.g., Propranolol) | May mask tachycardia (warning sign of hypoglycemia) and potentiate hypoglycemia. | Moderate |
| Alcohol | Acute: Increased risk of hypoglycemia and lactic acidosis. Chronic: May induce Antabuse-like reaction. | Major |
| Warfarin | Glimepiride may potentiate anticoagulant effect; monitor INR. | Moderate |
| CYP2C9 Inhibitors (e.g., Fluconazole, Amiodarone) | Increase Glimepiride plasma levels, risk of hypoglycemia. | Moderate |
| CYP2C9 Inducers (e.g., Rifampicin) | Decrease Glimepiride plasma levels, reducing efficacy. | Moderate |
| Cationic Drugs (e.g., Cimetidine, Ranitidine) | Competes with Metformin for renal tubular secretion, may increase Metformin levels. | Moderate |
| Diuretics (especially Loop and Thiazides) | May cause hyperglycemia, counteracting drug effect. Also risk of lactic acidosis with Metformin. | Moderate |
| Corticosteroids (e.g., Prednisolone) | Cause hyperglycemia, may require dose adjustment. | Moderate |
| Digestive Enzymes (e.g., Pancreatin) or Charcoal | May reduce the effect of Voglibose; avoid concomitant use. | Moderate |
Same composition (Glimepiride (2mg) + Metformin (500mg) + Voglibose (0.2mg)), different brands: