(di-mi-RELL)
glimepiride (glim-epi-RIDE)
Consumer Medicine Information (CMI)
What is in this leaflet
This leaflet answers some common questions about Dimirel.
It does not contain all the available information. It does not take the place of talking to your doctor, pharmacist or diabetes educator.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking Dimirel against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine.
You may need to read it again.
What Dimirel is used for
Dimirel is used to control blood glucose in patients with type 2 diabetes mellitus.
Dimirel is used when healthy eating and increased physical activity are not enough to control your blood glucose.
Dimirel can be used alone, or together with insulin or other medicines for treating diabetes.
How it works
Dimirel lowers high blood glucose by increasing the amount of insulin produced by your pancreas.
Dimirel belongs to a group of medicines called sulfonylureas.
If your blood glucose in not controlled properly, you may experience hypoglycaemia (low blood glucose - a "hypo") or hyperglycaemia (high blood glucose).
Low blood glucose can occur suddenly. Signs may include:
weakness, trembling or shaking
sweating
lightheadedness, dizziness, headache or lack of concentration
tearfulness or crying
irritability
hunger
numbness around the lips and tongue
If not treated promptly, these may progress to:
loss of co-ordination
slurred speech
confusion
loss of consciousness or seizures
High blood glucose usually occurs more slowly than low blood glucose. Signs of high blood glucose may include:
lethargy or tiredness
headache
thirst
passing large amounts of urine
blurred vision
High blood glucose can lead to serious problems with your heart, eyes, circulation or kidneys.
Ask your doctor if you have any questions about why this medicine has been prescribed for you.
This medicine is only available with a doctor's prescription.
There is no evidence that Dimirel is addictive.
Before you take Dimirel
When you must not take it
Do not take Dimirel if:
you have an allergy to:
Dimirel
sulfonylureas
related medicines such as sulfur antibiotics or thiazide diuretics
any of the ingredients listed at the end of this leaflet
Symptoms of an allergic reaction to Dimirel may include skin rash, itchiness, shortness of breath, or difficulty breathing.
If you are not sure you have an allergy to Dimirel, check with your doctor.
you have previously had a reaction to glimepiride or any other sulfonylurea or sulfonamide
you have or have had any of the following conditions:
type 1 diabetes mellitus
unstable diabetes
diabetic acidosis
diabetic coma or pre-coma
severe kidney disease or if you require dialysis
severe liver failure
If you are not sure if you have any of the above, ask your doctor.
you are pregnant or intend becoming pregnant
Insulin is more suitable for controlling blood glucose during pregnancy. Your doctor will replace Dimirel with insulin.
you are breastfeeding or plan to breastfeed
Dimirel passes into breast milk and therefore there is the possibility that the breastfed baby may be affected.
the packaging is torn or shows signs of tampering (or the tablets do not look quite right)
the expiry date printed on the pack has passed
If you take this medicine after the expiry date has passed, it may not work as well.
Do not give Dimirel to children.
There is not enough experience with the use of Dimirel in children.
If you are not sure whether you should start taking Dimirel, talk to your doctor or pharmacist.
Before you start to take it
Tell your doctor if:
you have any allergies to any other medicines or any other substances such as foods, preservatives or dyes
you are breastfeeding or plan to breastfeed
Dimirel passes into breast milk and therefore there is the possibility that the breastfed baby may be affected.
you have or have had any of the following medical conditions
kidney problems
liver problems
a history of diabetic coma
adrenal, pituitary or thyroid problems
heart failure
glucose-6-phosphate dehydrogenase (G6PD) deficiency
you drink alcohol in any amount
you do not eat regular meals
you do a lot of exercise or you do heavy exercise or work
you are ill or feeling unwell
Alcohol, diet, exercise and your general health all strongly affect the control of your diabetes.
you are taking any other anti-diabetic treatment
If you have not told your doctor or pharmacist about any of the above, tell them before you start taking Dimirel.
Taking other medicines
Tell your doctor, pharmacist or diabetes educator if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.
Some medicines may lead to low blood glucose (hypoglycaemia) by increasing the blood glucose-lowering effect of Dimirel. These include:
alcohol
other medicines used to treat diabetes
anabolic steroids
some antibiotics
some antidepressants
some medicines used to treat reflux and stomach ulcers
some anti-inflammatory agents, such as ibuprofen and naproxen
some medicines used to treat arthritis and gout
some blood pressure lowering medicines, such as beta-blockers and ACE inhibitors
some medicines used to treat blood clots, blood vessel problems and irregular heart rhythms
some cholesterol-lowering and weight reduction medicines
some cancer and organ transplant treatments
Some medicines may lead to loss of control of your diabetes by weakening the blood glucose-lowering effect of Dimirel.
These include:
alcohol
some antibiotics, such as rifampicin
some blood pressure, cholesterol and heart medications
some medicines used to treat reflux and stomach ulcers
thyroid medication
some medicines used to treat epilepsy
corticosteroids, glucagon, adrenaline and other hormonal therapies
oral contraceptives
some asthma medicines, preparations for coughs and colds, and weight reduction medicines
some fluid and glaucoma medications
large doses of laxatives
some psychiatric and sedating medications
Dimirel may change the effects of other medicines. These include:
coumarin derivatives, which are used to prevent blood clots
Some medicines may hide the symptoms of low blood glucose (hypoglycaemia). These include:
alcohol
certain heart medications, such as beta-blockers
You may need different amounts of your medicine or you may need to take different medicines. Your doctor, pharmacist or diabetes educator can tell you what to do if you are taking any of these medicines. They also have a complete list of medicines to be careful with or avoid while taking Dimirel.
Ask your doctor or pharmacist if you are not sure if you are taking any of these medicines.
How to take Dimirel
Follow all directions given to you by your doctor, pharmacist or diabetes educator carefully.
They may differ from the information contained in this leaflet.
If you do not understand the instructions on the box, ask your doctor or pharmacist for help.
How much to take
Your doctor will tell you how many tablets to take each day. Your doctor may increase or decrease the dose, depending on your blood glucose levels.
How to take it
Swallow the tablets whole with a glass of water.
When to take it
You must make sure that you take Dimirel just before or with a meal.
Dimirel tablets are usually taken once a day, immediately before breakfast. If you eat only a light breakfast, you should delay taking the tablet until after the first main meal of the day (e.g. lunch).
Do not skip meals while taking Dimirel.
How long to take it
Continue to take Dimirel for as long as your doctor recommends. Make sure you keep enough Dimirel to last over weekends and holidays.
Dimirel will help control your diabetes but will not cure it. Therefore, you may have to take it for a long time.
If you forget to take it
If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, and then go
back to taking your medicine as you would normally.
Missed doses can cause high blood glucose (hyperglycaemia).
If you are not sure whether to skip the dose, talk to your doctor or pharmacist.
Do not take a double dose to make up for the dose that you missed.
If you double a dose, this may cause low blood glucose (hypoglycaemia).
If you take too much (overdose)
Immediately telephone your doctor or pharmacist or or go to Accident and Emergency at your nearest hospital if you think that you or anyone else may have taken too much Dimirel.
Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.
If you take too much Dimirel, you may experience the symptoms of low blood glucose (hypoglycaemia).
At the first signs of hypoglycaemia, raise your blood glucose quickly by taking one of the following:
5-7 jelly beans
3 teaspoons of sugar or honey
1/2 can of a sugar-containing soft drink
2-3 concentrated glucose tablets
Unless you are within 10 to 15 minutes of your next meal, follow up with extra carbohydrates, e.g. plain biscuits, fruit or milk, when over the initial symptoms.
Taking this extra carbohydrate will prevent a second drop in your blood glucose level.
If not treated quickly, these symptoms may progress to loss of co-ordination, slurred speech, confusion, loss of consciousness and seizures.
While you are using Dimirel
Things you must do
If you become pregnant while you are taking Dimirel, stop taking it and tell your doctor immediately.
If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking Dimirel.
Tell all doctors, dentists and pharmacists who are treating you that you are taking Dimirel.
If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are taking Dimirel.
Make sure all friends, relatives, workmates or carers know that you have diabetes. Make sure they can recognise the symptoms of hypoglycaemia and know how to treat them.
Always carry some sugary food or drink with you.
If you experience any of the symptoms of low blood glucose (hypoglycaemia), immediately eat some sugary food or have a drink, e.g. lollies, biscuits or fruit juice. Diet and low calorie soft drinks do NOT contain sugar and are unsuitable to take for hypoglycaemia.
If you are elderly or are taking other medicines for diabetes, the risk of hypoglycaemia is increased.
The risk of hypoglycaemia is also increased in the following situations:
too much Dimirel
too much or unexpected exercise
delayed meal or snack
too little food
If you experience any of the signs of high blood glucose (hyperglycaemia), contact your doctor immediately.
The risk of hyperglycaemia is increased in the following situations:
undiagnosed or uncontrolled diabetes
illness, infection or stress
too little Dimirel
certain other medicines
too little exercise
sudden immobilisation, e.g. after an accident
eating more carbohydrate than normal
If you become ill or experience extra stress, injury, fever, infection or need surgery, tell your doctor.
Your blood glucose may become difficult to control at these times. Your doctor may decide to change your treatment and use insulin instead of Dimirel.
Make sure you check your blood glucose levels regularly.
This is the best way to tell if your diabetes is being controlled properly. Your doctor or diabetes educator will show you how and when to do this.
Visit your doctor for regular checks of your eyes, feet, kidneys, heart, circulation, blood and blood pressure.
Carefully follow your doctor's and/or dietician's advice on diet, drinking alcohol and exercise.
If you drink alcohol while taking Dimirel, you may get flushing, headache, breathing difficulties, rapid heart beat, stomach pains or feel sick and vomit.
Tell your doctor immediately if you notice the return of any symptoms you had before starting Dimirel.
These may include lethargy or tiredness, headache, thirst, passing large amounts of urine and blurred vision.
These may be signs that Dimirel is no longer working, even though you may have been taking it successfully for some time.
Things you must not do
Do not give Dimirel to anyone else, even if they have the same condition as you.
Do not skip meals while taking Dimirel.
Things to be careful of
Protect your skin when you are in the sun, especially between 10am and 3pm.
Dimirel may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight may cause a skin rash, itching, redness, or a severe sunburn.
If outdoors, wear protective clothing and use a 15+ sunscreen. If your skin does appear to be burning, tell your doctor immediately.
If you have to be alert, e.g. when driving, be especially careful not to let your blood glucose levels fall too low.
Low blood glucose levels may slow your reaction time and affect your ability to drive or operate machinery. Drinking alcohol can make this worse. However, Dimirel by itself is unlikely to affect how you drive or operate machinery.
Make sure you know how you react to Dimirel before you drive a car, operate machinery or do anything else that could be dangerous if you are dizzy or light-headed. If this occurs, do not drive.
If you are travelling, it is a good idea to:
wear some form of identification showing you have diabetes
carry some form of sugar to treat hypoglycaemia if it occurs, e.g. sugar sachets or jelly beans
carry emergency food rations in case of a delay, e.g. dried fruit, biscuits or muesli bars
keep Dimirel readily available
If you become sick with a cold, fever or flu, it is very important to continue taking Dimirel, even if you feel unable to eat your normal meal. If you have trouble eating solid foods, use sugar-sweetened drinks as a carbohydrate substitute or eat small amounts of bland
food.
Your diabetes educator or dietician can give you a list of food to use for sick days.
Side effects
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Dimirel.
Dimirel helps most people with diabetes, but it may have unwanted side effects in a few people.
All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor or pharmacist if you notice any of the following and they worry you:
signs of hypoglycaemia, which may include weakness, trembling or shaking, sweating, light-headedness, headache, dizziness, lack of concentration, tearfulness or crying, irritability, hunger and numbness around the lips and fingers
eye problems, including blurred or double vision
stomach upset including nausea (feeling sick) and vomiting
diarrhoea, abdominal pain or a feeling of fullness in the stomach
Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following:
rash, sores, redness or itching of the skin, itchy hives-like rash or spots
symptoms of sunburn such as redness, itching, swelling or blistering which may occur more quickly than normal
bleeding or bruising more easily than normal, or reddish or purplish blotches under the skin
yellowing of the skin or eyes, also called jaundice
signs of frequent or worrying infections, such as fever, severe chills, sore throat or mouth ulcers
signs of anaemia, such as tiredness, being short of breath and looking pale.
Tell your doctor or pharmacist if you notice anything that is making you feel unwell.
Other side effects not listed above may occur in some people.
Do not be alarmed by this list of possible side effects.
You may not experience any of them.
After using Dimirel
Storage
Keep your tablets in the blister pack until it is time to take them.
If you take the tablets out of the blister pack they may not keep well.
Keep your tablets in a cool dry place where the temperature stays below 25°C.
Do not store Dimirel or any other medicine in the bathroom or near a sink. Do not leave it in the car on hot days or on window sills.
Heat and dampness can destroy some medicines.
Keep it where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.
Disposal
If your doctor tells you to stop using Dimirel or the tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.
Product description
What it looks like
Dimirel 1 mg tablets: pink oblong, scored tablets with "NMK" and the Hoechst logo on both sides.
Dimirel 2 mg tablets: green oblong, scored tablets with "NMM" and the Hoechst logo on both sides.
Dimirel 3 mg tablets: pale yellow oblong, scored tablets with "NMN" and the Hoechst logo on both sides.
Dimirel 4 mg tablets: light blue oblong, scored tablets with "NMO" and the Hoechst logo on both sides.
The tablets are packed in blister packs of 30 tablets.
Ingredients
Active Ingredients:
glimepiride
Inactive Ingredients:
lactose monohydrate
magnesium stearate
microcrystalline cellulose
povidone
sodium starch glycollate
In order to distinguish between the different tablet strengths, each strength contains different colourings. These are:
Dimirel 1 mg tablets - iron oxide red
Dimirel 2 mg tablets - iron oxide yellow and indigo carmine lake
Dimirel 3mg tablets - iron oxide yellow
Dimirel 4 mg tablets - indigo carmine lake
