Gliclada

Gliclada, which contains gliclazide, is a second-generation oral hypoglycemic agent from the group of sulfonylurea derivatives used to treat non-insulin-dependent diabetes mellitus (type 2). Gliclazide improves insulin secretion and may have an effect on reducing insulin resistance observed in patients with this type of diabetes. The effects of gliclazide include a decrease in blood glucose levels that is maintained in both short-term and long-term use and are comparable to the results achieved by other sulfonylurea agents.

Of particular note, gliclazide may be useful in patients with diabetic retinopathy through its haematobiological actions, and the addition of gliclazide to insulin therapy allows for a reduction in insulin dosage. Thus, gliclazide is effective in correcting the metabolic abnormalities associated with non-insulin-dependent diabetes and may have the added benefit of potentially slowing the progression of diabetic retinopathy. These properties, together with good tolerability and a low incidence of hypoglycaemia, give gliclazide an important place among the available oral hypoglycaemic agents for the control of non-insulin-dependent diabetes (Palmer & Brogden, 1993).

Indications Glyclades

Glyclada is used to treat type 2 diabetes. This medication is prescribed when diet, exercise, and lifestyle changes are not effective enough to control blood sugar levels. It may be used alone or in combination with other antidiabetic medications, such as metformin or insulin, depending on the individual patient’s situation.

Release form

Glyclada is usually available as a tablet to take by mouth.

Pharmacodynamics

1. Mechanism of action:

   • Glyclada acts by stimulating the release of insulin from the β-cells of the pancreas.
   • It also increases tissue sensitivity to insulin, which improves the body's use of glucose and lowers blood sugar levels.
   • It is important to note that Gliclada does not usually cause hypoglycemia when used in the correct dosage, making it a preferred blood sugar control agent for patients with diabetes.

Pharmacokinetics

1. Absorption: Gliclazide is generally well absorbed from the gastrointestinal tract after oral administration. Peak plasma concentrations are usually reached 1-4 hours after administration.
2. Metabolism: After absorption, gliclazide is metabolized in the liver. The main metabolite is the active form of gliclazide, which exhibits hypoglycemic action.
3. Excretion: Gliclazide is excreted primarily in the urine as metabolites. In patients with normal renal function, the elimination half-life of gliclazide is approximately 8-12 hours.
4. Liver: Since gliclazide is metabolised in the liver, dosage adjustments may be required in patients with impaired liver function.
5. Renal: Since gliclazide is excreted in the urine, dosage adjustment may be required in patients with renal impairment.
6. Duration of action: The duration of action of gliclazide is about 12-24 hours, allowing it to be taken once or twice daily.

Dosing and administration

1. Directions for use:

   • Glyclada is usually taken orally, before meals.
   • The tablets should be swallowed whole with a small amount of water.
   • It is recommended to take the tablets every day at the same time of day to ensure stable levels of the drug in the blood.

2. Dosage:

   • The dosage of Glyclada is determined by the doctor depending on the individual needs of the patient and the severity of the disease.
   • The usual starting recommended dose for adults is 30 mg taken once daily.
   • The dose may be increased to 60 or 120 mg per day depending on the response to treatment and the doctor's recommendations.

3. Duration of admission:

   • The duration of taking Glyclada is determined by the doctor and depends on the nature and severity of diabetes.
   • The drug is usually taken over a long period of time to maintain stable blood glucose levels.

Use Glyclades during pregnancy

The use of gliclazide (Gliclad) during pregnancy is not recommended due to limited data on its safety for the fetus. Existing studies show that the use of gliclazide during pregnancy is not associated with an increased risk of maternal hospitalization or adverse neonatal outcomes compared with metformin use, however, the number of pregnancies studied is limited, which is a key limitation (Kelty et al., 2020).

In another case, despite normal pregnancy outcome after exposure to gliclazide and ramipril in the first 16 weeks, it is noted that this does not provide clear evidence for the safety of these drugs during pregnancy, especially given the known risks associated with ACE inhibitors such as ramipril (Kolağası et al., 2009).

Therefore, gliclazide should be avoided during pregnancy, especially without careful consultation with a physician who can assess the potential risks and benefits of its use.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to gliclazide or to any of the ingredients of the drug should not take Gliclada.
2. Diabetes mellitus type 1: Gliclazide is not recommended for the treatment of diabetes mellitus type 1, which is characterized by absolute insulin deficiency.
3. Antidiabetic agents: The use of gliclazide may be contraindicated in patients taking certain antidiabetic agents or insulin, particularly if this may lead to hypoglycemia.
4. Hepatic impairment: In patients with severe hepatic impairment, Glyclada should be used with caution and under medical supervision, as changes in drug metabolism may require dosage adjustment.
5. Pregnancy and breastfeeding: There is limited information on the safety of gliclazide during pregnancy and breastfeeding, so its use during this period should only be carried out on the advice of a doctor.
6. Paediatric population: The efficacy and safety of Glyclada in children have not been established, so its use in children may require consultation with a physician.
7. Elderly: In elderly patients, more careful prescribing and regular monitoring may be required when using gliclazide.

Side effects Glyclades

1. Hypoglycemia (low blood sugar), especially if you do not follow a diet or if you take it with other antidiabetic drugs.
2. Skin intolerance to sunlight (photosensitivity).
3. Increased blood sugar levels (hyperglycemia) when taking high doses of the drug.
4. Gastrointestinal disorders such as nausea, vomiting, diarrhea, constipation.
5. Headache, fatigue, drowsiness.
6. Elevated liver enzyme levels.
7. Rarely, allergic reactions may occur, including skin rash, itching, or angioedema.

Overdose

1. Headache and dizziness.
2. Irregular heartbeats or palpitations.
3. Irregular breathing or difficulty breathing.
4. Weakness, drowsiness or fatigue.
5. Anxiety, nervousness or irritability.
6. Starvation or trembling.
7. Loss of consciousness or coma.

Interactions with other drugs

1. Drugs that increase the hypoglycemic effect: Drugs that lower blood glucose levels (eg, insulin or other hypoglycemic agents) may increase the hypoglycemic effect of gliclazide. This may lead to hypoglycemia (low blood sugar) and requires careful monitoring of blood glucose levels.
2. Medicines that increase blood glucose levels: Some medicines, such as glucocorticosteroids (eg, prednisone) or some diuretics (eg, thiazide diuretics), can increase blood glucose levels. This may reduce the effectiveness of Glyclada and require adjustment of its dosage.
3. Drugs affecting the liver: Since Glyclada is metabolized in the liver, drugs that affect liver function (e.g., inhibitors or inducers of liver enzymes) may alter its pharmacokinetics. This may require a dosage adjustment of Glyclada in patients with liver dysfunction.
4. Alcohol: Drinking alcohol in combination with gliclazide may increase the risk of hypoglycemia. This is because alcohol may enhance the hypoglycemic effect of gliclazide.
5. Drugs affecting renal function: Since Glyclada is excreted in the urine, drugs affecting renal function (e.g. diuretics or nephrotoxic drugs) may alter its pharmacokinetics and require dosage adjustment.