Glyclada

Gliclada, containing gliclazide, is a second-generation oral hypoglycemic drug from the group of sulfonylureas used for the treatment of 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 reduction in blood glucose levels, which is maintained with both short-term and long-term use, and is comparable to the results achieved by other sulfonylureas.

It is particularly noteworthy that gliclazide may be beneficial for patients with diabetic retinopathy due to its hemobiological actions, and the addition of gliclazide to insulin therapy can reduce the insulin dose. Thus, gliclazide is effective in correcting the metabolic abnormalities associated with non-insulin-dependent diabetes and may have the additional benefit of potentially slowing the progression of diabetic retinopathy. These properties, along with good tolerability and a low incidence of hypoglycemia, allow gliclazide to occupy an important place among the available oral hypoglycemic agents for the control of non-insulin-dependent diabetes (Palmer & Brogden, 1993).

Indications Glyclades

Glyclade is used to treat type 2 diabetes. This drug is prescribed when diet, exercise, and lifestyle changes are not effective enough to control blood sugar levels. It can be used as monotherapy or in combination with other antidiabetic drugs such as metformin or insulin, depending on the patient's individual situation.

Release form

Glyclade is usually available in the form of tablets for oral administration.

Pharmacodynamics

1. Mechanism of action:

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

Pharmacokinetics

1. Absorption: Gliclazide is usually well absorbed from the gastrointestinal tract after oral administration. Maximum plasma concentrations are usually achieved 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 a hypoglycemic effect.
3. Excretion: Gliclazide is excreted mainly in the urine in the form of metabolites. In patients with normal renal function, the half-life of gliclazide from the body is approximately 8-12 hours.
4. Liver: Since the metabolism of gliclazide occurs in the liver, dosage adjustment may be required in patients with impaired liver function.
5. Kidneys: Since gliclazide is excreted in the urine, dosage adjustments may be required in patients with impaired renal function.
6. Duration of action: The duration of action of gliclazide is about 12-24 hours, which allows it to be taken once or twice a day.

Dosing and administration

1. Method of application:

   • Glyclade is usually taken orally, before meals.
   • The tablets should be swallowed whole with a little water.
   • It is recommended to take the tablets at the same time every 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 treatment:

   • The duration of taking Glyclada is determined by the doctor and depends on the nature and severity of diabetes.
   • The drug is usually taken for a long 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 gliclazide use 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 outcomes following exposure to gliclazide and ramipril in the first 16 weeks, it is noted that this does not provide clear evidence of the safety of these drugs during pregnancy, especially given the known risks associated with ACE inhibitors such as ramipril (Kolağası et al., 2009).

Gliclazide should therefore be avoided during pregnancy, especially without careful consultation with a doctor who can evaluate the potential risks and benefits of its use.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to gliclazide or any of the ingredients of the drug should not take Gliclada.
2. Type 1 diabetes mellitus: Gliclazide is not recommended for the treatment of type 1 diabetes mellitus, which is characterized by absolute insulin deficiency.
3. Antidiabetic agents: The use of gliclazide may be contraindicated in patients taking certain antihyperglycemic agents or insulin, especially if they may cause hypoglycemia.
4. Liver impairment: In patients with severe hepatic impairment, Gliclada should be used with caution and under medical supervision, as changes in drug metabolism may require dosage adjustment.
5. Pregnancy and breastfeeding: Data on the safety of gliclazide during pregnancy and breastfeeding are limited, so its use during this period should only be done on the advice of a physician.
6. Children: The effectiveness and safety of Glyclade in children has not been established, so its use in children may require consultation with a doctor.
7. Geriatric age: Elderly patients may require more careful prescribing and regular monitoring when using gliclazide.

Side effects Glyclades

1. Hypoglycemia (low blood sugar), especially when not following a diet or when taken together with other antidiabetic drugs.
2. Skin intolerance to sunlight (photosensitivity).
3. Increased blood sugar levels (hyperglycemia) when taking large doses of the drug.
4. Gastrointestinal disorders such as nausea, vomiting, diarrhea, constipation.
5. Headache, fatigue, drowsiness.
6. Increased levels of liver enzymes.
7. Allergic reactions, including skin rash, itching, or angioedema, may rarely occur.

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. Hungry or shaking.
7. Loss of consciousness or coma.

Interactions with other drugs

1. Drugs that increase hypoglycemic effects: Drugs that lower blood glucose levels (for example, insulin or other hypoglycemic agents) may increase the hypoglycemic effect of gliclazide. This can lead to hypoglycemia (low blood sugar) and requires careful monitoring of blood glucose levels.
2. Drugs that increase blood glucose: Some drugs, such as corticosteroids (such as prednisolone) or some diuretics (such as thiazide diuretics), may increase blood glucose levels. This may reduce the effectiveness of Glyclada and require adjustment of its dosage.
3. Drugs that affect the liver: Because Glyclade is metabolized in the liver, drugs that affect liver function (eg, liver enzyme inhibitors or inducers) may alter its pharmacokinetics. This may require dosage adjustment of Glyclada in patients with impaired liver function.
4. Alcohol: Consuming alcohol in combination with gliclazide may increase the risk of developing hypoglycemia. This is because alcohol can increase the hypoglycemic effect of gliclazide.
5. Drugs Affecting Renal Function: Because Glyclade is excreted in the urine, drugs affecting renal function (e.g., diuretics or nephrotoxic drugs) may alter its pharmacokinetics and require dosage adjustment.