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What is Glucovance?

Glucovance is an antidiabetic hypoglycemic drug, a combination of two active ingredients – glibenclamide and metformin hydrochloride (belongs to the class of biguanides). The medication is produced in tablet form. It is intended for the treatment of patients who have been diagnosed with type II diabetes mellitus, at a stage when diet and treatment with metformin do not allow to control the level of insulin in the blood. It’s also used as a replacement agent in patients taking drugs of metformin and glibenclamide groups separately. Metformin reduces the absorption of glucose in the gastrointestinal tract, stimulates the capture and utilization of glucose by the muscles of the body, reduces the production of glucose by the liver, contributes to the normalization of fat metabolism, reduces the level of cholesterol in the blood. Glibenclamide (sulfonylurea derivative) reduces the amount of glucose in the blood due to its ability to stimulate the pancreatic beta cells and increase insulin production.

How should I use Glucovance?

Take tablets as prescribed by a doctor who sets the individual dosage and duration of treatment for each patient. If 1 pill is prescribed, it is taken in the morning. If 2 or 4 tablets are prescribed, they are taken in two doses – in the morning and in the evening. If 4 or more tablets are prescribed, they are taken in three doses.

To avoid a hypoglycemic attack, the drug is taken together with food, during breakfast, lunch or dinner, it is also necessary to ensure that the food contains enough carbohydrates.

If it’s necessary to increase the dose, it can be done no faster than once every 2 weeks.The maximum daily dosage: 5 + 500 – 4 tablets, 2.5 + 500 – 6 tablets.

What are the contraindications of this medicine?

Do not take Glucovance if you have any of the following conditions:

  • hypersensitivity to glibenclamide and metformin;
  • leukopenia;
  • severe adrenal insufficiency;
  • type 1 diabetes;
  • diabetic ketoacidosis, diabetic precoma, diabetic coma;
  • renal failure or impaired renal function (creatinine clearance less than 60 ml/min);
  • acute conditions that can cause changes in kidney function: dehydration, severe infection, shock;
  • use within less than 48 hours before and within 48 hours after radioisotope or x-ray examinations with the introduction of an iodine-containing contrast agent;
  • chronic alcoholism, acute alcohol intoxication;
  • lactic acidosis (including in the anamnesis);
  • acute or chronic diseases that are accompanied by tissue hypoxia: cardiac or respiratory failure, recent myocardial infarction, shock;
  • liver failure;
  • porphyria;
  • adherence to a low-calorie diet (less than 1000 kcal/day);
  • simultaneous use of miconazole;
  • extensive surgeries and injuries when insulin therapy is indicated;
  • impaired absorption of food and drugs in the gastrointestinal tract (including intestinal obstruction, intestinal paresis);
  • pregnancy, breastfeeding period
  • children up to 18 years;
  • simultaneous use with bosentan.

With caution: individuals over 60 years old, performing heavy physical work; febrile syndrome, diseases of the thyroid gland (with impaired function), insufficiency of the function of the anterior pituitary or adrenal cortex; elderly patients due to the risk of hypoglycemia; insufficiency of glucose-6-phosphate dehydrogenase; during the first weeks of treatment (increased risk of hypoglycemia); in the presence of risk factors for hypoglycemia.

What are the side effects of Glucovance?

The drug can cause the following side effects:

  • nausea, vomiting, abdominal pain, loss of appetite, “metallic” taste in the mouth;
  • erythema (as a manifestation of hypersensitivity);
  • reduced absorption and, as a consequence, plasma cyanocobalamin concentrations (with prolonged use), lactic acidosis;
  • hypoglycemia;
  • maculopapular rash (including mucous membranes), pruritus, urticaria, photosensitization;
  • discomfort in the epigastric region, increased activity of liver transaminases, hepatitis;
  • leukopenia, thrombocytopenia, agranulocytosis, hemolytic anemia, bone marrow aplasia, pancytopenia;
  • skin and liver porphyria; hyponatremia, hypercreatininemia, elevated plasma urea, disulfiram-like reactions (when used simultaneously with ethanol).

What may interact with this medicine?

Do not use Glucovance if you are currently taking any of the medications listed below:

  • miconazole;
  • fluconazole;
  • phenylbutazone;
  • iodine-containing radiopaque drugs;
  • ethanol-containing agents;
  • GCS;
  • beta2-adrenostimulators;
  • diuretics;
  • ACE inhibitors;
  • beta-blockers;
  • antibacterial drugs from the group of sulfonamides;
  • fluoroquinolones;
  • anticoagulants (coumarin derivatives);
  • MAO inhibitors;
  • chloramphenicol;
  • pentoxifylline;
  • lipid-lowering drugs from the group of fibrates;
  • disopyramide

What should I watch for while using this medicine?

The use of Glucovance is contraindicated during pregnancy. The patient should be warned that during the period of treatment with glibenclamide + metformin, it is necessary to inform the doctor about the planned pregnancy and the onset of pregnancy. When planning a pregnancy, as well as in the event of pregnancy in the period of taking tablets, the drug should be canceled.

The medication is contraindicated during breastfeeding since there are no data on the ability of glibenclamide to penetrate into breast milk.

An overdose of glibenclamide + metformin can cause an attack of hypoglycemia. To stop an attack, you must always have a liquid with a high content of sugar on hand. A seizure that is not stopped in time may further lead to loss of consciousness, coma, paroxysm, and neurological disorders. Prolonged excess dosage may cause lactic acidosis.

Large surgical interventions and injuries, extensive burns, infectious diseases with the febrile syndrome may require the withdrawal of this drug.

It is necessary to regularly monitor the content of glucose in the blood on an empty stomach and after a meal, the daily curve of glucose in the blood.

Patients should be warned about the increased risk of hypoglycemia in cases of taking ethanol, NSAIDs, during fasting. Dose adjustment is necessary during physical and emotional overstrain, change in diet.

The medication is used with caution on the background of therapy with beta-blockers.

It is necessary to cancel the drug 2 days before any angiographic or urographic examination (therapy resumes 48 hours after the examination).

When used with ethanol-containing substances, Glucovance can cause disulfiram-like reactions.

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and psychomotor speed.