In principle, the dosage of Glimepiride governed by the desired blood sugar level. The dosage of Glimepiride must be the lowest which is sufficient to achieve the desired metabolic control. Treatment with Glimepiride must be initiated and monitored by a doctor. Glimepiride must be taken at the times and in the doses prescribed. The initial and the maintenance doses are set based on the results of regular checks of glucose in blood and urine. Monitoring of glucose levels in blood and urine also serves to detect either primary or secondary failure of therapy.

Initial dose and dose titration : The usual initial dose is 1 mg once daily. If necessary, the daily dose can be increased. Any increase should be based on regular blood sugar monitoring and should be gradual, i.e. at intervals of 1-2 weeks and carried out stepwise, as follows : 1 mg - 2 mg - 3 mg - 4 mg, and (in exceptional cases) 8 mg.

Dose range in patients with well controlled diabetes : The usual dose is 1-4 mg daily. Only some patients benefit from daily doses of more than 6 mg.

- Distribution of doses : Timing and distribution of doses are decided by the doctor, taking into consideration of the patients current life-style. Normally, a single dose of Glimepiride is sufficient. This dose should be taken immediately before a substantial breakfast or if none is taken immediately before the first main meal. It is very important not to skip meals after taking Glimepiride.

Secondary dosage adjustment : as the control of diabetes improves, sensitivity to insulin increases; therefore, Glimepiride requirements may fall as treatment proceeds. To avoid an excessive reduction in blood sugar (hypoglycaemia), a timely dose reduction or cessation of Glimepiride therapy must be considered. A dose adjustment must also be considered whenever the patients weight or life-style changes, or other factors causing an increased susceptibillity to hypoglycaemia or to an excessive increase in blood sugar levels (hyperglycaemia) arise.

Duration of treatment : Treatment with Glimepiride is normally a long-term therapy.

Changeover from other oral antidiabetics to Glimepiride : There is no exact dosage relationship between Glimepiride and other oral blood sugar lowering agents. When substituting Glimepiride for other such agents, the initial daily dose is 1 mg; this applies even in the changeovers from the maximum dose of another oral blood sugar lowering agents. Any Glimepiride dose increase should be in accordance with guidelines given above in "initial dose and dose titration".

Consideration must be given to the potency and duration of action of the previous blood sugar lowering agent. It may be necessary to interrupt treatment to avoid additive effects which would increase the risk of hypoglycaemia.

- Use in-combination with Meltformin : Whenever blood sugar levels cannot be controlled adequately with the maximum daily dose of either Glimepiride or a Metformin-containing antidiabetic alone, both medicines may be used concomitantly. In such cases, the dose of the established medicine remains unchanged. Treatment with the additional medicine is started at low dose, which-depending on the desired blood sugar level0may then be increased gradually up to the maximum daily dose. Combined treatment should be initiated under close medical supervision.

Use in combination with insulin : Whenever blood sugar levels cannot be controlled adequately with the maximum daily dose of Glimepiride, insulin may be given concomitantly. In this case, the current dose of Glimepiride remains unchanged. Insulin treatment is started at low dose, which is subsequently increased stepwise according to the desired blood sugar level. Combined treatment should be initiated under the close medical supervision. Long-term efficacyshould be monitored by measurement of Hb-Alc levels, for example every 3-6 months. Short-term administration of Glimepiride may be sufficient during periods of transient loss of control in patients usually controlled well on diet and exercise.

Administration : Glimepiride tablets must be swallowed without chewing and with sufficient amounts of liquid (approx 1/2 glass).