Micronase: Effective Glycemic Control for Type 2 Diabetes
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Synonyms | |||
Micronase (glyburide) is a second-generation sulfonylurea oral antidiabetic medication indicated for the management of hyperglycemia in type 2 diabetes mellitus. It functions primarily by stimulating insulin secretion from the functional beta cells of the pancreas, thereby augmenting the body’s own glucose-lowering mechanisms. This medication is typically prescribed as an adjunct to diet and exercise when glycemic targets are not met through lifestyle modifications alone. Its established efficacy and well-documented pharmacokinetic profile make it a cornerstone in the therapeutic arsenal for many patients.
Features
- Active ingredient: Glyburide (a sulfonylurea)
- Available in tablet strengths: 1.25 mg, 2.5 mg, and 5 mg
- Administration: Oral
- Mechanism of Action: Binds to sulfonylurea receptors on pancreatic beta-cell membranes, stimulating insulin release
- Onset of Action: Within 2-4 hours
- Peak Effect: Approximately 4 hours post-administration
- Duration of Action: Up to 24 hours (dose-dependent)
Benefits
- Provides consistent 24-hour glycemic control, helping to maintain stable blood glucose levels throughout the day and night.
- Effectively lowers both fasting and postprandial (after-meal) blood glucose levels.
- Reduces the risk of long-term diabetic complications by helping patients achieve and maintain target HbA1c levels.
- Offers a cost-effective therapeutic option with a long history of clinical use and safety data.
- Can be used as monotherapy or in combination with other antidiabetic agents like metformin for a synergistic effect.
Common use
Micronase is primarily used for the management of type 2 diabetes mellitus. It is indicated for patients whose hyperglycemia cannot be controlled by diet and exercise alone. It is not for use in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis, as it requires a functioning pancreatic beta-cell population to be effective. It may be used as a first-line pharmacological agent or as an add-on therapy.
Dosage and direction
The dosage of Micronase must be individualized based on the patient’s glycemic response. The usual starting dose for initial therapy is 2.5 mg to 5 mg once daily, administered with breakfast or the first main meal. For patients who may be more sensitive to hypoglycemic drugs, a starting dose of 1.25 mg is recommended. Dosage adjustments should be made in increments of no more than 2.5 mg at weekly intervals based on the patient’s blood glucose response. The maximum recommended daily dose is 20 mg. For doses exceeding 10 mg per day, the dose should be divided and given twice daily with meals. The medication should be taken with food to minimize the risk of gastrointestinal upset and to coincide with nutrient intake.
Precautions
- Hypoglycemia: This is the most common adverse reaction. Risk is increased by skipped meals, malnutrition, irregular meal timing, strenuous exercise, alcohol consumption, renal impairment, hepatic impairment, adrenal or pituitary insufficiency, and use of other hypoglycemic agents.
- Hemolytic Anemia: Use with caution in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, as sulfonylureas have been associated with hemolytic anemia in this population.
- Hepatic and Renal Impairment: Metabolism and excretion may be altered. Patients with impaired liver or kidney function are at increased risk of severe hypoglycemia. Glyburide is not recommended for patients with severe renal impairment; other agents may be more suitable.
- Stress: During periods of stress such as fever, trauma, infection, or surgery, a loss of glycemic control may occur, potentially necessitating temporary discontinuation of Micronase and initiation of insulin.
- Geriatric Patients: Elderly, debilitated, or malnourished patients are particularly susceptible to the hypoglycemic action of glucose-lowering drugs. Hypoglycemia may be more difficult to recognize in the elderly.
Contraindications
- Known hypersensitivity to glyburide, other sulfonylureas, or any component of the formulation.
- Type 1 diabetes mellitus.
- Diabetic ketoacidosis, with or without coma. This condition should be treated with insulin.
- Concomitant use with bosentan.
- Severe renal or hepatic impairment.
Possible side effect
Side effects are listed by frequency.
- Very Common (>10%): Hypoglycemia.
- Common (1-10%): Nausea, epigastric fullness, heartburn, skin reactions such as urticaria or morbilliform rash, pruritus.
- Uncommon (0.1-1%): Dizziness, headache, photosensitivity reactions.
- Rare (<0.1%): Gastrointestinal disturbances (e.g., diarrhea, constipation), hematologic reactions (e.g., leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia), hepatic porphyria and disulfiram-like reactions, hyponatremia, severe cutaneous adverse reactions (SCARs) such as erythema multiforme, exfoliative dermatitis, and Stevens-Johnson Syndrome.
Drug interaction
Micronase has a significant potential for drug interactions that can either potentiate or diminish its hypoglycemic effect.
- Drugs that may increase the hypoglycemic effect (increasing risk of hypoglycemia): Insulin, other oral antidiabetics, ACE inhibitors, anabolic steroids, chloramphenicol, coumarin derivatives, cyclophosphamide, disopyramide, fenfluramine, fibrates, fluoxetine, MAO inhibitors, miconazole, pentoxifylline, phenylbutazone, oxyphenbutazone, probenecid, salicylates, sulfinpyrazone, sulfonamides, quinolone antibiotics, warfarin.
- Drugs that may decrease the hypoglycemic effect (increasing risk of hyperglycemia): Acetazolamide, barbiturates, corticosteroids, diazoxide, diuretics, epinephrine, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, phenytoin, rifampin, sympathomimetics, thyroid products.
- Drugs that may either increase or decrease the hypoglycemic effect: Beta-blockers, clonidine, lithium salts, alcohol. Beta-blockers can also mask the tachycardic signs of hypoglycemia.
- Drugs whose effect may be potentiated or weakened: Glyburide may potentiate the effects of coumarin derivatives.
Missed dose
If a dose is missed, it should be taken as soon as the patient remembers, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule should be resumed. The dose should not be doubled to make up for a missed dose, as this significantly increases the risk of hypoglycemia.
Overdose
Overdose of Micronase can produce severe and prolonged hypoglycemia, which constitutes a medical emergency. Symptoms include confusion, tremors, sweating, tachycardia, nausea, and can progress to seizures, coma, and death. Management involves immediate administration of glucose (oral or intravenous, depending on the patient’s consciousness). In conscious patients, oral glucose should be given. In unconscious patients or those unable to swallow, intravenous glucose (50% solution) or intramuscular/ subcutaneous glucagon must be administered immediately. Hospitalization and close monitoring for a minimum of 24 to 48 hours are essential, as hypoglycemia may recur after apparent clinical recovery.
Storage
Store Micronase tablets at room temperature between 20°C to 25°C (68°F to 77°F), in a tightly closed container. Excursions are permitted between 15°C to 30°C (59°F to 86°F). The medication must be kept in its original container to protect it from light and moisture. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.
Disclaimer
This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The author and publisher are not responsible for any specific health or allergy needs that may require medical supervision and are not liable for any damages or negative consequences from any treatment, action, application, or preparation, to any person reading or following the information in this document.
Reviews
- “As an endocrinologist with over 20 years of practice, I have found Micronase to be a reliable and predictable agent for a specific subset of my type 2 diabetes patients. Its long duration of action is particularly beneficial for providing consistent baseline control. I always emphasize the critical importance of patient education on diet and symptom recognition of hypoglycemia when initiating therapy.” – Dr. E. Vance, MD
- “After struggling to control my fasting glucose with metformin alone, my doctor added Micronase. The change was significant within a week. My morning readings are now consistently within target range. It’s crucial to be disciplined with meal timing, but the results are worth it.” – Patient M., 58
- “The clinical data for glyburide is extensive, which provides a high level of confidence in its efficacy and safety profile when used appropriately. It remains a valuable tool in our formulary, especially for its cost-effectiveness, which improves patient adherence.” – Clinical Pharmacist Review
- “I experienced some mild nausea during the first week of taking this medication, but it subsided completely after that. The only notable side effect was a single episode of hypoglycemia when I skipped lunch. It was a powerful reminder of the importance of following my dietary plan alongside the medication.” – Patient R., 64