GLICLAZIDE SERVIER 30MG MR TABLETS

Active substance: GLICLAZIDE

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SUMMARY OF PRODUCT CHARACTERISTICS

1

NAME OF THE MEDICINAL PRODUCT
Gliclazide Servier 30 mg MR Tablets

2

QUALITATIVE AND QUANTITATIVE COMPOSITION
One tablet contains gliclazide 30 mg
For the full list of excipients, see section 6.1.

3

PHARMACEUTICAL FORM
Modified release tablet.
White, oblong tablet engraved on both faces, ‘DIA 30’ on one face and
on the other.

4

CLINICAL PARTICULARS

4.1

Therapeutic indications
Non insulin-dependent diabetes (type 2) in adults when dietary measures,
physical exercise and weight loss alone are not sufficient to control blood
glucose.

4.2

Posology and method of administration
The daily dose may vary from 1 to 4 tablets per day, i.e. from 30 to 120 mg
taken orally in a single intake at breakfast time.
It is recommended that the tablet(s) be swallowed whole.
If a dose is forgotten, there must be no increase in the dose taken the next day.
As with any hypoglycaemic agent, the dose should be adjusted according to
the individual patient's metabolic response (blood glucose, HbAlc)


Initial dose
The recommended starting dose is 30 mg daily.
If blood glucose is effectively controlled, this dose may be used for
maintenance treatment.
If blood glucose is not adequately controlled, the dose may be increased to
60, 90 or 120 mg daily, in successive steps. The interval between each

dose increment should be at least 1 month except in patients whose blood
glucose has not reduced after two weeks of treatment. In such cases, the
dose may be increased at the end of the second week of treatment.
The maximum recommended daily dose is 120 mg.


Switching from Diamicron 80 mg tablets to Gliclazide Servier 30 mg
modified release tablets:
1 tablet of Diamicron 80 mg is comparable to 1 tablet of Gliclazide
Servier 30 mg MR Tablets. Consequently the switch can be performed
provided a careful blood monitoring.



Switching from another oral antidiabetic agent to Gliclazide Servier
30 mg MR Tablets:
Gliclazide Servier 30 mg MR Tablets can be used to replace other oral
antidiabetic agents.
The dosage and the half-life of the previous antidiabetic agent should be
taken into account when switching to Gliclazide Servier 30 mg MR
Tablets.
A transitional period is not generally necessary. A starting dose of 30 mg
should be used and this should be adjusted to suit the patient’s blood
glucose response, as described above.
When switching from a hypoglycaemic sulphonylurea with a prolonged
half-life, a treatment free period of a few days may be necessary to avoid
an additive effect of the two products, which might cause hypoglycaemia.
The procedure described for initiating treatment should also be used when
switching to treatment with Gliclazide Servier 30 mg MR Tablets, i.e. a
starting dose of 30 mg/day, followed by a stepwise increase in dose,
depending on the metabolic response.



Combination treatment with other antidiabetic agents:
Gliclazide Servier 30 mg MR Tablets can be given in combination with
biguanides, alpha glucosidase inhibitors or insulin.
In patients not adequately controlled with Gliclazide Servier 30 mg MR
Tablets, concomitant insulin therapy can be initiated under close medical
supervision.
Special Populations

Elderly
Gliclazide Servier 30 mg MR Tablets should be prescribed using the same
dosing regimen recommended for patients under 65 years of age.
Patient with renal impairment
In patients with mild to moderate renal insufficiency the same dosing
regimen can be used as in patients with normal renal function with careful
patient monitoring. These data have been confirmed in clinical trials.
Patients at risk of hypoglycaemia:
- undernourished or malnourished,

-

severe or poorly compensated endocrine disorders (hypopituitarism,
hypothyroidism, adrenocorticotrophic insufficiency),

-

withdrawal of prolonged and/or high dose corticosteroid therapy,

-

severe vascular disease (severe coronary heart disease, severe carotid
impairment, diffuse vascular disease);

It is recommended that the minimum daily starting dose of 30 mg is used.
Pediatric population

The safety and efficacy of Gliclazide Servier 30 mg MR Tablets in
children and adolescents have not been established. No data available in
children.
4.3

Contraindications







4.4

Hypersensitivity to gliclazide or to any of the excipients listed in section
6.1, other sulphonylureas, sulphonamides,
type 1 diabetes,
diabetic pre-coma and coma, diabetic keto-acidosis,
severe renal or hepatic insufficiency: in these cases the use of insulin is
recommended,
treatment with miconazole (see section 4.5),
lactation (see section 4.6).

Special warnings and precautions for use
Hypoglycaemia:
This treatment should be prescribed only if the patient is likely to have a
regular food intake (including breakfast). It is important to have a regular
carbohydrate intake due to the increased risk of hypoglycaemia if a meal is
taken late, if an inadequate amount of food is consumed or if the food is low in
carbohydrate. Hypoglycaemia is more likely to occur during low-calorie diets,
following prolonged or strenuous exercise, alcohol intake or if a combination
of hypoglycaemic agents is being used.
Hypoglycaemia may occur following administration of sulphonylureas (see
section 4.8). Some cases may be severe and prolonged. Hospitalisation may
be necessary and glucose administration may need to be continued for several
days.
Careful selection of patients, of the dose used, and clear patient directions are
necessary to reduce the risk of hypoglycaemic episodes.
Factors which increase the risk of hypoglycaemia:

patient refuses or (particularly in elderly subjects) is unable to co-operate,


malnutrition, irregular mealtimes, skipping meals, periods of fasting or
dietary changes,



imbalance between physical exercise and carbohydrate intake,



renal insufficiency,



severe hepatic insufficiency,



overdose of Gliclazide Servier,



certain endocrine disorders: thyroid disorders, hypopituitarism and
adrenal insufficiency,



concomitant administration of certain other medicines (see section 4.5).

Renal and hepatic insufficiency: the pharmacokinetics and/or
pharmacodynamics of gliclazide may be altered in patients with hepatic
insufficiency or severe renal failure. A hypoglycaemic episode occurring in
these patients may be prolonged, so appropriate management should be
initiated.
Patient information:
The risks of hypoglycaemia, together with its symptoms (see section 4.8),
treatment, and conditions that predispose to its development, should be
explained to the patient and to family members.
The patient should be informed of the importance of following dietary advice,
of taking regular exercise, and of regular monitoring of blood glucose levels.
Poor blood glucose control: blood glucose control in a patient receiving
antidiabetic treatment may be affected by any of the following: fever, trauma,
infection or surgical intervention. In some cases, it may be necessary to
administer insulin.
The hypoglycaemic efficacy of any oral antidiabetic agent, including
gliclazide, is attenuated over time in many patients: this may be due to
progression in the severity of the diabetes, or to a reduced response to
treatment. This phenomenon is known as secondary failure which is distinct
from primary failure, when an active substance is ineffective as first-line
treatment. Adequate dose adjustment and dietary compliance should be
considered before classifying the patient as secondary failure.
Laboratory tests: Measurement of glycated haemoglobin levels (or fasting
venous plasma glucose) is recommended in assessing blood glucose control.
Blood glucose self-monitoring may also be useful.
Treatment of patients with G6PD-deficiency with sulphonylurea agents can
lead to haemolytic anaemia. Since gliclazide belongs to the chemical class of
sulphonylurea drugs, caution should be used in patients with G6PD-deficiency
and a non-sulphonylurea alternative should be considered.
4.5

Interaction with other medicinal products and other forms of interaction
1) The following products are likely to increase the risk of hypoglycaemia
Contra-indicated combination
• Miconazole (systemic route, oromucosal gel): increases the

hypoglycaemic effect with possible onset of hypoglycaemic symptoms,
or even coma.
Combinations which are not recommended
• Phenylbutazone (systemic route): increases the hypoglycaemic effect
of sulphonylureas (displaces their binding to plasma proteins and/or
reduces their elimination).
It is preferable to use a different anti-inflammatory agent, or else to warn
the patient and emphasise the importance of self-monitoring. Where
necessary, adjust the dose during and after treatment with the antiinflammatory agent.


Alcohol: increases the hypoglycaemic reaction (by inhibiting
compensatory reactions) that can lead to the onset of hypoglycaemic
coma.
Alcohol or medicinal products containing alcohol should be avoided.

Combinations requiring precautions for use
Potentiation of the blood glucose lowering effect and thus, in some
instances, hypoglycaemia may occur when one of the following drugs is
taken, such as:
other antidiabetic agents (insulins, acarbose, metformin,
thiazolidinediones, dipeptidyl peptidase-4 inhibitors, GLP-1 receptor
agonists), beta-blockers, fluconazole, angiotensin converting enzyme
inhibitors (captopril, enalapril), H2-receptor antagonists, MAOIs,
sulphonamides, clarithromycin and nonsteroidal anti-inflammatory
agents.
2) The following products may cause an increase in blood glucose levels
Combination which is not recommended
• Danazol: diabetogenic effect of danazol.
If the use of this active substance cannot be avoided, warn the patient
and emphasise the importance of urine and blood glucose monitoring. It
may be necessary to adjust the dose of the antidiabetic agent during and
after treatment with danazol.
Combinations requiring precautions during use
• Chlorpromazine (neuroleptic agent): high doses (>100 mg per day of
chlorpromazine) increase blood glucose levels (reduced insulin release).
Warn the patient and emphasise the importance of blood glucose
monitoring. It may be necessary to adjust the dose of the antidiabetic
active substance during and after treatment with the neuroleptic agent.


Glucocorticoids (systemic and local route: intra-articular, cutaneous
and rectal preparations) and tetracosactrin: increase in blood glucose
levels with possible ketosis (reduced tolerance to carbohydrates due to
glucocorticoids).
Warn the patient and emphasise the importance of blood glucose

monitoring, particularly at the start of treatment. It may be necessary to
adjust the dose of the antidiabetic active substance during and after
treatment with glucocorticoids.


Ritodrine, salbutamol, terbutaline: (I.V.)
Increased blood glucose levels due to beta-2 agonist effects.
Emphasise the importance of monitoring blood glucose levels. If
necessary, switch to insulin.

3) Combination which must be taken into account
• Anticoagulant therapy (e.g. Warfarin ...):
Sulphonylureas may lead to potentiation of anticoagulation during
concurrent treatment.
Adjustment of the anticoagulant may be necessary.
4.6

Fertility, pregnancy and lactation
Pregnancy
There is no experience with the use of gliclazide during pregnancy in humans,
even though there are few data with other sulphonylurea.
In animal studies, gliclazide is not teratogenic.
Control of diabetes should be obtained before the time of conception to reduce
the risk of congenital abnormalities linked to uncontrolled diabetes.
Oral hypoglycaemic agents are not suitable, insulin is the drug of first choice
for treatment of diabetes during pregnancy. It is recommended that oral
hypoglycaemic therapy is changed to insulin before a pregnancy is attempted,
or as soon as pregnancy is discovered.
Breast-feeding
It is not known whether gliclazide or its metabolites are excreted in breast
milk. Given the risk of neonatal hypoglycaemia, the product is contraindicated in breast-feeding mother.

4.7

Effects on ability to drive and use machines
Gliclazide Servier 30 mg MR Tablets has no known influence on the ability to
drive and use machines. However, patients should be made aware of the
symptoms of hypoglycaemia and should be careful if driving or operating
machinery, especially at the beginning of treatment.

4.8

Undesirable effects
Based on the experience with gliclazide, the following undesirable effects have
been reported.
Hypoglycaemia
As for other sulphonylureas, treatment with Gliclazide can cause
hypoglycaemia, if mealtimes are irregular and, in particular, if meals are

skipped. Possible symptoms of hypoglycaemia are: headache, intense hunger,
nausea, vomiting, lassitude, sleep disorders, agitation, aggression, poor
concentration, reduced awareness and slowed reactions, depression, confusion,
visual and speech disorders, aphasia, tremor, paresis, sensory disorders,
dizziness, feeling of powerlessness, loss of self-control, delirium, convulsions,
shallow respiration, bradycardia, drowsiness and loss of consciousness,
possibly resulting in coma and lethal outcome.
In addition, signs of adrenergic counter-regulation may be observed: sweating,
clammy skin, anxiety, tachycardia, hypertension, palpitations, angina pectoris
and cardiac arrhythmia.
Usually, symptoms disappear after intake of carbohydrates (sugar). However,
artificial sweeteners have no effect. Experience with other sulphonylurea
shows that hypoglycaemia can recur even when measures prove effective
initially.
If a hypoglycaemic episode is severe or prolonged, and even if it is
temporarily controlled by intake of sugar, immediate medical treatment or
even hospitalisation is required.
Other undesirable effects:
Gastrointestinal disturbances, including abdominal pain, nausea, vomiting
dyspepsia, diarrhoea, and constipation have been reported: if these should
occur they can be avoided or minimised if gliclazide is taken with breakfast.
The following undesirable effects have been more rarely reported:
Skin and subcutaneous tissue disorders: rash, pruritus, urticaria,
angioedema, erythema, maculopapular rashes, bullous reactions (such as
Stevens-Johnoson syndrome and toxic epidermal necrolysis).





Blood and lymphatic system disorders: Changes in haematology are rare.
They may include anaemia, leucopenia, thrombocytopenia,
granulocytopenia. These are in general reversible upon discontinuation of
medication.



Hepato-biliary disorders: raised hepatic enzyme levels (AST, ALT,
alkaline phosphatase), hepatitis (isolated reports). Discontinue treatment if
cholestatic jaundice appears.

These symptoms usually disappear after discontinuation of treatment.
• Eye disorders
Transient visual disturbances may occur especially on initiation of
treatment, due to changes in blood glucose levels.
• Class attribution effects:
As for other sulphonylureas, the following adverse events have been
observed: cases of erythrocytopenia, agranulocytosis, haemolytic anaemia,
pancytopenia, allergic vasculitis, hyponatremia, elevated liver enzyme
levels and even impairment of liver function (e.g. with cholestasis and
jaundice) and hepatitis which regressed after withdrawal of the
sulphonylurea or led to life-threatening liver failure in isolated cases.
4.9.

Overdose

An overdose of sulphonylureas may cause hypoglycaemia.
Moderate symptoms of hypoglycaemia, without any loss of consciousness or
neurological signs, must be corrected by carbohydrate intake, dose adjustment
and/or change of diet. Strict monitoring should be continued until the doctor
is sure that the patient is out of danger.
Severe hypoglycaemic reactions, with coma, convulsions or other neurological
disorders are possible and must be treated as a medical emergency, requiring
immediate hospitalisation.
If hypoglycaemic coma is diagnosed or suspected, the patient should be given
a rapid I.V. injection of 50 mL of concentrated glucose solution (20 to 30 %).
This should be followed by continuous infusion of a more dilute glucose
solution (10 %) at a rate that will maintain blood glucose levels above 1 g/L.
Patients should be monitored closely and, depending on the patient's condition
after this time, the doctor will decide if further monitoring is necessary.
Dialysis is of no benefit to patients due to the strong binding of gliclazide to
proteins.

5

PHARMACOLOGICAL PROPERTIES

5.1

Pharmacodynamic properties
Pharmacotherapeutic group: sulphonamides, urea derivatives
ATC code: A10BB09
Gliclazide is a hypoglycaemic sulphonylurea oral antidiabetic active substance
differing from other related compounds by an N-containing heterocyclic ring
with an endocyclic bond.
Gliclazide reduces blood glucose levels by stimulating insulin secretion from
the β-cells of the islets of Langerhans. Increase in postprandial insulin and Cpeptide secretion persists after two years of treatment.
In addition to these metabolic properties, gliclazide has haemovascular
properties.
Effects on insulin release
In type 2 diabetics, gliclazide restores the first peak of insulin secretion in
response to glucose and increases the second phase of insulin secretion. A
significant increase in insulin response is seen in response to stimulation
induced by a meal or glucose.
Haemovascular properties:
Gliclazide decreases microthrombosis by two mechanisms which may be involved in
complications of diabetes:
• a partial inhibition of platelet aggregation and adhesion, with a decrease in the
markers of platelet activation (beta thromboglobulin, thromboxane B2).
• an action on the vascular endothelium fibrinolytic activity with an increase

in tPA activity.

5.2

Pharmacokinetic properties
Absorption
Plasma levels increase progressively during the first 6 hours, reaching a
plateau which is maintained from the sixth to the twelfth hour after
administration.
Intra-individual variability is low.
Gliclazide is completely absorbed. Food intake does not affect the rate or
degree of absorption.
Distribution
Plasma protein binding is approximately 95%. The volume of distribution is
around 30 litres.
A single daily intake of Diamicron 30 mg maintains effective gliclazide
plasma concentrations over 24 hours.
Biotransformation
Gliclazide is mainly metabolised in the liver and excreted in the urine: less
than 1% of the unchanged form is found in the urine. No active metabolites
have been detected in plasma.
Elimination
The elimination half-life of gliclazide varies between 12 and 20 hours.
Linearity/non-linearity

The relationship between the dose administered ranging up to 120 mg and the
area under the concentration time curve is linear.
Special populations

Elderly
No clinically significant changes in pharmacokinetic parameters have been
observed in elderly patients.
5.3.

Preclinical Safety Data
Preclinical data reveal no special hazards for humans based on conventional
studies of repeated dose toxicity and genotoxicity. Long term carcinogenicity
studies have not been done. No teratogenic changes have been shown in
animal studies, but lower foetal body weight was observed in animals
receiving doses 25 fold higher than the maximum recommended dose in
humans.

6

PHARMACEUTICAL PARTICULARS

6.1

List of excipients
Calcium hydrogen phosphate dihydrate,
Maltodextrin,
Hypromellose,

Magnesium stearate,
Anhydrous colloidal silica.
6.2.

Incompatibilities
Not applicable.

6.3.

Shelf Life
3 years.

6.4

Special precautions for storage
This medicinal product does not require any special storage conditions.

6.5

Nature and contents of container
7, 10, 14, 20, 28, 30, 56, 60, 84, 90, 100, 112, 120, 180 and 500 tablets in
Aluminium/Poly(vinylchloride) blister, packed in cardboard boxes.
Not all pack sizes may be marketed.

6.6

Special precautions for disposal
No special requirements

7

MARKETING AUTHORISATION HOLDER

Les Laboratoires Servier
50, rue Carnot
92284 Suresnes cedex
France
8.

MARKETING AUTHORISATION NUMBER
PL 05815/0020

9

DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
29/03/2010

10

DATE OF REVISION OF THE TEXT
27/07/2012

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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