Active substance(s): GLICLAZIDE
NAME OF THE MEDICINAL PRODUCT
Diamicron 80 mg Tablets
QUALITATIVE AND QUANTITATIVE COMPOSITION
One tablet contains 80 mg Gliclazide.
For the full list of excipients, see section 6.1.
White, circular tablets with flat bevelled edges and cross scoring on one face.
Non insulin dependent diabetes (type 2) in adults when dietary measures, physical
exercise and weight loss alone are not sufficient to control blood glucose.
Posology and method of administration
The total daily dose may vary from 40 to 320 mg taken orally. The dose should be
adjusted according to the individual patient's response, commencing with 40-80 mg
daily (1/2 - 1 tablet) and increasing until adequate control is achieved. A single dose
should not exceed 160 mg (2 tablets). When higher doses are required, Diamicron
80 mg Tablets should be taken twice daily and according to the main meals of the
In obese patients or those not showing adequate response to Diamicron 80 mg Tablets
alone, additional therapy may be required.
Switching from another oral antidiabetic agent to DIAMICRON 80 mg:
DIAMICRON 80 mg 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 DIAMICRON 80 mg.
A transitional period is not generally necessary. A starting dose of 40-80 mg (½ to 1
tablet) should be used and this should be adjusted to suit the patient’s blood glucose
response, as described above.
When switching from a hypoglycaemic sulfonylurea 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.
Combination treatment with other antidiabetic agents:
DIAMICRON 80 mg can be given in combination with biguanides, alpha glucosidase
inhibitors or insulin.
In patients not adequately controlled with DIAMICRON 80 mg, concomitant insulin
therapy can be initiated under close medical supervision.
DIAMICRON 80 mg should be prescribed using the same dosing regimen
recommended for patients under 65 years of age.
Patients 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 40-80 mg is used.
The safety and efficacy of DIAMICRON 80 mg in children and adolescents have not
been established. No data are available.
This medicine is contra-indicated in case of:
Hypersensitivity to gliclazide or to any of the excipients listed in section 6.1,
other sulfonylureas, sulfonamides,
type 1 diabetes,
diabetic pre-coma and coma, diabetic keto-acidosis,
severe renal or hepatic insufficiency: in these cases the use of insulin is
treatment with miconazole (see section 4.5),
lactation (see section 4.6).
Special warnings and precautions for use
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 sulfonylureas (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
imbalance between physical exercise and carbohydrate intake,
severe hepatic insufficiency,
overdose of Diamicron 80 mg Tablets,
certain endocrine disorders: thyroid disorders, hypopituitarism and adrenal
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.
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase
deficiency or glucose-galactose malabsorption should not take this medicine.
Treatment of patients with G6PD-deficiency with sulfonylurea agents can lead to
haemolytic anaemia. Since gliclazide belongs to the class of sulfonylurea agents,
caution should be used in patients with G6PD-deficiency and a non-sulfonylurea
alternative should be considered.
Interaction with other medicinal products and other forms of interaction
The following products are likely to increase the risk of hypoglycaemia
• 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
sulfonylureas (displaces their binding to plasma proteins and/or reduces their
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 anti-inflammatory agent.
• Alcohol: increases the hypoglycaemic reaction (by inhibiting compensatory
reactions) that can lead to the onset of hypoglycaemic coma.
Avoid alcohol or medicines containing alcohol.
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:
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, sulfonamides, clarithromycin and nonsteroidal
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
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.
Combination which must be taken into account
• Anticoagulant therapy (Warfarin ...):
Sulfonylureas may lead to potentiation of anticoagulation during concurrent
Adjustment of the anticoagulant may be necessary.
Fertility, pregnancy and lactation
There is no or limited amount of data (less than 300 pregnancy outcomes) from the
use of gliclazide in pregnant women, even though there are few data with other
Studies in animals have shown reproductive toxicity (see section 5.3).
As a precautionary measure, it is preferable to avoid the use of Gliclazide during
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.
It is unknown whether gliclazide or its metabolites are excreted in human milk. Given
the risk of neonatal hypoglycaemia, the product is therefore contra-indicated in
breast-feeding mothers. A risk to the newborns/infants cannot be excluded.
No effect on fertility or reproductive performance was noted in male and female rats
(see section 5.3).
Effects on ability to drive and use machines
Diamicron 80 mg has no or negligible influence on the ability to drive and use
machines. However, patients should be informed that their concentration may be
affected if their diabetes is not satisfactorily controlled, especially at the beginning of
treatment (see section 4.4).
Based on the experience with gliclazide, the following undesirable effects have been
The most frequent adverse reaction with gliclazide is hypoglycaemia
As for other sulfonylureas, treatment with Diamicron 80 mg Tablets 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
Usually, symptoms disappear after intake of carbohydrates (sugar). However,
artificial sweeteners have no effect. Experience with other sulfonylureas 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 are
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-Johnson
syndrome and toxic epidermal necrolysis), and exceptionally, drug rash with
eosinophilia and systemic symptoms (DRESS).
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
Transient visual disturbances may occur especially on initiation of treatment, due
to changes in blood glucose levels.
Class attribution effects:
As for other sulfonylureas, 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 sulfonylurea or led to life-threatening
liver failure in isolated cases.
Reporting of suspected adverse reactions:
Reporting suspected adverse reactions after authorisation of the medicinal product is
important. It allows continued monitoring of the benefit/risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard
An overdose of sulfonylureas 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
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.
Pharmacotherapeutic group: sulfonamides, urea derivatives . ATC code: A10BB09
Mechanism of action
Gliclazide is a hypoglycaemic sulfonylurea antidiabetic active substance differing
from other related compounds by an N-containing heterocyclic ring with an
Gliclazide reduces blood glucose levels by stimulating insulin secretion from the βcells of the islets of Langerhans. Increase in postprandial insulin and C-peptide
secretion persists after two years of treatment.
In addition to these metabolic properties, gliclazide has haemovascular properties.
Clinical efficacy and safety
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.
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
Plasma levels increase reaching maximal concentrations between 2 and 6 hours.
Gliclazide is well absorbed.
Food intake does not affect the rate or degree of
Plasma protein binding is approximately 95%. The volume of distribution is around
Gliclazide is mainly metabolised in the liver and excreted in the urine; less than 1% of
the dose is excreted unchanged in the urine. No active metabolites have been detected
The elimination half-life of gliclazide is between 10 and 12 hours.
The relationship between the dose administered between 40 and 400mg and the mean
plasma concentrations is linear.
No clinically significant changes in pharmacokinetic parameters have been observed
in elderly patients.
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 9.4 fold higher than the
maximum recommended dose in humans. Fertility and reproductive performance
were unaffected after gliclazide administration in animal studies.
List of excipients
Pregelatinised maize starch,
Special precautions for storage
Store in the original package.
Nature and contents of container
Boxes of 28, 56, 60 and 112 tablets in blister strips (PVC/Aluminium).
Not all pack sizes may be marketed.
Special precautions for disposal
No special requirements
MARKETING AUTHORISATION HOLDER
Servier Laboratories Ltd
Rowley, Wexham Springs
Framewood Road, Wexham
MARKETING AUTHORISATION NUMBER
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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