Glimepiride + Metformin + Voglibose
Medicine Type :
Allopathy
Allopathy
Prescription Type:
Prescription Required
Prescription Required
Approval :
DCGI (Drugs Controller General of India)
DCGI (Drugs Controller General of India)
Schedule
Schedule H
Schedule H
Pharmacological Class:
Sulfonylureas, Biguanide, Alpha-Glucosidase Inhibitor, Therapy Class:
Antidiabetic Agent, Approved Countries
India, Thailand, Vietnam, Indonesia, Malaysia, Singapore, the Philippines and Japan.
Glimepiride + Metformin + Voglibose is an anti-diabetic agent belonging to the pharmacological class of second-generation sulfonylureas, biguanides and Alpha-Glucosidase inhibitors.
Glimepiride + Metformin + Voglibose is commonly approved for the treatment of type 2 diabetes mellitus in adults, especially when diet and exercise alone are not sufficient to control blood sugar levels.
Upon oral ingestion, glimepiride is absorbed in the gut, metabolized in the liver, and eliminated via urine. Metformin is absorbed in the stomach, doesn't undergo metabolism, and is excreted unchanged in urine. Voglibose is minimally absorbed, primarily metabolized in the gut, and eliminated through faeces.
The common side effect of Glimepiride+ Metformin + Voglibose is low blood glucose levels (hypoglycemia).
Glimepiride+ Metformin + Voglibose is available as a tablet for convenient administration.
Glimepiride+ Metformin+ Voglibose is available in India, Thailand, Vietnam, Indonesia, Malaysia, Singapore, the Philippines and Japan.
Glimepiride + Metformin + Voglibose is an anti-diabetic agent belonging to the pharmacological class of second-generation sulfonylureas, biguanides and Alpha-Glucosidase inhibitors.
Glimepiride: ATP-sensitive potassium channels, made up of Kir6.2 and SUR subunits and essential for glucose-stimulated insulin secretion (GSIS), are activated by ATP and ADP in pancreatic beta cells. Reduced ATP: ADP causes the channel to open, which in turn causes insulin inhibition, K+ outflow, and cell hyperpolarization. By attaching to SUR1 and SUR2A subunits and blocking these channels, glimepiride increases insulin release by changing the conformation of these channels and ultimately increasing the activity of beta cells in secreting insulin.
Metformin: Metformin decreases hepatic glucose production, reduces glucose absorption in the intestine and improves insulin sensitivity (increases peripheral glucose uptake and utilization).
Voglibose: A synthetic substance called Voglibose, an alpha-glucosidase inhibitor, has strong and long-lasting therapeutic effects against diseases of the sensory, motor, and autonomic nerve systems brought on by diabetes mellitus. Alpha-glucosidase inhibitors are oral anti-diabetic medications used to treat type 2 diabetes mellitus. They function by stopping the breakdown of complex carbohydrates, such as starch. Usually, simple sugars, or monosaccharides, are formed from complex carbohydrates and can be absorbed by the colon. As a result, alpha-glucosidase inhibitors lessen complex carbohydrates' effect on blood glucose.
Synergistic Benefits: Glimepiride + Metformin + Voglibose combination has synergistic effects on type 2 diabetes management. Metformin decreases liver glucose synthesis and insulin sensitivity in peripheral tissues, whereas glimepiride increases insulin release from pancreatic beta cells. Postprandial glucose surges are reduced by Voglibose, which slows down the gut's absorption of carbohydrates. This combination enhances blood sugar control by managing various aspects of glucose metabolism, increasing insulin activity, decreasing sugar absorption, and regulating hepatic glucose output.
Glimepiride + Metformin + Voglibose is available in oral tablets.
Tablets: To be swallowed whole with water/liquid. Do not chew, crush or break it.
As the physician recommends, take the medication orally once or twice daily, generally with a meal.
Glimepiride+ Metformin+ Voglibose can be used in the following health conditions:
- Treatment for individuals with type 2 diabetes mellitus when glycemic control is inadequate with diet and exercise alone.
- It may improve insulin sensitivity and reduce carbohydrate absorption from the gut.
- Prevention of diabetic complications such as cardiovascular issues, kidney problems, and nerve damage.
Glimepiride: Glimepiride helps increase the amount of insulin your body produces (in the pancreas). It works by boosting the amount of insulin your body generates following a meal and prevents excessive glucose (sugar) release into the blood. In doing so, it decreases your body's blood glucose levels. It often only causes a single frequent adverse effect and is taken once each day.
Metformin: Metformin improves glucose tolerance by lowering basal and postprandial plasma glucose. It exerts its effect by decreasing hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis, delaying intestinal glucose absorption, and increasing insulin sensitivity by increasing peripheral glucose uptake and utilization.
Voglibose: For those with diabetes mellitus, voglibose is an alpha-glucosidase inhibitor that lowers blood glucose levels after meals.
Glimepiride + Metformin + Voglibose is used to treat type 2 diabetes. This combination helps control blood sugar levels effectively by enhancing insulin sensitivity and release, facilitating improved glucose utilization. Additionally, it delays the absorption of carbohydrates in the digestive system, thus reducing the occurrence of post-meal glucose spikes.
When used in addition to diet and exercise, glimepiride + metformin + voglibose is indicated for patients with type-2 diabetes who are not responding well to metformin alone, who are already receiving treatment with glimepiride and metformin or who have responded well to glimepiride alone but need further glycemic control.
Orally: Glimepiride+ Metformin + Voglibose is available as a tablet that can be taken orally. It is advised to administer once or twice daily during breakfast or the first main meal and avoid breaking, crushing, dissolving, or chewing extended-release pills; swallow them whole with a glass of water. If a dose is missed, the individual should take it promptly upon recall. If the missed dose coincides with the upcoming scheduled dose, it is advisable to skip the missed dose and proceed with the regular schedule. Discontinuation of the medication should only occur under medical guidance to prevent fluctuations in blood sugar levels.
The dosage and duration of treatment should be as per the treating physician's clinical judgment.
Glimepiride+ Metformin + Voglibose has various strengths, such as 1mg+ 500mg + 0.2 mg, 2mg+ 500mg+ 0.2 mg, 3mg+ 500mg + 0.3 mg.
Glimepiride+ Metformin + Voglibose is available in the form of Oral tablets.
Dosage Adjustment for Adult Patients
The combination should be given once or twice daily with meals and started at a low dose. Starting dose for patients inadequately controlled on Metformin monotherapy or Glimepiride and Metformin dual therapy.
Initial amount: This may be initiated once daily and gradually titrated after assessing the therapeutic response.
Based on the initial starting dose of Glimepiride+ Metformin + Voglibose, it may be initiated once daily and progressively titrated after evaluating the therapeutic response.
Glimepiride+ Metformin + Voglibose should be used in treating type 2 diabetes mellitus, along with appropriate dietary restrictions.
Glimepiride + Metformin + Voglibose is usually taken with meals to lower the risk of gastrointestinal side effects and to ensure proper absorption.
Alcohol consumption should be moderated or avoided due to potential interactions and the risk of hypoglycemia.
Individuals should follow a diet that is low in fat and sugar. This involves substituting carbohydrates with whole grains, fruits, and vegetables, as carbohydrates can be converted into sugars, resulting in elevated blood sugar levels.
The dietary restriction should be individualized as per patient requirements.
Glimepiride + Metformin + Voglibose may be contraindicated under the following conditions: -
- Serum creatinine values ≥1.5 mg/dL [females], ≥1.4 mg/dL [males], or aberrant creatinine clearance, which can also be caused by situations including septicemia, acute myocardial infarction, and cardiovascular collapse, indicate renal illness or renal dysfunction.
- Hepatic impairment.
- Hypersensitivity to the product or any of its ingredients is known.
- Metabolic acidosis, either acute or chronic, involves diabetic ketoacidosis, with or without unconsciousness. Insulin should be administered to treat diabetic ketoacidosis.
- Individuals having radiologic examinations need the intravascular injection of iodinated contrast agents, as using such agents may lead to an abrupt modification of renal function.
- Blockages in the intestines or a predisposition to it.
- Cardiac Effects: Compared to diet-alone or diet-plus-insulin therapies, oral hypoglycemic medications such as tolbutamide have been proven to increase cardiovascular mortality. Because of the same consequences, glimepiride is also liable for this warning.
- Lactic acidosis: Metformin accumulation during glimepiride and metformin therapy can result in this uncommon but serious consequence. It primarily affects diabetic individuals with severe renal insufficiency and heart failure, and it is fatal in roughly 50% of cases. Metformin levels of more than 5 μg/mL have been associated with lactic acidosis, which calls for quick hospital treatment, stopping the medication, and sometimes hemodialysis for treatment.
- Hypoglycemia: Severe hypoglycemia can be caused by any sulphonylurea medication. Proper patient selection, dose, and instructions are crucial to prevent hypoglycemia episodes.
- Consumption of alcohol: Metformin's effect on lactate metabolism is known to be increased by alcohol. Patients using metformin should be cautioned against consuming large amounts of alcohol.
- Hypoxic states: Lactic acidosis and prerenal azotemia have been linked to hypoxemia-related illnesses such as acute congestive heart failure, acute myocardial infarction, and cardiovascular collapse (shock) from any cause.
- Loss of Blood Glucose Control: Patients with stable diabetes may experience acute blood glucose instability under stressful events such as fever, trauma, or illness. It may be required to discontinue the diabetic regimen and start insulin; oral antidiabetic medication should be resumed once the acute episode concludes.
- Hypoxic States: Patients on metformin may develop lactic acidosis as a result of conditions that cause hypoxemia or circulatory collapse (shock), such as sudden heart failure or myocardial infarction. It's advisable to stop taking metformin immediately.
- Hemolytic Anemia: Patients lacking in glucose 6-phosphate dehydrogenase (G6PD) may develop hemolytic anaemia due to sulfonylurea medications such as glimepiride. For patients with G6PD deficiency, caution should be exercised, and non-sulfonylurea alternatives should be considered.
Alcohol Warning
It is unsafe to consume Glimepiride Metformin + Voglibose with alcohol.
Breast Feeding Warning
It is not safe to use glimepiride + metformin + Voglibose together when breastfeeding. The medication may damage an unborn child if it enters the breastmilk, according to limited human data.
Pregnancy Warning
It is not recommended during pregnancy as it may harm the unborn baby.
Food Warning
Avoid excessive intake of high-sugar or high-fat foods. Take low fat and a low sugar diet.
The adverse reactions related to Glimepiride+ Metformin + Voglibose can be categorized as:-
- Common Adverse Effects: Gastrointestinal issues like nausea, diarrhea, or abdominal discomfort.
- Less Common Adverse Effects: Hypoglycemia, skin reactions
- Rare Adverse Effects: Lactic acidosis, severe allergic responses or liver-related problems.
The clinically relevant drug interactions of Glimepiride + Metformin + Voglibose are briefly summarized here:
- Cationic drugs: The risk of lactic acidosis may rise if certain medications are used concurrently with metformin. By competing for the same renal tubular transport channels, cationic medications that are excreted by renal tubular secretions (such as amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, or vancomycin) may lessen the removal of metformin. Therefore, it is advised to closely monitor the patient and modify the cationic medication dosage and metformin dosage.
- Miconazole (systemic route, oromucosal gel) and Phenylbutazone (systemic route): Increases the hypoglycemic effect of glimepiride.
- Furosemide: Pharmacokinetic characteristics of both medications were altered by co-administration, according to a single-dose drug interaction study between furosemide and metformin in healthy patients. Furosemide did not significantly change metformin renal clearance; however, it did raise blood AUC and plasma and blood Cmax by 15% and 22%, respectively. The Cmax and AUC of furosemide were 31% and 12% lower, respectively, when given with metformin than when given alone. The terminal half-life was also 32% shorter, and there was no apparent difference in the renal clearance of furosemide.
- Vitamin B12: By competitively inhibiting the calcium-dependent binding of the intrinsic factor vitamin B12 complex to its receptor, metformin may cause inadequate oral vitamin B12 absorption. Pernicious anaemia is an infrequent side effect of the reaction that can be avoided by stopping metformin and taking extra vitamin B12.
- Nifedipine: Nifedipine increases plasma metformin Cmax and AUC by 20% and 9%, respectively, and increases the quantity of metformin excreted in the urine. These results suggest that nifedipine may improve metformin absorption.
- Danazol: The patient's blood sugar and urine must be watched if this active ingredient is used and it cannot be avoided. Glimepiride and metformin dosage adjustments might be required during and after danazol treatment.
- Salicylates: Patients on oral antidiabetic medications should be closely watched for hypoglycemia or a lack of blood glucose control if salicylates are given to them or stopped.
- Thiazide: Thiazide diuretics and oral antidiabetic medications interact to reduce insulin sensitivity, which causes hyperglycemia and glucose intolerance. Therefore, patients with diabetes need to be continuously watched.
- Other: Concomitant use of NSAIDs, beta-blockers, insulin, acarbose, sulphonamides, fluconazole, monoamine oxidase inhibitors (MAOIs), enalapril, captopril, and other antidiabetic medications increases insulin sensitivity, enhances the effect of lowering blood sugar, and can lead to in hypoglycemia. Individuals taking oral contraceptives, phenytoin, quinolones, or estrogens should be continually monitored for any loss of control over diabetes.
The most common side effects of Glimepiride+ Metformin + Voglibose include:
- Hypoglycemia, or low blood sugar
- Headache
- Evident symptoms of upper respiratory
- Taste change
- Nausea
- Diarrhoea
- Stomach pain
- Flatulence
Glimepiride+ Metformin + Voglibose should be prudent in the following group of special populations.
- Pregnancy
Glimepiride: Pregnancy Category C: Use caution if the benefits outweigh the risks.
Insufficient research on glimepiride's impact on pregnant individuals exists. Poorly managed diabetes during pregnancy poses risks like diabetic ketoacidosis, preterm birth, and complications. Inadequate control heightens the risk of birth abnormalities, stillbirth, and neonatal issues such as respiratory distress and hypoglycemia. Close monitoring for hypoglycemia and respiratory problems in newborns is necessary. Discontinue glimepiride two weeks before delivery to avoid severe neonatal hypoglycemia and adjust dosages cautiously during and after pregnancy.
Metformin: Pregnancy Category B; Could be acceptable. Either no danger has been shown by animal research, but human studies have not been conducted, or some risk has been shown by animal studies but not by human studies.
According to recent data, there may be a link between elevated blood glucose levels during pregnancy and a higher risk of congenital disabilities. Most medical professionals advise using insulin to keep blood glucose levels as near to normal as feasible when pregnant. If metformin HCl is unnecessary, it is not advisable to use it during pregnancy because research on animal reproduction does not necessarily indicate human response.
Voglibose: Pregnancy Category C: Use caution if the benefits outweigh the risks.
There are currently no relevant epidemiological data available. Because there are no reported adverse effects of the medication on pregnancy, fetal or embryonic development, parturition, or postnatal development, it should only be administered to pregnant or potentially pregnant women when the potential benefits outweigh the risks.
- Nursing Mothers
Glimepiride: Nursing mothers should not take Glimepiride to avoid potential consumption through breast milk and potential harm to the infant. If required, the patient needs to discontinue nursing or switch to insulin.
Metformin: In nursing rats, metformin excretes into the milk. Since there is no comparable human data, a choice should be made, either stopping metformin or nursing while considering the mother's need for the chemical.
Voglibose: Lactating rats excrete metformin into their milk. Since there is a lack of comparable data for humans, the benefits of continuing the compound in the mother should be considered when deciding whether to stop nursing or stop taking metformin.
- Pediatric Use
As per FDA, safety and effectiveness in the pediatric population have yet to be established.
- Geriatric Use
The safety and effectiveness of Glimepiride+ Metformin + voglibose in elderly individuals should be carefully considered due to age-related factors, and caution is advised when using this combination in older individuals, with close monitoring for potential side effects and adjustments made as necessary under medical supervision.
Dose Adjustment in Kidney Impairment Patients:
Kidney impairment (Mild to Severe): Not recommended.
Glimepiride + metformin + Voglibose should only be taken in people with normal renal function since metformin is known to be eliminated by the kidneys and because patients with impaired renal function are more likely to experience major adverse medication events.
Dose Adjustment in Hepatic Impairment Patients:
There is no FDA guidance on using Glimepiride+ Metformin in patients with hepatic impairment.
Extreme caution should be used when giving Glimepiride + Metformin + Voglibose to patients with inadequate liver function. You should consult a doctor to determine the appropriate dosage and/or intervals between doses.
Signs and Symptoms
The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of Glimepiride Metformin + Voglibose.
Overconsumption of Glimepiride+ Metformin + Voglibose could lead to severe hypoglycemia (very low blood sugar), gastrointestinal disturbances, such as nausea, vomiting, and diarrhoea, and a risk of lactic acidosis.
Management
There is no specific antidote or treatment for excessive Glimepiride + Metformin + Voglibose intake. However, immediate medical attention is essential. Glimepiride + Metformin + Voglibose should be terminated immediately when an overdose is suspected or if any unusual symptoms occur after intake.
Promptly treat mild hypoglycemic symptoms without loss of consciousness or neurological findings with oral glucose and consider adjusting medication dosage or meal patterns. Continuously monitor patients until their safety is ensured. Hospitalize for severe hypoglycemic episodes with coma or seizures; administer concentrated glucose intravenously, followed by a diluted infusion to maintain blood glucose levels above 100 mg/dL. Monitor closely for 24 to 48 hours due to potential recurrence. Monitor for lactic acidosis with metformin until patient safety is confirmed. Voglibose delays carbohydrate hydrolysis by competitively inhibiting α-glucosidase enzymes in the small intestine.
Pharmacodynamics
Glimepiride: Glimepiride enhances insulin granule production from pancreatic beta cells and increases insulin sensitivity in peripheral tissues, increasing peripheral glucose absorption and lowering plasma blood glucose and glycated haemoglobin (HbA1C) levels. A multicenter, randomized, placebo-controlled clinical trial assessed the efficacy of glimepiride (1-8 mg) as monotherapy titrated over ten weeks to placebo in T2DM participants not managed by diet alone. Fasting plasma glucose (FPG) was reduced by 46 mg/dL, post-prandial glucose (PPG) was reduced by 72 mg/dL, and HbA1c was reduced by 1.4% more than the placebo in this trial. In another randomized study of patients with T2DM who received either a placebo or one of three doses (1, 4, or 8 mg) of glimepiride over 14 weeks, all glimepiride regimens significantly reduced FPG, PPG, and HbA1c values (P 0.001) compared to placebo. The 4- and 8-mg doses of glimepiride were more efficacious than the 1-mg dose; however, the 4-mg dose gave almost maximal antihyperglycemic efficacy.
Metformin: Metformin is an antihyperglycemic medication that lowers basal and postprandial plasma glucose levels in people with type 2 diabetes, improving their glucose tolerance. Its pharmacologic modes of action are distinct from those of other oral antihyperglycemic medication groups. Metformin increases peripheral glucose uptake and utilization, which lowers intestinal glucose absorption, reduces hepatic glucose synthesis, and enhances insulin sensitivity. Metformin, unlike sulfonylureas, does not result in hyperinsulinemia or hypoglycemia in either type 2 diabetes patients or healthy persons. Metformin medication does not alter insulin secretion, although it may reduce the plasma insulin response throughout the day and insulin levels while fasting.
Voglibose: Alpha-glucosidase inhibitors are saccharides that function as competitive inhibitors of the alpha-glucosidase enzymes in the small intestine's brush border, which are necessary for digesting carbohydrates. In the small intestine, oligosaccharides, trisaccharides, and disaccharides are hydrolyzed to glucose and other monosaccharides by the membrane-bound intestinal alpha-glucosidases. Acarbose inhibits membrane-bound alpha-glucosidases and also suppresses pancreatic alpha-amylase. In the small intestine lumen, complex starches are hydrolyzed to oligosaccharides by pancreatic alpha-amylase. Compromising these enzyme systems slows down the rate at which complex carbohydrates are metabolized. Because the carbs are not converted into glucose molecules, less glucose is absorbed. The short-term impact of these medication regimens on diabetes patients is a decline in blood glucose levels; the long-term effect is a slight decrease in haemoglobin A1c levels.
Pharmacokinetics
Absorption
Glimepiride: Glimepiride is entirely absorbed after oral dosing within 1 hour and has a linear pharmacokinetic profile. Peak plasma concentrations (Cmax) of glimepiride were attained 2- 3 hours after a single oral dose in healthy participants and several oral doses in type 2 diabetes patients. Accumulation does not develop after numerous doses. When glimepiride was administered with meals, the duration to attain Cmax rose by 12%, while the mean and AUC (area under the curve) fell by 8 to 9%, respectively. In a pharmacokinetic investigation of Japanese patients with T2DM, Cmax values in once-daily dosages were higher than those in twice-daily doses. Following oral administration, the absolute bioavailability of glimepiride is reported to be complete.
Metformin: Incompletely and slowly absorbed from the digestive system. Food reduces and delays absorption slightly. Complete bioavailability: 50%–60%. Time to peak plasma concentration: 2–3 hours (for rapid release); 4–8 hours (for delayed release); 7 hours.
50–60% bioavailability (metformin [fasted])
Voglibose: About 35% of the medicine as metabolites and less than 2% of the active ingredient are absorbed from the digestive system.
Distribution
Glimepiride: Following dosage, the volume of distribution in healthy participants was 8.8 L (113 mL/kg). Glimepiride has a plasma protein binding rate of more than 99.5%.
Vd: 8.8 L
Protein-bound: 99.5%
Metformin: Concentrates in the liver, kidney and gastrointestinal tract. It crosses the placenta and then enters breast milk (small amounts). Volume of distribution: 654 ± 358 L.
Protein-bound: Negligible (Metformin)
Voglibose: Time to peak plasma concentration: Approx 1 hour (active drug).
Metabolism
Glimepiride: Glimepiride is said to be metabolized in the liver. Following an intravenous or oral dosage, glimepiride undergoes oxidative biotransformation mediated by the CYP2C9 enzyme to create a pharmacologically active primary metabolite, cyclohexyl hydroxymethyl derivative (M1). One or more cytosolic enzymes can further convert M1 to the inactive metabolite carboxyl derivative (M2). M1 preserved roughly one-third of its parent's pharmacologic action in an animal model, with a half-life of 3-6 hours. However, whether M1's glucose-lowering action is therapeutically relevant is still being determined.
Metformin: Excreted unchanged in the urine and did not undergo specific hepatic metabolism (no metabolites have been found in humans) or biliary excretion.
Voglibose: Exclusively metabolized down into at least 13 metabolites in the gastrointestinal tract, with sulfate, methyl, and glucuronide conjugates serving as the main products. This process is primarily carried out by intestinal bacteria and digestive enzymes.
Elimination
Glimepiride: After seven days, when three healthy male individuals were given 14C-glimepiride orally, nearly 60% of the total radioactivity was recovered in the urine. M1 and M2 were responsible for 80-90% of the radioactivity collected in urine. M1:M2 ratio in urine was roughly 3:2 in two participants and 4:1 in one subject. In faeces, around 40% of the total radioactivity was recovered. M1 and M2 accounted for almost 70% of the radioactivity collected in faeces (the M1:M2 ratio was 1:3). No parent medication was found in the urine or faeces. There was no substantial biliary excretion of glimepiride or its M1 metabolite after treatment in subjects.
Metformin: With a plasma elimination half-life of roughly 6.2 hours, 90% of the absorbed medication is excreted via the renal pathway during the first 24 hours following oral administration. The elimination half-life of blood is roughly 17.6 hours, indicating that the erythrocyte bulk could constitute a distribution compartment.
Voglibose: Via faeces (about 51% of unabsorbed drug); urine (approximately 34% of inactive metabolites; <2% of unmodified drug and active metabolites). Half-life of elimination: approximately two hours.
Therapeutic benefits of a combination of Glimepiride + Metformin + Voglibose
- Blood Glucose Control: Glimepiride stimulates insulin release, metformin reduces glucose production in the liver, and Voglibose slows carbohydrate absorption in the gut.
- Lower Risk of Hypoglycemia: To minimize the risk of hypoglycemic events by modulating glucose release and absorption, reducing the likelihood of sudden blood sugar drop.
- Krishna Murti, Manoj Kumar Sethi, Akalanka Dey, Chandra Sekhar Lal, Krishna Pandey and Pradeep Das, 2016. Addition of Voglibose to Glimepiride and Metformin Have Better Glucose Control in Diabetics: A Prospective, Parallel-group and Open-label Comparative Study. International Journal of Pharmacology, 12: 422-428.
- Das, AshokK & Wangnoo, SubhashK & Chawla, Rajeev & Shaikh, Altamash & Bantwal, Ganapathi & Kalra, Pramila & Jaggi, Shalini & Abhyankar, MaheshV & Prasad, Ashish & Sarda, Prashant. (2022). Expert consensus on the triple combination of glimepiride, metformin, and voglibose usage in patients with type 2 diabetes mellitus in Indian settings. Journal of Diabetology. 13. 145. 10.4103/jod.jod_118_21.
- Nigam, N., Anand, P., Kumar, S., & Manchi, R. (2021). COMPARATIVE STUDY OF EFFICACY AND SAFETY OF METFORMIN+GLIMEPIRIDEVSMETFORMIN +GLIMEPIRIDE+VOGLIBOSE IN TYPE 2 DIABETES MELLITUS PATIENTS AT TERTIARY CARE CENTRE, KANPUR. Journal of Advanced Scientific Research, 12(01 Suppl 2), 204-207. https://doi.org/10.55218/JASR.s12021121sup209
- KD Tripathi. [link]. Seventh Edition. New Delhi, India: Jaypee Brothers Medical Publishers; 2013: Page No 272
- https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020496s027lbl.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448454/
- https://www.medicaid.nv.gov/Downloads/provider/ Voglibose _2015-1215.pdf
- https://www.centaurpharma.com/downloads/Glimitab-MV2018.pdf
Published on: 18 Nov 2023 11:55 AM GMT
