Consumer medicine information

APO-Gliclazide MR Tablets

Gliclazide

BRAND INFORMATION

Brand name

APO-Gliclazide MR

Active ingredient

Gliclazide

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using APO-Gliclazide MR Tablets.

What is in this leaflet

Read this leaflet carefully before taking your medicine. This leaflet answers some common questions about gliclazide. It does not contain all the available information. It does not take the place of talking to your doctor, pharmacist or diabetes educator.

The information in this leaflet was last updated on the date listed on the last page. More recent information on this medicine may be available.

Ask your doctor or pharmacist:

  • if there is anything you do not understand in this leaflet
  • if you are worried about taking your medicine, or
  • to obtain the most up-to-date information.

You can also download the most up to date leaflet from www.apotex.com.au.

All medicines have risks and benefits. Your doctor has weighed the risks of you using this medicine against the benefits they expect it will have for you.

Pharmaceutical companies cannot give you medical advice or an individual diagnosis.

Keep this leaflet with your medicine. You may want to read it again.

What this medicine is used for

The name of your medicine is APO-Gliclazide MR. It contains the active ingredient gliclazide.

The tablets release the gliclazide gradually over 24 hours.

The medicine is used to control, blood glucose in patients with Type II diabetes mellitus.

This type of diabetes is also known as non-insulin-dependent diabetes mellitus (NIDDM) or maturity onset diabetes.

Gliclazide is used when diet and exercise are not enough to control your blood glucose.

Gliclazide can be used alone, or together with other medicines for treating diabetes.

Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed this medicine for another reason.

This medicine is available only with a doctor's prescription.

How it works

Gliclazide belongs to a group of medicines called the sulfonylureas.

Gliclazide lowers high blood glucose by increasing the amount of insulin produced by your pancreas.

Glucose is used by the body as fuel, and all people have glucose circulating in their blood.

In diabetes, levels of blood glucose are higher than is needed. This is called hyperglycaemia.

A section at the end of this leaflet contains advice about recognising and treating hyperglycaemia.

It is very important to control high blood glucose whether or not you feel unwell. This really helps to avoid serious long-term health problems, which can involve the heart, eyes, circulation, and/or kidneys.

As with many medicines used for the treatment of diabetes, there is a possibility that blood glucose levels may become very low during treatment with gliclazide.

This is known as hypoglycaemia.

A section at the end of this leaflet contains advice about recognising and treating hypoglycaemia.

There is no evidence that this medicine is addictive.

Be careful driving or operating machinery until you know how gliclazide affects you.

Gliclazide may cause dizziness and drowsiness in some people.

Use in children

This medicine should not be used in children.

Before you take this medicine

When you must not take it

Do not take this medicine if:

  • You have or have had any of the following:
    - Type I diabetes mellitus (insulin dependent diabetes mellitus, also known as IDDM, or juvenile or growth onset diabetes)
    - unstable or brittle diabetes
    - diabetic ketoacidosis (a problem which affects the acidity of your blood and can lead to coma)
    - diabetic coma or pre-coma/coma
    - severe kidney disease
    - severe liver disease
  • You are pregnant or planning to become pregnant.
    Gliclazide may affect your developing baby if you take it during pregnancy. Your doctor will usually replace gliclazide with insulin while you are pregnant.
  • You are breastfeeding or plan to breastfeed.
    It is not known whether gliclazide passes into human breast milk.
  • You are using miconazole to treat fungal infections.
  • You are taking medicines called phenylbutazone or danazol. You should not take these while taking gliclazide.
  • The expiry date (EXP) printed on the pack has passed.
  • The packaging is torn, shows signs of tampering or it does not look quite right.
  • You are hypersensitive to, or have had an allergic reaction to:
    - gliclazide or other sulfonylureas
    - antibiotics called sulfonamides
    - thiazide diuretics (a type of "fluid" or "water" tablet)
    - any of the ingredients listed at the end of this leaflet.
    Symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue, throat or other parts of the body, rash, itching or hives on the skin; fainting or hayfever-like symptoms.
    If you think you are having an allergic reaction, do not take any more of the medicine and contact your doctor immediately or go to the Accident and Emergency department at the nearest hospital.

Before you start to take it

Before you start taking this medicine, tell your doctor if:

  1. You have allergies to:
  • any other medicines
  • any other substances, such as foods, preservatives or dyes.
  1. You have or have had any medical conditions, especially the following:
  • kidney problems
  • liver problems
  • a growth in your pancreas, called an insulinoma
  • adrenal, pituitary or thyroid problems
  • heart failure
  • a condition called Glucose-6-Phosphate dehydrogenase Deficiency (G6PD)
  1. You have any medical condition, or do anything, that may increase the risk of hyperglycaemia (high blood sugar) - for example:
  • you are ill or feeling unwell (especially with fever or infection)
  • you are injured
  • you are having surgery
  • you are taking less gliclazide than prescribed
  • you are doing less exercise than normal
  • you are eating more carbohydrate than normal.
  1. You are taking a medicine called a beta-blocker.
Taking this may mask the symptoms of diabetes.
  1. You have any medical condition, or do anything, that may increase the risk of hypoglycaemia (low blood sugar) - for example:
  • drinking alcoholic drinks
  • not eating regular meals, including breakfast
  • doing more exercise than usual
  • eating less carbohydrate than normal.
Alcohol, diet, exercise, and your general health all strongly affect the control of your diabetes.
  1. You do not have regular meals
  2. You are taking or are planning to take any other medicines. This includes vitamins and supplements that are available from your pharmacy, supermarket or health food shop.

Taking other medicines

Some medicines may interact with gliclazide. These include:

  • other medicines used to treat diabetes (tablets and insulin)
  • some medicines used to treat high blood pressure and other heart conditions, such as beta-blockers, ACE inhibitors
  • some hormones used in hormone replacement therapy and oral contraceptives (oestrogens and progestogens)
  • monoamine oxidase inhibitors (MAOIs), used for treating depression, Parkinsons Disease or infections
  • some medicines used for mental illness (e.g. chlorpromazine)
  • clofibrate, a medicine for lowering cholesterol
  • medicines used to treat arthritis, pain and inflammation (e.g. oxyphenbutazone, phenylbutazone, high dose salicylates)
  • antibiotics called fluoroquinolones, sulfonamides, or chloramphenicol
  • miconazole, or fluconazole, used to treat fungal infections
  • some medicines used to prevent blood clots (warfarin and similar medicines)
  • cimetidine and similar medicines used to treat acid reflux and stomach ulcers
  • steroid medicines called glucocorticoids (e.g. prednisolone, cortisone)
  • barbiturates, medicines used for sedation
  • some medicines for hormonal disturbances (such as danazol)
  • salbutamol and terbutaline (intravenous), medicines for asthma.
  • St John's wort (hypericum perforatum), a medicine used to treat depression

If you are taking any of these you may need a different dose or you may need to take different medicines.

Remember to keep checking your blood glucose levels.

Drinking alcohol can also affect your blood sugar levels and how well gliclazide works. If taken with gliclazide, it can also cause flushing of the face, throbbing headache, giddiness, fast breathing, fast heart rate, angina, stomach pains or feeling sick or vomiting.

Other medicines not listed above may also interact with gliclazide.

How to take this medicine

Follow carefully all directions given to you by your doctor or pharmacist or diabetes educator.

Their instructions may be different to the information in this leaflet.

How much to take

Your doctor or pharmacist will tell you how much of this medicine you should take. This will depend on your condition and whether you are taking any other medicines.

The starting dose is usually 30 mg per day. This will be adjusted slowly over several weeks, depending on how well your body responds to the dose.

The usual dose of this medicine may vary from one to four tablets taken daily.

Your doctor may increase or decrease the dose, depending on your blood glucose levels.

Do not stop taking your medicine or change your dosage without first checking with your doctor.

How to take it

Swallow the tablets whole with a glass of water.

Do not crush the tablets or break them.

When to take it

Take it at about the same time each day, usually with breakfast. Taking these tablets with food can help to minimise the risk of hypoglycaemia.

It will also help you remember when to take them.

Do not skip meals while taking these tablets.

How long to take it for

Gliclazide can help to control your blood glucose level, but it cannot cure your Type 2 diabetes.

Gliclazide treatment is usually for a long period of time - so you should keep taking the tablets regularly unless advised otherwise by your doctor.

Make sure you have enough of this medicine to last over weekends and holidays.

If you forget to take it

If it is almost time to take your next dose, skip the missed dose and take your next dose at the usual time. Otherwise, take it as soon as you remember and then go back to taking your medicine as you would normally.

Do not take a double dose to make up for the dose that you missed. If you double a dose, this may cause hypoglycaemia (low blood glucose).

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints to help you remember.

If you take too much (overdose)

If you think that you or anyone else may have taken too much of this medicine, immediately telephone your doctor or the Poisons Information Centre (Tel: 13 11 26 in Australia) for advice. Alternatively go to the Accident and Emergency Department at your nearest hospital.

Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

If you take too much gliclazide you may experience symptoms of hypoglycaemia (low blood glucose).

If not treated quickly, these symptoms may progress to loss of co-ordination, slurred speech, confusion, loss of consciousness and fitting.

At the first signs of hypoglycaemia (low blood glucose), raise your blood glucose quickly by following the instructions at the end of this leaflet.

Note that artificial sweeteners will NOT help to raise your blood sugar levels.

While you are taking this medicine

Things you must do

Follow carefully all directions given to you by your doctor.

Otherwise you may not get the full benefits from treatment.

Make sure you check your blood glucose levels regularly. This is the best way to tell if your diabetes is being controlled properly.

Your doctor, pharmacist or diabetes educator will show you how and when to do this.

Make sure that you, your friends, family and work colleagues can recognise the symptoms of hypoglycaemia (low blood glucose) and hyperglycaemia (high blood glucose) and know what to do.

Instructions at the end of this leaflet can help you with this.

Visit your doctor for regular blood tests and checks of your eyes, feet, kidneys, heart, circulation, blood, and blood pressure.

Carefully follow your doctor's and dietician's advice on diet, drinking alcohol and exercise.

Tell your doctor immediately if you notice the return of any symptoms of hyperglycaemia that you had before starting gliclazide, or if your blood sugar levels are high.

These may be signs that gliclazide is no longer working, even though you may have been taking it successfully for some time.

If you are elderly or are taking other medicines for diabetes such as insulin or metformin, the risk of hypoglycaemia (low blood glucose) is increased.

The risk of hypoglycaemia (low blood glucose) is also increased in the following situations:

  • too much gliclazide
  • too much or unexpected exercise
  • delayed meal or snack
  • too little food.

If you experience any of the signs of high blood glucose (hyperglycaemia), contact your doctor immediately.

The risk of hyperglycaemia (high blood glucose) is increased in the following situations:

  • undiagnosed or uncontrolled diabetes
  • illness, infection or stress
  • too little gliclazide
  • certain other medicines
  • too little exercise
  • eating more carbohydrate than normal.

If you become ill or experience extra stress, injury, fever, infection or need surgery, tell your doctor. Your blood glucose may become difficult to control at these times. Your doctor may decide to change your treatment and use insulin instead of gliclazide.

Tell your doctor that you are taking this medicine if:

  • you are about to be started on any new medicine
  • you become pregnant or are planning to become pregnant (tell your doctor immediately)
  • you are breastfeeding or are planning to breastfeed
  • you are about to have any blood tests
  • you are going to have surgery or are going into hospital.

Tell any other doctors, dentists and pharmacists who are treating you that you take this medicine.

Things you must not do

Do not:

  • Give this medicine to anyone else, even if their symptoms seem similar to yours
  • Take your medicine to treat any other condition unless your doctor tells you to
  • Stop taking your medicine, or change the dosage, without first checking with your doctor
  • Skip meals while taking gliclazide.

Things to be careful of

Be careful when driving or operating machinery until you know how this medicine affects you.

Gliclazide may cause dizziness and drowsiness in some people.

Drinking alcohol can make this worse. If you do feel dizzy or drowsy, do not drive, operate machinery or do anything else that could be dangerous.

Be careful not to let your blood glucose levels fall too low. Low blood glucose levels may slow your reaction time and affect your ability to drive or operate machinery.

A section at the end of this leaflet contains advice about recognising and treating hypoglycaemia.

If you are travelling, it is a good idea to:

  • wear some form of identification showing you have diabetes
  • carry some form of sugar to treat hypoglycaemia (low blood glucose) if it occurs, for example, sugar sachets or jelly beans
  • carry emergency food rations in case of a delay, for example, dried fruit, biscuits or muesli bars
  • keep gliclazide tablets readily available.

If you become sick with a cold, fever or flu, it is very important to continue taking gliclazide, even if you feel unable to eat your normal meal.

If you have trouble eating solid food, use sugar-sweetened drinks as a carbohydrate substitute or eat small amounts of bland food. Your diabetes educator or dietician can give you a list of foods to use for sick days.

Possible side effects

Tell your doctor, pharmacist, or diabetes educator as soon as possible if you do not feel well while you are taking gliclazide or if you have any questions or concerns.

Do not be alarmed by the following lists of side effects. You may not experience any of them. All medicines can have side effects. Sometimes they are serious but most of the time they are not.

Tell your doctor or pharmacist if you notice any of the following:

  • stomach upset including nausea and vomiting (feeling or being sick), heartburn, diarrhoea, constipation or a feeling of fullness in the stomach
  • sight problems (this may happen when you first start taking this medicine and your blood sugar levels change)
  • weariness
  • dizziness or giddiness
  • headache
  • mild rash or redness of the skin.

Tell your doctor as soon as possible if you notice any of the following.

These may be serious side effects and you may need medical attention.

  • hypoglycaemia or hyperglycaemia. A section at the end of this leaflet contains advice about recognising and treating hypoglycaemia or hyperglycaemia.
  • signs of frequent or worrying infections such as fever, severe chills, sore throat or mouth ulcers
  • signs of anaemia such as tiredness, being short of breath and looking pale
  • bleeding or bruising more easily than normal, reddish or purplish blotches under the skin
  • itchy, red veins.

If you experience any of the following, stop taking your medicine and contact your doctor immediately or go to the Accident and Emergency department at your nearest hospital.

These are very serious side effects and you may need urgent medical attention or hospitalisation.

  • yellowing of the skin or eyes, also called jaundice, and/or pale stools and dark urine.
  • vomiting blood or passing bloody or black, tarry stools
  • angina (chest pain caused by reduced blood flow to the heart)
  • flu like symptoms, with quickly developing red rashes, blisters or ulcers, particularly around the mucous membranes (mouth and lips, genital and anal regions). These conditions are life-threatening.

Other side effects not listed above may occur in some patients.

Allergic reactions

If you think you are having an allergic reaction to gliclazide, do not take any more of this medicine and tell your doctor immediately or go to the Accident and Emergency department at your nearest hospital.

Symptoms of an allergic reaction may include some or all of the following:

  • shortness of breath, wheezing or difficulty breathing.
  • swelling of the face, lips, tongue, throat or other parts of the body
  • severe rash, itching or hives on the skin
  • fainting
  • hayfever-like symptoms

Storage and disposal

Storage

Keep your medicine in its original packaging until it is time to take it.

If you take your medicine out of its original packaging it may not keep well.

Keep your medicine in a cool dry place where the temperature will stay below 30°C. Protect it from moisture. Do not store your medicine, or any other medicine, in the bathroom or near a sink. Do not leave it on a window sill or in the car. Heat and dampness can destroy some medicines.

Keep this medicine where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor or pharmacist tells you to stop taking this medicine or it has passed its expiry date, your pharmacist can dispose of the remaining medicine safely.

Product description

What APO-Gliclazide MR looks like

White to off-white, flat faced, radial edge, capsule shaped tablets, engraved "APO 30" on one side and plain on the other side.

Blister pack of 100 tablets.

Bottles of 100 tablets.

* Not all pack types may be available.

Ingredients

Each tablet contains 30 mg of gliclazide as the active ingredient.

It also contains the following inactive ingredients:

  • hypromellose
  • stearic acid
  • silica-colloidal anhydrous.

This medicine is gluten-free, lactose-free, sucrose-free, tartrazine-free and free of other azo dyes.

Australian Registration Numbers

APO-Gliclazide MR
30 mg Tablets

Blister packs
AUST R 151303.

Bottles
AUST R 151307

Sponsor

Apotex Pty Ltd
16 Giffnock Avenue
Macquarie Park NSW 2113

APO is a registered trade mark of Apotex Inc.

Recognising and treating hypoglycaemia (very LOW blood glucose levels)

Hypoglycaemia may occur during treatment with gliclazide.

The first signs of hypoglycaemia may include weakness, trembling or shaking, sweating, anxiety, changes in heart rate and breathing, light-headedness, dizziness, problems with sight, headache or lack of concentration, irritability, depression, aggression, tearfulness, hunger, nausea, vomiting, chest pain and/ or numbness around the lips and tongue.

These symptoms can occur suddenly.

If not treated promptly, these may progress to:

  • loss of co-ordination
  • slurred speech
  • confusion, drowsiness
  • loss of consciousness or fitting.

At the first signs of hypoglycaemia take some sugar to raise your blood sugar level quickly.

Do this by taking one of the following:

  • 5-7 jelly beans
  • 3 teaspoons of sugar or honey
  • half a can of ordinary (non-diet) soft drink
  • 2-3 concentrated glucose tablets
  • a tube of glucose gel.

Note that taking artificial sweeteners will not help raise your blood sugar levels.

Then take some extra carbohydrates such as plain biscuits, fruit or milk - unless you are within 10-15 minutes of your next meal.

Taking this extra carbohydrate will help to prevent a second drop in your blood glucose level.

If hypoglycaemia symptoms do not get better straight away after taking sugar, or the symptoms are severe or prolonged, then go to the Accident and Emergency department at your nearest hospital - if necessary by calling an ambulance.

Contact your doctor or diabetes educator for advice if you are concerned about hypoglycaemia.

Recognising and treating hyperglycaemia (HIGH blood glucose levels)

Some people may feel fine when their glucose levels are high.

High blood glucose usually occurs more slowly than low blood glucose. Signs of high blood glucose may include:

  • lethargy or tiredness
  • headache
  • thirst
  • passing large amounts of urine
  • blurred vision.

If you notice symptoms of hyperglycaemia, or your blood sugar levels are high, tell your doctor immediately. You may need adjustments of the dose or type of medicines you are taking.

It is very important to control high blood glucose whether or not you feel unwell. This really helps to avoid serious long-term health problems, which can involve the heart, eyes, circulation, and/or kidneys.

This leaflet was last updated in:
September 2020.

Published by MIMS November 2020

BRAND INFORMATION

Brand name

APO-Gliclazide MR

Active ingredient

Gliclazide

Schedule

S4

 

1 Name of Medicine

Gliclazide.

2 Qualitative and Quantitative Composition

Gliclazide MR 30 mg tablets are intended for oral administration. Each tablet contains gliclazide 30 mg, as the active ingredient.
For full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Modified release tablets.
White to off-white, flat faced, radial edge, capsule shaped tablets, engraved "APO 30" on one side and plain on the other side.

4 Clinical Particulars

4.1 Therapeutic Indications

Type II diabetes in association with dietary measures when dietary measures alone are inadequate to control blood glucose.
During controlled clinical trials in patients with type II diabetes, modified release formulation of gliclazide (30 mg-120 mg), taken as a single daily dose, was shown to be effective long-term in controlling blood glucose levels, based on monitoring of HbA1c.

4.2 Dose and Method of Administration

Gliclazide MR 30 mg tablets are for adult use only.
The daily dose may vary from 30 mg to 120 mg taken orally, once daily. Gliclazide MR 30 mg tablets should be taken with food because there is an increased risk of hypoglycemia if a meal is taken late, if an inadequate amount of food is consumed or if the food is low in carbohydrate. It is recommended that the medication be taken at breakfast time. If a dose is forgotten, the dose taken on the next day should not be increased.
Gliclazide MR 30 mg tablets are modified release tablets and therefore should be neither broken nor chewed.
As with all hypoglycaemic agents, the dose should be titrated according to the individual patient's response.
The initial recommended dose is 30 mg daily, even in elderly patients (≥ 65 years).
Dose titration should be carried out in steps of 30 mg, according to the fasting blood glucose response. Each step should last for at least two weeks. A single daily dose provides an effective blood glucose control. The single daily dose may be between one and three, or even four, tablets. The daily dose should not exceed 120 mg.
Previously untreated patients should commence with a dose of 30 mg and will benefit from dose titration until the appropriate dose is reached.
Gliclazide MR 30 mg tablets, can replace gliclazide 80 mg tablets, tablet for tablet, for doses of 1 to 4 tablets per day.
Gliclazide MR 30 mg tablets, may be used to replace other antidiabetic treatments without any transitional period. If a patient is switched from a hypoglycaemic sulfonylurea with a prolonged half-life he/she should be carefully monitored (for 1 to 2 weeks) in order to avoid hypoglycaemia due to possible residual effects of the previous therapy.
Gliclazide MR 30 mg tablets, may be given in combination with biguanides, alpha glucosidase inhibitors or insulin.

Elderly patients.

The efficacy and tolerance of gliclazide MR 30 mg tablets has been confirmed in clinical trials in patients over 65 years who were given the same dosage regimen as the general population. The dosage is therefore identical to that recommended for adults under the age of 65 years.

Renal impairment.

The efficacy and tolerance of gliclazide MR 30 mg tablets has been confirmed in clinical trials of subjects with mild to moderate renal failure (creatinine clearance of between 15-80 mL/min) who were given the same dosage regimen as the general population. No dosage adjustment is therefore required in subjects patients with mild to moderate renal impairment. Use of gliclazide MR 30 mg in patients with severe renal impairment is contraindicated (see Section 4.3 Contraindications).

4.3 Contraindications

This medication is contraindicated in the following cases:
Hypersensitivity to gliclazide, other sulphonylureas, sulfonamides, or to any of the excipients.
Type I diabetes, diabetic ketoacidosis, diabetic precoma and coma.
Severe renal or hepatic impairment.
Treatment with miconazole (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).
Pregnancy and lactation (see Section 4.6 Fertility, Pregnancy and Lactation, Use in pregnancy, Use in lactation).
It is generally not recommended to use this agent in combination with phenylbutazone or danazol (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).

4.4 Special Warnings and Precautions for Use

Acute complications such as severe trauma, fever, infection or surgery.

These acute complications provoke additional metabolic stress, which accentuate the predisposition to hyperglycaemia and ketosis. Patients presenting with such conditions may require insulin to maintain control. It is not appropriate to increase the dosage of gliclazide.

Hypoglycaemia.

The risks of hypoglycaemia, together with its symptoms, 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.
Hypoglycaemia may occur following administration of sulphonylureas. Rarely, cases may be severe and prolonged. This may involve hospitalisation and glucose infusion may need to be continued for several days.
Careful selection of patients and of the dose used, as well as provision of adequate information to the patient are necessary to avoid hypoglycaemic episodes.
The following factors may increase the risk of hypoglycaemia:
patient does not follow the doctor's treatment advice (particularly elderly subjects);
malnutrition;
irregular mealtimes, skipping meals, periods of fasting or dietary changes;
imbalance between physical exercise and carbohydrate intake;
renal impairment;
severe hepatic impairment;
overdose of antidiabetic agents;
certain endocrine disorders: thyroid disorders, hypopituitarism and adrenal impairment;
concomitant administration of certain other medicines (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).
Experience with sulfonylureas shows that hypoglycaemia can recur even when measures such as the intake of carbohydrate such as sugar are initially effective. 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.
Patients must be warned that artificial sweeteners are not recommended in the treatment of hypoglycaemia as they have negligible effect.
Hypoglycaemia may be difficult to recognise in elderly patients and those receiving beta-blockers.
This treatment should only be prescribed 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 delayed, an inadequate amount of food is consumed or the food is low in carbohydrate. Hypoglycaemia is more likely to occur during periods of low calorie diet, following prolonged or strenuous exercise, following alcohol intake or during treatment with a combination of hypoglycaemic agents.

Patient awareness.

Comprehensive instructions must be given to the patient about the nature of the disease and what must be done to detect and prevent complications.

Poor blood glucose control.

Blood glucose control in treated patients may be affected by St John's wort (Hypericum perforatum) preparations (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions), fever, trauma, infection or surgical intervention. It may be necessary to discontinue treatment and to administer insulin in these cases.
The efficacy of oral antidiabetic agents often decreases in the long-term. 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 and should be distinguished from primary failure, when the drug is ineffective as first line treatment. However, before classifying the patient as a secondary failure, dose adjustment and reinforcement of dietary measures should be considered.

Unstable blood glucose level (dysglycaemia).

Disturbances in blood glucose, including hypoglycaemia and hyperglycaemia have been reported, in diabetic patients receiving concomitant treatment with fluoroquinolones, especially in elderly patients. Indeed, careful monitoring of blood glucose is recommended in all patients receiving gliclazide and a fluoroquinolone at the same time.

Use in renal and hepatic impairment.

Severe renal or hepatic impairment may affect the distribution of gliclazide and hepatic impairment may also reduce the capacity for neoglucogenesis. These two effects increase the risk of severe hypoglycaemic reactions. A hypoglycaemic episode in these patients may be prolonged and appropriate management should be initiated.

Glucose-6-phosphate dehydrogenase deficiency (G6PD).

Treatment of patients with G6PD deficiency with sulfonylurea agents can lead to haemolytic anaemia. Since gliclazide belongs to the chemical class of sulfonylurea drugs, caution should be used in patients with G6PD deficiency and a nonsulfonylurea alternative should be considered.

Use in the elderly.

See Section 4.2 Dose and Method of Administration; Section 5.2 Pharmacokinetic Properties.

Paediatric use.

See Section 4.2 Dose and Method of Administration.

Effects on laboratory tests.

Glycated haemoglobin should be monitored regularly. Blood glucose measurement may also be useful.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Blood glucose monitoring during and after treatment is necessary when gliclazide is used with medicines which can interact with gliclazide. It may also be necessary to adjust the dose of gliclazide MR during and after treatment with such medicines.

The following medications are likely to increase the risk of hypoglycaemia.

Concomitant use which is contraindicated.

Miconazole (systemic route, oromucosal gel).

Increases the hypoglycaemic effect with possible onset of hypoglycaemia symptoms or even coma.

Concomitant use which is 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 anti-inflammatory agent.

Alcohol.

Acute alcohol intoxication potentiates the hypoglycaemic action of all sulfonylurea agents by inhibiting compensatory reactions. This can lead to the onset of hypoglycaemic coma. Ingestion of alcohol may also cause a disulfiram-like reaction with characteristic flushing of the face, throbbing headache, giddiness, tachypnoea, tachycardia or angina pectoris.
Chronic alcohol abuse may, as a result of liver enzyme induction, increase the metabolism of sulfonylurea drugs, shortening the plasma half-life and duration of action.
Avoid alcohol or medicines containing alcohol.

Concomitant use which requires special care.

Potentiation of the blood glucose lowering effect and therefore in some instances, hypoglycaemia may occur when one of the following medications is taken: other antidiabetic agents (insulins, acarbose, biguanides, metformin, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, GLP-1 receptor agonists), sulfonamides, clarithromycin, clofibrate, salicylates (high doses), chloramphenicol, MAOIs, β-blockers, H2-receptor antagonists, ACE inhibitors, fluconazole, nonsteroidal anti-inflammatory agents.

The following medications may cause an increase in blood glucose levels.

Advise the patient and emphasise the importance of glucose monitoring.

Concomitant use which is not recommended.

Danazol.

If the use of danazol cannot be avoided, it may be necessary to adjust the dose of gliclazide MR during and after treatment with danazol.

Concomitant use which requires special care.

Chlorpromazine.

High doses (> 100 mg per day of chlorpromazine) can increase blood glucose levels (reduced insulin release).
Advise the patient and emphasise the importance of glucose monitoring. It may be necessary to adjust the dose of gliclazide MR during and after treatment with chlorpromazine.

Glucocorticoids (systemic and local route: intra-articular, cutaneous and rectal preparations) and tetracosactrin.

Concomitant use may increase blood glucose levels with possible ketosis (glucocorticoids cause reduced tolerance to carbohydrates). Emphasize the importance of blood glucose monitoring, particularly at the start of treatment. It may be necessary to adjust the dose of gliclazide MR during and after treatment with glucocorticoids.

Salbutamol, terbutaline (intravenous).

May cause increased blood glucose levels due to β2-agonist effects. If necessary, switch to insulin.

Barbiturates, oestrogens and progestogens.

May adversely affect blood sugar control with hypoglycaemic agents in some patients by causing increased blood glucose levels.

St John's wort (Hypericum perforatum) preparations.

Gliclazide exposure is decreased by St John's wort (Hypericum perforatum).

The following products may cause unstable glucose.

Concomitant use which requires special care.

Fluroquinolones.

In case of a concomitant use of gliclazide and a fluoroquinolone, the patient should be warned of the risk of unstable blood glucose, and the importance of blood glucose monitoring should be emphasised.

Concomitant use to be taken into consideration.

Anticoagulant therapy (warfarin).

Sulphonylureas may lead to potentiation of anticoagulation during concurrent treatment. Adjustment of warfarin may be necessary.

4.6 Fertility, Pregnancy and Lactation

Effect on fertility.

No data available.
(Category C)
The sulfonylureas may enter the foetal circulation and cause neonatal hypoglycaemia. In animal studies embryotoxicity and/or birth defects have been demonstrated with some sulfonylureas.
Gliclazide should not be used in pregnant women although animal studies of gliclazide have not shown any teratogenic effect. From a clinical point of view, there are no adequate data to allow evaluation of the possible malformative or foetotoxic effects of gliclazide, when administered during pregnancy.
Gliclazide is contraindicated during pregnancy and insulin is the drug of first choice for treatment of diabetes during pregnancy. Treatment should be changed from gliclazide to insulin therapy before pregnancy is attempted, or as soon as pregnancy is discovered. Control of diabetes should be achieved before the time of conception to reduce the risk of congenital abnormalities linked to uncontrolled diabetes.
It is not known whether gliclazide or its metabolites are excreted in breast milk. Given the risk of neonatal hypoglycaemia, breastfeeding is contraindicated during treatment with this product. A risk to newborns/ infants cannot be excluded.

4.7 Effects on Ability to Drive and Use Machines

Patients should be made aware of the signs and symptoms of hypoglycaemia and should be careful if driving or operating machinery, especially at the beginning of treatment.

4.8 Adverse Effects (Undesirable Effects)

Good clinical acceptability of gliclazide, has been established in many studies as well as in medical practice.
The safety of gliclazide MR has been evaluated in controlled clinical trials in 955 patients, of which 728 patients were treated in long-term comparative trials, against an immediate release formulation of gliclazide 80 mg tablets, for up to 10 months. In these comparative trials, the overall incidence and type of adverse events were similar in both gliclazide MR and gliclazide 80 mg groups.
Adverse events were generally mild and transient, not requiring discontinuation of therapy.
However, where patients did discontinue due to adverse events, the percentage was lower in the gliclazide MR group (2.9%) than in the immediate release group (4.5%).
Serious reactions which have been reported with sulfonylureas are pancytopenia and gastrointestinal haemorrhage. (See Class effects near the end of this section.)

Hypoglycaemia.

(See Section 4.3 Contraindications; Section 4.4 Special Warnings and Precautions for Use; Section 4.9 Overdose).
The most frequent adverse reaction with gliclazide is hypoglycaemia.
As is the case with all sulfonylurea drugs, hypoglycaemic reactions have been reported following gliclazide administration. However, a number of studies have shown that hypoglycaemia is less common with gliclazide than with glibenclamide.
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/or death.
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 carbohydrate such as sugar (artificial sweeteners have no effect).
Experience with other sulphonylureas shows that hypoglycaemia can recur even when these measures are initially effective. 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.
In long-term comparative studies, the percentage of patients experiencing hypoglycaemic episodes was similar between patients treated with gliclazide MR (11.6%) and those treated with the immediate release formulation of gliclazide (11.1%). However, the number of hypoglycaemic episodes per 100 patient months was lower in the gliclazide MR group (3.5) than in the immediate release group (4.8).
Analysis of elderly patients (over 65 years old) showed less hypoglycaemia than in the general population, with a prevalence of hypoglycaemic episodes lower in the gliclazide MR group (2.6 hypoglycaemic episodes for 100 patient months) than in the immediate release group (4.1).
The percentage of patients experiencing hypoglycaemic episodes in the subpopulation with renal failure, was similar to that observed in the general population.

Other adverse events.

Adverse events reported during controlled clinical trials with gliclazide MR were those expected in an ageing population with diabetes. Adverse events that were reported in at least 2.0% of patients, in long-term controlled clinical studies, are presented in Table 1. The most frequent adverse events were not specifically related to the disease (such as respiratory infections or back pain).
Analysis of adverse events in subpopulations showed a similar pattern to that seen in the general population. Gender, age and renal impairment had no significant influence on the safety profile of gliclazide MR.

Skin and subcutaneous tissue disorders.

Pruritus, urticaria, maculopapular rashes, rash, angioedema, erythema and bullous reactions (such as Stevens-Johnson Syndrome [SJS] and toxic epidermal necrolysis [TEN]) (as with other sulfur containing medications) and exceptionally, drug rash with eosinophilia and systemic symptoms (DRESS).

Blood and lymphatic system disorders (as with other sulphonylurea medications).

Anaemia, leucopenia, thrombocytopenia and agranulocytosis. These are in general reversible upon discontinuation of medication.

Hepatobiliary disorders.

Elevations of serum bilirubin and hepatic enzymes (AST, ALT, alkaline phosphatase) levels, and exceptionally, hepatitis (isolated reports). Treatment should be discontinued if cholestatic jaundice appears. These symptoms usually disappear after discontinuation of treatment.

Investigations.

Occasional elevations of serum creatinine, blood urea nitrogen.

Eye disorders.

Transient visual disturbances may occur due to changes in blood glucose levels, particularly on initiation of treatment. As with any glucose lowering medication, transient visual disturbances may occur on initiation of treatment due to changes in blood glucose levels.

Class effects.

The following adverse events have been observed with sulfonylureas: cases of erythrocytopenia, agranulocytosis, haemolytic anaemia, pancytopenia and 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.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration 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 at www.tga.gov.au/reporting-problems.

4.9 Overdose

Symptoms.

Overdose of sulphonylureas may cause hypoglycaemia.
Moderate symptoms of hypoglycaemia (without loss of consciousness or neurological signs), should be corrected by carbohydrate intake, dose adjustment and/or modification of diet.
Strict monitoring should be continued until the doctor is sure that the patient is out of danger.
Severe hypoglycaemic reactions are possible (with coma, convulsions or other neurological disorders) and must be treated as a medical emergency, requiring immediate hospitalisation.

Treatment.

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 necessary to maintain blood glucose levels above 5 mmol/L. It is recommended that patients should be monitored closely for a 48 hour period at least.
Plasma clearance of gliclazide may be prolonged in patients with hepatic disease. However, due to the strong binding of gliclazide to proteins, dialysis is not effective in these patients.
For information on the management of overdose, contact the Poison Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Gliclazide is an oral hypoglycaemic sulfonylurea which differs from other related compounds. It has an N-containing heterocyclic ring with an endocyclic bond. Gliclazide reduces blood glucose levels by stimulating insulin secretion from the beta-cells of the Islets of Langerhans. Gliclazide shows high affinity, strong selectivity and reversible binding to the β-cell KATP channels with a low affinity for cardiac and vascular KATP channels. Increased postprandial insulin and C-peptide secretion persists after two years of treatment.
In type II diabetes, 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 release is seen in response to stimulation induced by a meal or glucose.
Gliclazide also has extrapancreatic effects and haemovascular properties.
It has been shown to increase peripheral insulin sensitivity:
in muscle, euglycaemic hyperinsulinaemic clamp studies with gliclazide have demonstrated significantly increased (35%) insulin mediated glucose uptake which may improve diabetes control. Gliclazide potentiates insulin action on muscle glycogen synthase. These effects are consistent with a post-transcriptional action of gliclazide on GLUT4 glucose transporters;
studies on glucose turnover have further shown that gliclazide decreases hepatic glucose production, leading to an improvement in fasting blood glucose levels.
Gliclazide has been shown in some studies to have actions independent of that on glucose levels. These haemovascular effects of gliclazide include:
partial inhibition of platelet aggregation and adhesion with a decrease in markers of platelet activation (beta thromboglobulin, thromboxane B2);
increased vascular endothelial fibrinolytic activity (increased tPA activity);
antioxidant properties, notably a reduction in plasma lipid peroxides and increased erythrocyte superoxide dismutase activity;
inhibition of the increased adhesiveness of type II diabetic patient's monocytes to endothelial cells in vitro.
The antioxidant, platelet inhibiting and fibrinolytic actions of gliclazide involve processes which have been implicated in the pathogenesis of vascular complications of type II diabetes.
There is no clinical evidence that the haemovascular effects of gliclazide are of therapeutic benefit in type II diabetes patients.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

Absorption.

Hydration of the tablets induces formation of a gel to activate drug release.
Plasma levels increase progressively, resulting in a plateau shaped curve from the sixth to the twelfth hour after administration. Intra-individual variability is low. Gliclazide is completely absorbed and food intake does not affect the rate or degree of absorption.

Distribution.

Plasma protein binding is approximately 95%. The relationship between the dose administered and the area under the concentration curve as a function of time is linear for doses of gliclazide up to 90 mg/day. At the highest evaluated dose (135 mg/day), the AUC increases slightly more than proportionally to the dose.

Metabolism.

Gliclazide is mainly metabolised in the liver, the products of which are extensively excreted in the urine.

Excretion.

Less than 1% of unchanged drug is recovered in the urine. No active metabolites have been detected in plasma.
The clearance of gliclazide has been found to be slightly reduced as a function of age. This reduction, however, is not considered to be clinically significant.
The elimination half-life of gliclazide is approximately 16 hours.
No clinically significant modifications in the pharmacokinetic parameters have been observed in elderly patients.

5.3 Preclinical Safety Data

Genotoxicity.

In animal studies embryotoxicity and/or birth defects have been demonstrated with some sulphonylureas.
Animal studies of gliclazide have not shown any teratogenic effect.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Hypromellose, stearic acid, colloidal anhydrous silica.

6.2 Incompatibilities

See Section 4.5 Interactions with Other Medicines and Other Forms of Interactions.

6.3 Shelf Life

In Australia, the information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 30°C. Protect from moisture.

6.5 Nature and Contents of Container

30 mg tablets.

Blister pack (PVC/PVDC/Aluminium silver foil) of 100 tablets.
AUST R 151303.
Bottle (HDPE bottle/ CR-III PP cap with LDPE foam liner) of 100 tablets.
AUST R 151307.
* Not all pack sizes and/or pack types may be available.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Chemical structure.

Gliclazide is a white or almost white powder which is practically insoluble in water. Freely soluble in dichloromethane, sparingly soluble in acetone and slightly soluble in ethanol 96%. The melting point of gliclazide is approximately 168°C.
Chemical Name: 1-(3-azabicyclo[3.3.0]oct-3-yl)-3-p-tolylsulphonylurea.
Chemical Formula: C15H21N3O3S.
Molecular Weight: 323.4.

CAS number.

21187-98-4.

7 Medicine Schedule (Poisons Standard)

S4 - Prescription Only Medicine.

Summary Table of Changes