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Glimepiride, Oral Tablet

Highlights for glimepiride

  1. Glimepiride oral tablet is available as a generic drug and as a brand-name drug. Brand name: Amaryl.
  2. Glimepiride comes as a tablet you take by mouth.
  3. Glimepiride is used to treat type 2 diabetes. It helps control blood sugar when used along with a healthy diet and exercise.
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Important warnings

Important warnings

  • Low blood sugar warning: Glimepiride can cause low blood sugar (hypoglycemia). Symptoms may include:
    • trembling or shaking
    • nervousness or anxiety
    • irritability
    • sweating
    • lightheadedness or dizziness
    • headache
    • fast heart rate or palpitations
    • intense hunger
    • fatigue or tiredness
  • High blood sugar warning: If glimepiride isn’t working well enough to control your blood sugar, your diabetes won’t be under control. This will lead to high blood sugar (hyperglycemia). Call your doctor if you have any of these symptoms:
    • urinating more often than usual
    • feeling very thirsty
    • feeling very hungry even though you’re eating
    • extreme fatigue
    • blurred vision
    • cuts or bruises that are slow to heal
    • tingling, pain, or numbness in your hands or feet
  • Fatal heart problems warning: Glimepiride may increase your risk of fatal heart problems compared to treatment with diet alone or diet plus insulin. Ask your doctor if this drug is right for you.

About

What is glimepiride?

Glimepiride is a prescription drug. It comes as an oral tablet.

Glimepiride is available as the brand-name drug Amaryl and as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it's used

Glimepiride is used to reduce high blood sugar levels in people with type 2 diabetes. It’s used in combination with a healthy diet and exercise.

This medication may be used with insulin or other types of diabetes drugs to help control your high blood sugar.

How it works

Glimepiride belongs to a class of drugs called sulfonylureas. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Glimepiride helps your pancreas to release insulin. Insulin is a chemical that your body makes to move sugar (glucose) from your bloodstream into your cells. Once the sugar enters your cells, they can use it as fuel for your body.

With type 2 diabetes, your body doesn’t make enough insulin, or it can't properly use the insulin that it makes, so the sugar stays in your bloodstream. This causes high blood sugar levels (hyperglycemia).

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Side effects

Glimepiride side effects

Glimepiride oral tablet doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with glimepiride include:

  • low blood sugar (hypoglycemia). Symptoms may include:
    • trembling or shaking
    • nervousness or anxiety
    • irritability
    • sweating
    • lightheadedness or dizziness
    • headache
    • fast heart rate or palpitations
    • intense hunger
    • fatigue or tiredness
  • headache
  • nausea
  • dizziness
  • weakness
  • unexplained weight gain

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • severe low blood sugar (less than 35–40 mg/dL). Symptoms may include:
    • mood changes, such as irritability, impatience, anger, stubbornness, or sadness
    • confusion, including delirium
    • lightheadedness or dizziness
    • sleepiness
    • blurred or impaired vision
    • tingling or numbness in your lips or tongue
    • headaches
    • weakness or fatigue
    • lack of coordination
    • nightmares or crying out in your sleep
    • seizures
    • unconsciousness
  • hypersensitivity (allergic) reactions. This drug can cause several types of allergic reactions, including:
    • anaphylaxis. This is a severe and possibly a life-threatening allergic reaction. Symptoms may include trouble breathing, swelling of your throat or tongue, hives, or difficulty swallowing.
    • angioedema. This involves swelling of your skin, the layers under your skin, and your mucous membranes (inside your mouth).
    • Stevens-Johnsons syndrome. This is a rare and serious disorder of your skin and mucous membranes (mouth and nose). It starts with flu-like symptoms and is followed by a painful red rash and blisters.
  • liver damage. Symptoms may include:
    • yellowing of your skin and the whites of your eyes (jaundice)
    • stomach pain and swelling
    • swelling in your legs and ankles (edema)
    • itchy skin
    • dark-colored urine
    • pale stool or tar-colored stool
    • constant sleepiness
    • nausea
    • vomiting
    • bruising easily
  • low blood cell or platelet counts. Symptoms may include infections and bruising or bleeding that doesn’t stop as quickly as normal.
  • low sodium levels (hyponatremia) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). In SIADH, your body is unable to get rid of excess water by urinating. This leads to lower sodium levels in your blood (hyponatremia), which is dangerous. Symptoms may include:
    • nausea and vomiting
    • headache
    • confusion
    • loss of energy and fatigue
    • restlessness and irritability
    • muscle weakness, spasms or cramps
    • seizures
    • coma

Interactions

Glimepiride may interact with other medications

Glimepiride oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with glimepiride are listed below.

Quinolone antibiotics

These drugs can increase the effect of glimepiride and cause low blood sugar. Examples of these drugs include:

  • ciprofloxacin (Cipro)
  • levofloxacin (Levaquin)

Blood pressure and heart drugs (angiotensin-converting enzyme [ACE] inhibitors)

These drugs can increase the effect of glimepiride and cause low blood sugar. Examples of these drugs include:

  • benazepril (Lotensin)
  • captopril (Capoten)
  • enalapril (Vasotec)
  • enalaprilat
  • fosinopril (Monopril)
  • lisinopril (Prinivil)
  • moexipril (Univasc)
  • perindopril (Aceon)
  • quinapril (Accupril)
  • ramipril (Altace)
  • trandolapril (Mavik)

Antifungals

These drugs can increase the effect of glimepiride and cause low blood sugar. Examples of these drugs include:

  1. fluconazole (Diflucan)
  2. ketoconazole (Nizoral)

Drug that treats eye infections

Chloramphenicol can increase the effect of glimepiride and cause low blood sugar.

Drug that treats high cholesterol and triglycerides

Clofibrate can increase the effect of glimepiride and cause low blood sugar.

Drugs that treat depression

These drugs can increase the effect of glimepiride and cause low blood sugar. Examples of these drugs include:

  • monoamine oxidase inhibitors (MAOIs), such as:
    • isocarboxazid (Marplan)
    • phenelzine (Nardil)
    • tranylcypromine (Parnate)

Drugs that contain salicylate

These drugs can increase the effect of glimepiride and cause low blood sugar. Examples of these drugs include:

  • aspirin
  • magnesium salicylate (Doan’s)
  • salsalate (Disalcid)

Drugs that contain sulfonamides

These drugs can increase the effect of glimepiride and cause low blood sugar. Examples of these drugs include:

  • sulfacetamide
  • sulfadiazine
  • sulfamethoxazole/trimethoprim (Bactrim)
  • sulfasalazine (Azulfidine)
  • sulfisoxazole

Drug that treats cholesterol and type 2 diabetes

Colesevelam can decrease the amount of glimepiride that’s absorbed by your body. This means that the drug may not work as well. This interaction may cause high blood sugar.

Drug that treats low blood sugar

Diazoxide can decrease the effect of glimepiride and cause high blood sugar.

Tuberculosis drugs

These drugs can decrease the effect of glimepiride and cause high blood sugar. Examples of these drugs include:

  • rifabutin (Mycobutin)
  • rifampin (Rifadin)
  • rifapentine (Priftin)

Thiazide diuretics

These drugs can decrease the effect of glimepiride and cause high blood sugar. Examples of these drugs include:

  • orothiazide (Diuril)
  • chlorthalidone
  • hydrochlorothiazide (Hydrodiuril)
  • indapamide (Lozol)
  • metolazone (Zaroxolyn)
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Other warnings

Glimepiride warnings

This drug comes with several warnings.

Allergy warning

This drug is chemically similar to a class of medications called sulfonamides (sulfa drugs). If you’re allergic to sulfa medications, you may be allergic to glimepiride. If you have a sulfa allergy, tell your doctor before taking this drug.

Glimepiride can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

Alcohol interaction warning

Drinking alcohol while taking glimepiride may affect your blood sugar levels. They can either increase or decrease. Avoid drinking alcohol while taking this medication.

Warnings for people with certain health conditions

For people with G6PD deficiency: Glimepiride can cause hemolytic anemia (destruction of red blood cells) in people with the genetic problem Glucose 6-Phosphate Dehydrogenase (G6PD) deficiency. Your doctor may switch you to another diabetes drug if you have this condition.

For people with kidney disease: Glimepiride is removed from your body by your kidneys. If your kidneys aren’t working as well, glimepiride may build up in your body and cause low blood sugar. Your doctor may start you at a lower dose and slowly increase your dose if needed.

For people with liver disease: Glimepiride hasn’t been fully studied in patients with liver disease. If you have liver disease, you may be more sensitive to glimepiride. Your doctor may start you at a lower dose and slowly increase your dose if needed.

Warnings for other groups

For pregnant women: Glimepiride is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. Glimepiride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Call your doctor if you become pregnant while taking this drug.

For women who are breastfeeding: It isn’t known if glimepiride passes through breast milk. If it does, it may cause serious effects in a child who is breastfed. You and your doctor may need to decide if you’ll take glimepiride or breastfeed.

For seniors: As you age, your organs, such as your kidneys and liver, may not work as well as they did when you were younger. This means that you may be more sensitive to the effects of this medication. It may also be more difficult for you to recognize the symptoms of low blood sugar (hypoglycemia).

For these reasons, your doctor may start you at a lower dose of glimepiride.

For children: Glimepiride isn’t recommended for people under 18 years old because it may affect body weight and cause low blood sugar.

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Dosage

How to take glimepiride

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Generic: Glimepiride

  • Form: oral tablet
  • Strengths: 1 mg, 2 mg, 3 mg, 4 mg, 6 mg, and 8 mg

Brand: Amaryl

  • Form: oral tablet
  • Strengths: 1 mg, 2 mg, and 4 mg

Dosage for type 2 diabetes

Adult dosage (ages 18-64 years)

  • The recommended starting dose is 1 mg or 2 mg taken once per day with breakfast or the first main meal of the day.
  • After reaching a dose of 2 mg per day, your doctor may increase your dose by 1 mg or 2 mg based on your blood sugar levels. They may increase your dose every 1–2 weeks until your blood sugar levels are controlled.
  • The maximum recommended dose is 8 mg taken once per day.

Child dosage (ages 0-17 years)

Glimepiride isn’t recommended for people under 18 years old because it may affect body weight and cause low blood sugar.

Senior dosage (ages 65 years and older)

  • The starting dose is 1 mg taken once per day with breakfast or the first main meal of the day.
  • Your doctor may adjust your dose based on your blood sugar levels. Since seniors may be more sensitive to glimepiride and are more likely to have decreased kidney function, your doctor may increase your dose more slowly.
  • The maximum recommended dose is 8 mg taken once per day.

Special dosage considerations

For people with kidney disease: Because you’re at risk for low blood sugar, your dose of glimepiride will likely be lower than the typical dose.

  • The starting dose is 1 mg taken once per day with breakfast or the first main meal of the day.
  • Your dose of glimepiride may be adjusted based on your blood sugar levels.
  • The maximum recommended dose is 8 mg taken once per day.

For people with liver disease: If you have liver disease, you may be more sensitive to the effects of glimepiride. Your doctor may start you at a lower dose and slowly increase your dose if needed.

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Take as directed

Take as directed

Glimepiride is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you don't take it at all: If you don’t take glimepiride at all, you may still have high blood sugar levels. Over time, higher blood sugar levels can injure your eyes, kidneys, nerves, or heart. Severe issues include heart attack, stroke, blindness, kidney failure and dialysis, and possible amputations.

If you take too much: If you take too much glimepiride, monitor your blood sugar very closely and begin treatment if your blood sugar falls below 70 mg/dL. If this happens, take 15–20 grams of glucose (a type of sugar). You need to eat or drink one of the following:

  • 3–4 glucose tablets
  • a tube of glucose gel
  • ½ cup of juice or regular, non-diet soda
  • 1 cup of nonfat or 1% cow’s milk
  • 1 tablespoon of sugar, honey, or corn syrup
  • 8–10 pieces of hard candy, such as lifesavers

Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, then repeat the above treatment.

Once your blood sugar is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later.

If you don’t treat low blood sugar, you can have a seizure, pass out, and possibly develop brain damage. Low blood sugar can even be fatal.

If you pass out because of a low sugar reaction or cannot swallow, someone must give you an injection of glucagon to treat the low sugar reaction. You may need to go to the emergency room.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours before the time for your next dose, only take one dose.

Never try to catch up by taking two doses at once. This could result in severe side effects, such as low blood sugar.

How to tell if the drug is working: Your blood sugar readings should be lower and may be in the target range for people with type 2 diabetes. Unless otherwise directed by your doctor, target ranges for blood sugar are as follows:

  • Blood sugar before a meal (pre-prandial plasma glucose): between 70–130 mg/dL.
  • Blood sugar 1–2 hours after starting of a meal (postprandial plasma glucose): less than 180 mg/dL.

Important considerations

Important considerations for taking glimepiride

Keep these considerations in mind if your doctor prescribes glimepiride for you.

General

  • Glimepiride should be taken with breakfast or the first meal of the day.
  • You can crush or cut the tablet.

Storage

  • Store glimepiride at room temperature. Keep it at a temperature between 68ºF and 77ºF (20°C and 25°C).
  • Don’t freeze glimepiride.
  • Keep this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They won’t damage your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
  • Check for special rules about traveling with medication and lancets. You’ll need to use lancets to check your blood sugar.

Self-management

You may need to test your blood sugar levels at home using a blood glucose monitor. You’ll need to learn how to do the following:

  • use a blood glucose monitor to test your blood sugar regularly at home
  • recognize the signs and symptoms of high and low blood sugar
  • treat low and high blood sugar reactions

To check your blood sugar levels, you’ll need to have:

  • sterile alcohol wipes
  • lancing device and lancets (needles used to prick your finger to test your blood sugar)
  • blood sugar test strips
  • blood glucose monitor
  • needle container for safe disposal of lancets

Lancets are used to test your blood sugar while you’re taking glimepiride. Don’t throw out individual lancets into trashcans or recycling bins, and never flush them down the toilet. Ask your pharmacist for a safe container for disposing used lancets.

Your community may have a program for throwing away lancets. If disposing the container in the trash, label it “do not recycle.”

Clinical monitoring

Before you start and while you’re taking glimepiride, your doctor may check your:

  • blood sugar levels
  • glycosylated hemoglobin (A1C) levels (your blood sugar control over the last 2–3 months)
  • liver function
  • kidney function

Your diet

Glimepiride is used to treat diabetes along with diet changes and exercise. Talk to your doctor about how to change your eating habits.

Sun sensitivity

Glimepiride may cause increased sensitivity to the sun (photosensitivity). While taking this medication, you should use sunscreen, wear protective clothing, and limit how often you’re in the sun.

Hidden costs

Besides the drug, you’ll need to purchase the following:

  • sterile alcohol wipes
  • lancing device and lancets
  • blood sugar test strips
  • blood glucose monitor
  • needle container for safe disposal of lancets
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Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

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