Amaryl (Glimepiride)

How does it work?

Amaryl tablets contain the active ingredient glimepiride, which is a type of medicine called a sulphonylurea. (NB. Glimepiride is also available without a brand name, ie as the generic medicine.) Glimepiride is used to help control blood sugar levels in people with type 2 diabetes.

People with type 2 diabetes (non-insulin dependent diabetes) have a deficiency of a hormone called insulin. Insulin is produced by the pancreas and is the main hormone responsible for controlling sugar levels in the blood. It normally makes the cells of the body remove excess sugar from the blood. In type 2 diabetes insulin is produced inefficiently in response to surges of blood sugar, eg following a meal. The cells of the body also become resistant to the action of insulin that is produced, which means that blood sugar levels can become too high.

Glimepiride works mainly by stimulating the cells in the pancreas that produce insulin. These cells are called beta cells. Glimepiride causes the beta cells to produce more insulin and this insulin removes sugar from the blood.

Glimepiride also increases the uptake of sugar from the blood into muscle and fat cells and decreases the production of sugar by the liver.

All these actions help to decrease the amount of sugar in the blood of people with type 2 diabetes.

Glimepiride tablets are normally taken once a day, shortly before or during the first meal of the day.

Glimepiride is a first line option for treating type 2 diabetes in people who are not overweight. It is used when diet and exercise have failed to control blood sugar levels. It can also be used in combination with other antidiabetic medicines to provide better control of blood sugar.

What is it used for?

  • Type 2 diabetes(non-insulin dependent) , when diet has failed to fully control blood sugar.

Warning!

  • Your doctor may want you to check the level of sugar in your blood or urine from time to time while you are taking this medicine. Make sure you discuss how to do this and how often with your GP, pharmacist or diabetes specialist.
  • On rare occasions, low blood sugar (hypoglycaemia) can occur as a side effect of this medicine. This is more likely to happen if you suddenly do more exercise than normal, have your meals at irregular times or miss meals altogether. For this reason, it is important that you are aware of the symptoms of hypoglycaemia (these may include cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness or weakness, confusion, difficulty in concentration, excessive hunger, temporary vision changes, headache or nausea) and what to do if you experience these symptoms. Discuss this with your GP, pharmacist or diabetes specialist.
  • People who are taking antidiabetic tablets should only drink alcohol in moderation and accompanied by food. This is because alcohol can make your warning signs of low blood sugar less clear, and can cause delayed low blood sugar, even several hours after drinking.
  • If you get an infection or illness, or have an accident while taking this medicine you should let your doctor know, because when the body is put under stress this medicine may become less effective at controlling your blood sugar. In these cases your doctor may need to temporarily replace your treatment with insulin. You should also consult your doctor about your diabetes treatment if you are due to have surgery under a general anaesthetic, or if you get pregnant. In these situations blood sugar is normally controlled by insulin.
  • This type of medicine can occasionally cause liver problems. For this reason, you should consult your doctor if you develop any of the following symptoms while taking this medicine, so that your liver can be checked: unexplained nausea, vomiting, abdominal pain, fatigue, loss of appetite, darkened urine or yellowing of the eyes or skin (jaundice).
  • It is recommended that your liver function and the levels of blood cells in your blood are regularly monitored while you are taking this medicine.

Use with caution in

  • Elderly people.
  • Decreased kidney function.
  • Decreased liver function.
  • Problems with the production of natural steroid hormones by the adrenal glands.
  • Disorders of the thyroid gland.
  • Lack of the enzyme G6PD in the blood (G6PD deficiency).

Not to be used in

  • Children.
  • Type 1 (insulin dependent) diabetes.
  • Diabetic keto-acidosis.
  • Loss of conciousness due to ketoacidosis in severe and inadequately treated diabetes (diabetic coma).
  • Severely decreased liver function.
  • Severely decreased kidney function.
  • Hereditary blood disorders called porphyrias.
  • Pregnancy.
  • Breastfeeding.
  • Allergy to other sulphonylurea medicines, eg gliclazide, glibenclamide, tolbutamide.
  • Allergy to sulphonamide medicines, eg the antibiotic sulfamethoxazole.
  • Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Amaryl tablets contain lactose).

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine should not be used during pregnancy. Diabetes is usually controlled using insulin during pregnancy, because this provides a more stable control of blood sugar. If you get pregnant while taking this medicine, or are planning a pregnancy, you should seek medical advice from your doctor.
  • This medicine may pass into breast milk. As this could cause low blood sugar in the nursing infant, this medicine should not be used by breastfeeding mothers. Discuss this with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

  • Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
  • Temporary visual disturbances at start of treatment.
  • Weight gain.
  • Low blood sugar level (hypoglycaemia).
  • Allergic skin reactions such as rash or itching.
  • Disturbance in liver function.
  • Inflammation of the liver (hepatitis).
  • Cholestatic jaundice.
  • Disturbance in the normal numbers of blood cells in the blood.
  • Allergy to active ingredients (hypersensitivity).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Many medicines can affect blood sugar levels. It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

The following medicines may enhance the blood sugar lowering effect of this medicine and therefore increase the chance of low blood sugar (hypoglycaemia):

  • ACE inhibitors, eg captopril (these can cause unpredictable drops in blood sugar)
  • co-trimoxazole
  • disopyramide
  • fibrates, eg clofibrate
  • fenfluramine
  • fluconazole
  • insulin
  • MAOI antidepressants, eg phenelzine
  • miconazole
  • other antidiabetic tablets
  • phenylbutazone
  • large doses of salicylates, eg aspirin (small pain relieving doses do not normally have this effect)
  • sulphonamides.

Beta-blockers, eg propranolol (including eye drops containing beta-blockers) can mask some of the signs of low blood sugar, such as increased heart rate and tremor. They also prolong episodes of low blood sugar and impair recovery back to normal glucose levels.

The warning symptoms of hypoglycaemia may also be masked by clonidine.

The following medicines may increase blood glucose levels. If you start treatment with any of these your dose of this medicine may therefore need increasing:

  • some antipsychotic medicines, eg chlorpromazine, olanzapine
  • corticosteroids, eg hydrocortisone, prednisolone
  • danazol
  • diuretics, especially thiazide diuretics, eg bendroflumethiazide
  • lithium
  • isoniazid
  • oestrogens and progesterones, such as those contained in oral contraceptives
  • protease inhibitors, eg ritonavir
  • somatropin (human growth hormone).

Rifampicin may reduce the blood level of this medicine. If you are prescribed rifampicin, your dose of this medicine may need to be increased to control your blood sugar.

Other medicines containing the same active ingredient

Glimepiride tablets are also available without a brand name, ie as the generic medicine.