Glimepiride should be used with caution in:
- People with decreased kidney function
- People with decreased liver function
- People in stressful situations such as injury, operation or infection with fever
- People lacking an enzyme in the blood known as glucose-6-phosphate dehydrogenase (G6PD)
- People with thyroid problems
- People with adrenal gland problems
- People with pituitary gland problems
- People with a poor diet or suffering from malnutrition
- People drinking alcohol, particularly if a meal is skipped
- People taking certain medications to treat high blood pressure, infections and other conditions (see interactions)
This medication may lead to low blood sugar levels when meals are taken at irregular hours or if you take more exercise than normal. The symptoms of low blood sugar include headache, excessive hunger, sweating, nausea, vomiting, tiredness, sleepiness, feeling restless, feeling aggressive, difficulty in concentrating, tremor, confusion, speech and sight problems. It is important to take some form of sugar as soon as possible to prevent your blood sugar level dropping any further.
It should not be used in:
- Children (under 18 years)
- People with an allergy to glimepiride or any of the ingredients in the medicine
- People with an allergy to other sulfonylureas (such as glibenclamide, glipizide)
- People with an allergy to sulfonamides (to treat infections such as sulfamethoxazole)
- People with insulin dependent diabetes (type 1 diabetes)
- People with severe liver problems
- People with severe kidney problems
- People in a diabetic coma
- People with porphyria (inherited blood disorder)
- People with diabetic ketoacidosis (complication of diabetes with body producing ketone bodies)
- Pregnant women
- Women breastfeeding
- Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (as the tablets contain lactose).
Also see list of precautions and interactions
Do not store above 30°C.
What is it used for?
- Glimepiride is used to treat type 2 diabetes mellitus.
- It is a sulfonylurea, sometimes known as an oral hypoglycaemic.
- It is used to control blood sugar levels in people with type 2 diabetes. People with type 2 diabetes do not normally require insulin (non-insulin dependent) and glimepiride is used when diet, exercise and weight loss have not sufficiently controlled the blood sugar levels. Glimepiride mainly works by stimulating the release of insulin from the pancreas. The insulin then lowers the blood sugar levels.
- In general this drug is used treat type 2 diabetes in adults by controlling the blood sugar levels.
- Benefits of being on this drug can include better control of blood sugar levels thus reducing the risk of complications.
Listed below are the typical uses of glimepiride.
- Type 2 (non-insulin dependent) diabetes, when diet, exercise and weight loss alone are not sufficient to control blood sugar levels.
- On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below.
- None known.
HOW TO USE/TAKE
How often do I take it?
- Take this medication by mouth usually once daily, before or with breakfast or the first main meal of the day. Swallow the tablets whole with some water or other suitable liquid. It is important not to leave out any meal when you are on glimepiride.
- Use this medication regularly in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take up to a few hours before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines. The dose of glimepiride taken is determined by the blood and urinary glucose levels.
Do I need to avoid anything?
- If you have low or high blood sugar levels, or you have visual problems, then avoid driving or operating machinery. It is important that take extra care to avoid low blood sugar levels when driving and that you pay attention to the warning signs of low blood sugar. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
GLIMEPIRIDE SIDE EFFECTS
- Temporary visual disturbances (usually at start of treatment)
- Blood abnormalities
- Decreases in white blood cell count (more likely to get an infection)
- Decreases in platelet count (more likely to bruise and bleed)
- Decreases in red blood cell count (look pale and feel tired)
- Low blood sugar (hypoglycaemia)
- Increases in liver enzymes
- Stomach ache
- Allergic skin reactions such as rash, itching, hives or increased sensitivity to sunlight
- Abnormal liver function
- Inflammation of the liver (hepatitis)
- Yellowing of the skin and eyes (jaundice)
- Bile flow problems (cholestasis)
- Liver failure
- Decreases in blood sodium level
- Very low blood sugar levels (severe hypoglycaemia) with fits, loss of consciousness or coma
If any of these persist or you consider them severe then inform doctor or pharmacist.
Glimepiride can lead to low blood sugar (hypoglycaemia). The symptoms of low blood sugar include headache, excessive hunger, nausea, vomiting, tiredness, sleepiness, feeling restless, feeling aggressive, difficulty in concentrating, tremor, confusion, speech and sight problems.
Tell your doctor immediately if you develop any of the following symptoms:
- Yellowing of eyes and skin (signs of liver problems)
- Skin rash, itching hives or increased sensitivity to sunlight as mild allergic reactions can progress into more serious allergic reactions
- Severely low blood sugar with fits, loss of consciousness or coma
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking glimepiride, tell your doctor or pharmacist if you are allergic to it; or to other sulfonylureas; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have:
- Allergy to glimepiride, other sulfonylureas (such as glibenclamide, glipizide), sulfonamides (to treat infections such as sulfamethoxazole) or any of the ingredients in the medication
- Severe liver problems
- Severe kidney problems
- Diabetic coma
- Porphyria (inherited blood disorder)
- Diabetic ketoacidosis (complication of diabetes with body producing ketone bodies)
- Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (as the tablets contain lactose)
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following:
- Decreased kidney function
- Decreased liver function
- Hormonal problems such as thyroid, adrenal gland or pituitary gland problems
- Ongoing stressful situations such as injury, operation or infection with fever
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency (an enzyme in the blood)
- Poor diet or malnutrition
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- Alcohol can increase or decrease the blood sugar lowering effect of glimepiride in an unpredictable way.
The elderly: glimepiride should be used with caution in the elderly as it may increase the risk of hypoglycaemia (low blood sugar levels).
Pregnancy and breastfeeding - please ensure you read the detailed information below
Glimepiride is not safe to take if you are, or are planning to become, pregnant. During pregnancy, it is preferred to control diabetes through the use of insulin.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
It is not known whether glimepiride passes into breast milk. The manufacturer therefore states that it should not be taken if you are breastfeeding.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur: None known.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
Medications taken with glimepiride which increase the risk of low blood sugar (hypoglycaemia). These include the following:
- Other medications to treat diabetes such as insulin or metformin
- Anabolic steroids and male sex hormones such as testosterone
- Coumarins to stop blood clotting such as warfarin
- Fibrates used to treat for high cholesterol such as clofibrate
- Medications to treat high blood pressure such as
-ACE inhibitors e.g. captopril
-Alpha blockers, also used to treat enlarged prostate gland e.g. clonidine, doxazosin and prazosin
- Medications to treat bacterial infections such as clarithromycin, chloramphenicol, sulfonamides (e.g. sulfamethoxazole or antibiotics containing sulphonamides e.g. co-trimoxazole), tetracyclines and quinolone antibiotics
- Medications to treat fungal infections such as fluconazole, miconazole and voriconazole
- Medications used to treat gout such as allopurinol, probenecid and sulfinpyrazone
- Medications used to treat cancer such as cyclophosphamide
- Medications used to reduce weight such as fenfluramine
- Medicines used to treat depression such as fluoxetine, monoamine oxidase inhibitors (e.g. moclobemide and phenelzine)
- Medicines called anti-arrhythmic agents used to control abnormal heart beat (e.g. disopyramide)
- Medicines used to treat nasal allergies such as hayfever (e.g. tritoqualine)
- Non-steroidal anti-inflammatory drugs (NSAIDs) and salicylates to treat pain and/or inflammation such as aspirin, ibuprofen and naproxen
Medications taken with glimepiride which increase the risk of high blood sugar (hyperglycaemia). These include the following:
- Adrenaline, noradrenaline and similar medications
- Corticosteroids used to treat allergies and inflammation such as hydrocortisone, prednisolone
- Medications known as phenothiazines
- used to treat psychoses (severe mental health problems) such as chlorpromazine
- used to treat allergies, nausea and vomiting such as some antihistamines (e.g. cetirizine, promethazine)
- Medications used to treat epilepsy such as phenobarbital and phenytoin
- Medications used to treat increased eye pressure (glaucoma) such as acetazolamide
- Medications used to treat high blood pressure such as diazoxide and diuretics (water tablets), particularly thiazide diuretics e.g. bendroflumethiazide
- Medications used to treat very low blood sugar levels such as glucagon
- Nicotinic acid (used to lower cholesterol)
- Oestrogens and progestogens (e.g. oral contraceptives, hormone replacement therapy)
- Rifampicin, isoniazid (antibiotics used to treat tuberculosis)
- Thyroid hormones
Other medications which may interact with glimepiride include:
- Cimetidine and other H2 antagonists (for ulcers and indigestion)
- Beta-blockers e.g. propranolol (including eye drops) and reserpine used to treat high blood pressure
The warning signs of low blood sugar can be masked by beta-blockers and clonidine.
This information does not contain all possible interactions. Therefore, before using glimepiride, tell your doctor or pharmacist of all the products you use.
If you happen to have taken too much of this medication there is a danger of low blood sugar levels, and therefore you should instantly consume foods or drinks containing sugar (e.g. a small bar of sugar cubes, sweet juice,sweetened tea) and inform a doctor immediately.
When treating low blood sugar due to accidental intake in children, the quantity of sugar given must be carefully controlled to avoid the possibility of producing dangerously high blood sugar levels. Anyone in a state of unconsciousness must not be given food or drink.
Since a low blood sugar state may last for some time it is very important that the patiient is carefully monitored until there is no more danger. Admission into hospital may be necessary, also as a measure of precaution.
Show the doctor the package or remaining tablets, so the doctor knows what has been taken.
An overdose of glimepiride may cause headache, excessive hunger, sweating, nausea, vomiting, tiredness, sleepiness, feeling restless, feeling aggressive, difficulty in concentrating, tremor, confusion, speech and sight problems.
Severe cases of low blood sugar accompanied by loss of consciousness and coma are cases of medical emergency requiring immediate medical treatment and admission into hospital. It may be helpful to tell your family and friends to call a doctor immediately if this happens to you.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of glimepiride or intentional overdose is suspected, contact your local hospital, GP or if in the UK call NHS Direct on 0845 4647.
If you forget to take a dose, do not take a double dose to make up for the forgotten doses.