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BRAND NAME: Amaryl

DRUG CLASS AND MECHANISM:
Glimepiride is an oral blood sugar-lowering drug in a class of medicines for controlling diabetes called sulfonylureas. Glimepiride is related to other sulfonylureas including glyburide (Micronase; Diabeta), glipizide (Glucotrol), tolbutamide (Orinase) and tolazamide (Tolinase). Glimepiride is used in type II diabetes, the most common type of diabetes that is found in 90% of patients with diabetes. In type II diabetes, insulin usually is not necessary to control the blood sugar. Instead, diet and oral medications often are sufficient. Intolerance to sugar that results in elevated blood sugar is caused by reduced insulin secretion by the pancreas and resistance to insulin's effects on the body's cells. Glimepiride lowers the sugar level in the blood by stimulating insulin to be secreted from the pancreas into the blood. Insulin causes sugar to leave the blood and enter cells throughout the body. Glimepiride was approved by the FDA in December of 1995.

STORAGE: Tablets should be stored at room temperature between 59-86 F (15-30 C).

PRESCRIBED FOR:
Glimepiride is used for controlling blood sugar in people with diabetes, and decreases the risks of eye, kidney, and nerve damage. Glimepiride is used to treat type II diabetes that cannot be controlled by a strict diabetes diet alone. If sulfonylureas are not effective, other oral drugs or insulin may be used.

DOSING:
Like other medicines used to treat diabetes, the dose of glimepiride is individualized using periodic measurements of blood sugar to determine the best dose. The recommended dose is 1 to 8 mg once daily. The usual starting dose is 1 or 2 mg daily.

DRUG INTERACTIONS:
Medicines that can increase blood sugar can reverse the action of glimepiride. These drugs include diuretics, for example, hydrochlorothiazide (Hydrodiuril, Ezide, Hydro-Par, Microzide, and many combinations with other drugs), furosemide (Lasix), corticosteroids such as prednisone and methylprednisolone (Medrol), phenytoin (Dilantin), niacin, and sympathomimetics such as pseudoephedrine (Sudafed).
Beta blockers such as propranolol (Inderal) and atenolol (Tenormin) can cause low or high blood sugar. Additionally, they can directly reverse the sugar-lowering effect of sulfonylureas and render them less effective. Beta blockers also can blunt some of the body's protective responses to low blood sugar, thus making it difficult for patients to recognize reactions due to low blood sugar (hypoglycemia). This notwithstanding, beta blockers have been used successfully in patients with diabetes and have been associated with improved survival in patients with diabetes and high blood pressure. Rifampin increases the breakdown of glimepiride by liver enzymes. This might reduce the effect of glimepiride and result in higher levels of sugar in the blood.

PREGNANCY:
In animal studies, glimepiride and other sulfonylureas were associated with a higher risk of fetal death. However, there have been no good studies in women. On the other hand, abnormal blood sugar concentrations (high or low) during pregnancy increase the risk of abnormalities in the fetus. Therefore, physicians must carefully weigh the benefits and risks of sulfonylurea treatment during pregnancy. Insulin is the drug of choice for treating diabetes in pregnant women.

NURSING MOTHERS:
It is not known if glimepiride is excreted in breast milk like other sulfonylureas. Because of the risk of low blood sugar in the infant, it is recommended that glimepiride be discontinued in nursing mothers. If therapy other than diet and exercise is needed, insulin is recommended.

SIDE EFFECTS:
Common side effects of glimepiride include dizziness, headache, and nausea or vomiting. A rash and allergic reactions also may occur. Low blood sugar (hypoglycemia) can occur during glimepiride therapy. Symptoms of low blood sugar include hunger, nausea, tiredness, perspiration, headache, heart palpitations, numbness around the mouth, tingling in the fingers, tremors, muscle weakness, blurred vision, chilliness, excessive yawning, irritability, confusion, or loss of consciousness.
Glimepiride is a derivative of a sulfonamide drug. People allergic to other sulfonamide-related drugs may develop an allergic reaction to glimepiride.

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