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Glimepiride

1. About glimepiride

Glimepiride is a medicine used to treat type 2 diabetes.

Type 2 diabetes is a condition where the body doesn't make enough insulin, or the insulin that it makes doesn't work properly. This can cause high blood sugar levels (hyperglycaemia).

Glimepiride lowers your blood sugar by increasing the amount of insulin your body produces.

Glimepiride is only available on prescription. It comes as tablets.

2. Key facts

  • It's usual to take glimepiride once a day in the morning.
  • The most common side effects are feeling sick, indigestion and diarrhoea.
  • Glimepiride can sometimes give you low blood sugar (hypoglycaemia). Carry some sweets or fruit juice with you to help when this happens.
  • Some people find they put on weight with glimepiride.
  • Glimepiride is also known by the brand name Amaryl.

3. Who can and can't take glimepiride

Glimepiride can be taken by adults (aged 18 years and older).

A diabetes specialist may sometimes prescribe glimepiride for children and young people less than 18 years of age.

Glimepiride isn't suitable for some people. To make sure it's safe for you, tell your doctor if you:

  • have had an allergic reaction to glimepiride or any other medicines in the past
  • have severe kidney or liver disease
  • have G6PD-deficiency (an inherited condition affecting red blood cells)
  • are due to have surgery
  • are pregnant, trying to get pregnant or breastfeeding

This medicine isn't used to treat type 1 diabetes (when your body does not produce insulin).

4. How and when to take it

Doses of glimepiride can vary. Follow your doctor's instructions when taking this medicine.

You'll usually take glimepiride once a day. Take this medicine with food.

Most people take it in the morning with their breakfast. If you don't eat breakfast, make sure you take it with your first meal of the day. Try to take it at the same time every day.

Swallow the tablets whole, with a glass or water. Do not chew them.

If you find it difficult to swallow tablets, use the score line in the middle of the tablet to break it in 2, then take both halves.

How much will I take?

Glimepiride comes as 1mg, 2mg, 3mg and 4mg tablets.

Your doctor will tell you how many tablets to take. You may need to take 1 or 2 tablets to make up your daily dose.

The usual starting dose for adults is 1mg, taken once a day. Your doctor may increase your dose gradually over a few weeks or months, up to a regular dose of 4mg once a day.

The maximum daily dose is 6mg.

Will my dose go up or down?

Your doctor will check your blood sugar levels regularly. They may change your dose of glimepiride to keep your blood sugar under control.

What if I take too much?

The amount of glimepiride that can lead to an overdose varies from person to person.

Urgent advice: Contact your doctor straight away if you take too much glimepiride

Taking too many glimepiride tablets can give you low blood sugar.

Early warning signs of low blood sugar include:

  • feeling hungry
  • trembling or shaking
  • sweating
  • feeling confused
  • having problems concentrating

If you think you have low blood sugar, have some food or drink that quickly gets sugar into your bloodstream such as sugar cubes or fruit juice.

This type of sugar won't last long in your blood. You may also need to eat a starchy carbohydrate, like a sandwich or a couple of biscuits.

What if I forget to take it?

If you forget to take your daily glimepiride, skip the missed dose and take your next dose at the usual time.

Do not take a double dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could ask your pharmacist for advice on other ways to remember your medicines.

5. Side effects

Like all medicines, glimepiride can cause side effects although not everyone gets them.

Common side effects

These common side effects happen in more than 1 in 100 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away:

  • feeling sick (nausea) or indigestion
  • diarrhoea

Your eyesight may also be affected for a short time. This often happens when you start your treatment because of changes in your blood sugar levels.

Serious side effects

It happens rarely, but some people may have serious side effects after taking glimepiride.

Call your doctor straight away if:

  • your skin or the whites of your eyes turn yellow - these can be signs of a liver problem
  • you have a sore throat and high temperature, your skin is unusually pale, you are bleeding for longer than usual or get unexpected bruises - these can be signs of a blood disorder

Low blood sugar

Glimepiride can sometimes cause low blood sugar (known as "hypos" or hypoglycaemia).

Early warning signs of low blood sugar include:

  • feeling hungry
  • trembling or shaking
  • sweating
  • confusion
  • difficulty concentrating

It's also possible for your blood sugar to go too low while you're asleep. If this happens, it can make you feel sweaty, tired and confused when you wake up.

Low blood sugar may happen if you:

  • take too much of some types of diabetes medicines
  • eat meals irregularly or skip meals
  • are fasting
  • don't eat a healthy diet and aren't getting enough nutrients
  • change what you eat
  • increase your physical activity without eating more to compensate
  • drink alcohol, especially after skipping a meal
  • take some other medicines or herbal medicines at the same time
  • have a hormone disorder such as hypothyroidism
  • have kidney or liver problems

To prevent hypos, it's important to have regular meals, including breakfast. Never miss or delay a meal.

If you're planning to exercise more than usual, make sure you eat carbohydrates (bread, pasta, cereals) before, during or afterwards.

Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners won't help. You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

If taking in sugar does not help or if the hypo symptoms come back, contact your doctor or the nearest hospital.

Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.

Serious allergic reaction

It is possible to have a serious allergic reaction (anaphylaxis) to glimepiride.

Urgent advice: Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

These are not all the side effects of glimepiride. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • feeling sick (nausea) or indigestion - make sure you take your tablets with a meal. Stick to simple meals and avoid rich or spicy food.
  • diarrhoea - drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

7. Pregnancy and breastfeeding

Glimepiride is not generally recommended in pregnancy or while breastfeeding. It's not clear whether glimepiride can harm your unborn baby.

For safety, your doctor will probably change your medicine to insulin if you're trying for a baby or as soon as you find out you're pregnant.

Glimepiride and breastfeeding

Glimepiride isn't usually recommended while breastfeeding as there's a risk your baby may get low blood sugar.

Talk to your doctor if you want to breastfeed. They will be able to recommend the best treatment for you and your baby.

Non-urgent advice: Tell your doctor if you're:

  • pregnant
  • trying to get pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines interfere with the way glimepiride works. Your doctor may need to adjust your dose of glimepiride. They may also recommend checking your blood sugar levels more often.

Tell your doctor if you're taking any of these medicines before starting on glimepiride:

  • steroid tablets such as prednisolone
  • some medicines used to treat heart problems, high blood pressure and high cholesterol
  • medicines to treat bacterial or fungal infections such as clarithromycin, co-trimoxazole, miconazole or fluconazole
  • rifampicin, a medicine used to treat tuberculosis
  • other diabetes medicines

Some women may need to adjust their dose of glimepiride after starting contraceptive pills. In rare cases contraceptive pills can increase blood sugar levels.

Taking glimepiride with painkillers

It's safe to take paracetamol with glimepiride.

However, check with your doctor or pharmacist before taking non-steroidal anti-inflammatories (NSAIDs) with glimepiride. NSAIDs such as ibuprofen or high-dose aspirin can sometimes lower your blood sugar level.

Mixing glimepiride with herbal remedies and supplements

There's very little information about taking herbal remedies or supplements with glimepiride.

Important

For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does glimepiride work?

Glimepiride is a type of medicine known as a sulfonylurea.

Sulfonylureas increase the amount of insulin that your pancreas makes. Insulin is the hormone that controls the level of sugar in your blood.

How long does it take to work?

Glimepiride reduces blood sugar levels in 2 to 3 hours.

You may not feel any different as you may not have any symptoms with type 2 diabetes. This doesn't mean that glimepiride isn't working - and it's important to keep taking it.

Glimepiride helps keep your blood sugar level stable and will reduce your chance of getting health problems due to diabetes in the future.

How long will I take glimepiride for - and can I come off it?

Treatment for diabetes is usually for life. Do not stop taking glimepiride without talking to your doctor.

If you stop taking glimepiride suddenly your diabetes may get worse.

If you want to stop taking your medicine, speak to your doctor. They may be able to suggest an alternative treatment for your diabetes.

Is it safe to take long-term?

Glimepiride is safe to take for a long time. There's no evidence that it harms your general health or your pancreas.

However, glimepiride may stop working properly after a while. Your doctor may want to try you on a different medicine, or start prescribing another diabetes medicine along with glimepiride.

Are there different types of diabetes medicines?

Glimepiride belongs to a group of medicines called sulphonylureas. These include gliclazide, glibenclamide, glipizide and tolbutamide.

There are several other types of medicines that can lower blood sugar levels:

Glimepiride can be prescribed on its own or together with other diabetes medicines.

It's usually prescribed if you can't take metformin, or if metformin on its own isn't keeping your blood sugar under control.

Can I get diabetes medicines for free?

If you have diabetes, you're entitled to free prescriptions for all of your medicines (not just your diabetes ones).

To claim your free prescriptions, you'll need to have a medical exemption certificate (FP92A). You can get an application form at your GP surgery. Once you've filled in the form, ask your doctor to sign it.

Can I take glimepiride before surgery?

If you're going to have an operation, tell your doctor beforehand that you're taking glimepiride.

They may switch you to insulin for a few days before and after your surgery.

This is because glimepiride increases your risk of low blood sugar during the operation. Low blood sugar can be difficult to detect when you're put to sleep with general anaesthetic.

Will it affect my contraception?

Glimepiride doesn't affect any type of contraception, including the combined pill and emergency contraception.

However, talk to your doctor before starting to take contraceptive pills if you're already taking glimepiride. They may change your dose of glimepiride. This is because contraceptive pills change how your body handles sugar.

Will it affect my fertility?

There's no firm evidence to suggest that taking glimepiride will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking glimepiride. However, it's best to drink no more than 2 units a day. Drinking more than this can increase your risk of low blood sugar.

Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Is there any food or drink I need to avoid?

It's a good idea to cut down on foods with added sugar. Check the nutrition labels as many foods and drinks are high in sugar, such as:

  • sweets
  • cakes
  • biscuits
  • chocolate
  • some fizzy drinks
  • juice drinks

Be careful eating food and drink containing karela because it can lower your blood sugar levels and mean your diabetes isn't controlled as well as it should be.

Karela (also called bitter gourd) is used to flavour foods such as curries. It has a bitter taste and is also made into juice and tea.

Will I put on weight or lose weight?

Glimepiride can make you feel more hungry and some people find they put on weight.

Try to eat a healthy balanced diet without increasing your portion sizes. Regular exercise will also help you to keep your weight stable.

If you are already overweight, talk to your doctor about the best way to avoid putting on any more weight.

Glimepiride will not help you lose weight.

Can I drive or ride a bike?

If your blood sugar levels are stable, your ability to drive, cycle or use machines or tools shouldn't be affected by glimepiride.

However, if your blood sugar levels become too low, this can reduce your concentration. If this happens to you, do not drive, cycle, or use machines or tools until you feel better.

If your eyesight if affected by changes in your blood sugar, do not drive or use machinery until you can see clearly again. See your doctor or optician if your vision doesn't get better.

Can lifestyle changes help?

There are some lifestyle changes you can make to help control the symptoms of diabetes. These include: