glimepiride, Amaryl

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GENERIC NAME: glimepiride


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.



PREPARATIONS: Tablets: 1, 2, and 4 mg

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.

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