Indications for: AMARYL
Adjunct to diet and exercise in type 2 diabetes mellitus. Limitations of use: not for the treatment of type 1 diabetes or ketoacidosis.
Initially 1–2mg once daily with breakfast or first main meal; after reaching a dose of 2mg, may further increase by 1–2mg at 1–2 week intervals if needed; max 8mg/day. Increased risk of hypoglycemia (eg, elderly or renal impairment): initially 1mg once daily, titrate carefully.
Renal or hepatic impairment. Adrenal or pituitary insufficiency. Risk of hemolytic anemia in G6PD deficiency; consider non-sulfonylurea alternative. Increased risk of cardiovascular mortality. Discontinue if hypersensitivity reaction is suspected. Elderly. Debilitated. Malnourished. Neonates: monitor. Pregnancy: adjust dose during and the postpartum period. Labor & delivery: discontinue at least 2 weeks before expected date. Nursing mothers.
Sulfonylurea (2nd generation).
May be potentiated by pramlintide acetate, insulin, ACE inhibitors, H2 receptor antagonists, fibrates, propoxyphene, pentoxifylline, somatostatin analogs, anabolic steroids and androgens, cyclophosphamide, phenyramidol, guanethidine, fluconazole, sulfinpyrazone, tetracyclines, clarithromycin, disopyramide, quinolones, NSAIDs, highly protein bound drugs (eg, fluoxetine), oral miconazole (possibly), salicylates, sulfonamides, warfarin, chloramphenicol, probenecid, MAOIs. May be antagonized by danazol, glucagon, somatotropin, protease inhibitors, atypical antipsychotics, barbiturates, diazoxide, laxatives, rifampin, thiazides, diuretics, corticosteroids, phenothiazines, thyroid products, phenytoin, niacin, sympathomimetics, isoniazid, estrogens, oral contraceptives. Monitor closely for hypoglycemia when concomitant drugs that affect glucose metabolism and upon withdrawal. Caution with CYP2C9 inhibitors (eg, fluconazole) or inducers (eg, rifampin). May be potentiated or antagonized by β-blockers, clonidine, reserpine, alcohol. May be antagonized by colesevelam; administer glimepiride ≥4hrs prior to colesevelam. Disulfiram reactions have been reported with other sulfonylureas. Monitor for 1–2 weeks if transferring from long-acting sulfonylureas.
Hypoglycemia, headache, nausea, dizziness, weight gain; allergic skin reactions, hemolytic anemia.