Glimepiride

About Glimepiride

Glimepiride is a sulfonylurea: it lowers blood sugar mainly by making the pancreas release more insulin. The label approves it, alongside diet and exercise, to improve blood sugar control in adults with type 2 diabetes; it is not for type 1 diabetes or diabetic ketoacidosis, and it is not recommended for children because of its effects on body weight and the risk of low blood sugar. It is taken once a day with breakfast or the first main meal. Treatment starts at 1 or 2 mg; once the dose reaches 2 mg it can rise by 1 or 2 mg, no more often than every one to two weeks, up to 8 mg once a day. Older adults, people with reduced kidney function and others at higher risk of low blood sugar start at 1 mg, and after a switch from a longer-acting sulfonylurea the two drugs’ effects can overlap for one to two weeks.

There is no boxed warning. The label’s first warning is that all sulfonylureas, glimepiride included, can cause severe low blood sugar, which can impair driving: eating too little, severe or prolonged exercise, alcohol, reduced kidney function and other diabetes medicines raise the risk, and beta blockers and similar drugs can hide its warning signs. Serious allergic reactions, including anaphylaxis, angioedema and Stevens-Johnson syndrome, have been reported. Sulfonylureas can cause hemolytic anemia in people with G6PD deficiency, and it has also been reported without a known deficiency. The label also warns that oral diabetes drugs of this kind have been reported to be associated with more cardiovascular deaths than diet alone or diet plus insulin; the warning comes from a long-term study of tolbutamide, another sulfonylurea, and the label says it is prudent to consider that it may apply to glimepiride too. No clinical study has shown conclusive evidence that glimepiride lowers the risk of large blood vessel complications. Low blood sugar, dizziness, weakness, headache and nausea are the most common side effects.

Reports since approval include sun sensitivity, allergic inflammation of blood vessels, hepatitis that can progress to liver failure, low blood counts, low blood sodium and disulfiram-like reactions. Sulfonylureas, glimepiride included, cross the placenta, and newborns of mothers taking one at delivery have had severe low blood sugar lasting 4 to 10 days, so the label advises stopping it at least two weeks before the expected delivery; a breastfed baby is watched for signs of low blood sugar. Low blood sugar can be harder to recognize in older adults. The FDA lists Amaryl as discontinued in all strengths, not for safety or effectiveness reasons. Duetact (with pioglitazone) is a separate product, and Avandaryl (with rosiglitazone) is discontinued.

Taking Glimepiride

How to take it

Once a day with breakfast or the first main meal of the day, at about the same time each day. If you also take colesevelam, take glimepiride at least 4 hours before it.

If you miss a dose

Ask the prescriber in advance what to do. As a general rule, take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Other diabetes medicines, insulin, ACE inhibitors, fluconazole and fluoxetine can add to the risk of low blood sugar, and oral miconazole has been reported to cause severe lows; rifampin, steroids, thiazides, danazol, protease inhibitors and some antipsychotics such as olanzapine can weaken its effect. Beta blockers can hide the warning signs of low blood sugar, and alcohol can raise or lower blood sugar.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Glimepiride differs from pharmacy to pharmacy

With the brand discontinued, every glimepiride prescription is filled with a generic, so quotes for the same tablets differ in each pharmacy’s dispensing fee and markup and in which maker’s tablets it dispenses. The 3, 6 and 8 mg tablets come from far fewer makers than the 1, 2 and 4 mg tablets, so the strength written decides which tablets a pharmacy can supply.

Ways to pay less for Glimepiride without insurance

• Ask whether glimepiride is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is settled, ask the prescriber for a ninety-day supply.
• If your dose uses a 3, 6 or 8 mg tablet, ask the prescriber whether whole 1, 2 or 4 mg tablets could give the same dose.
• If the quotes are a barrier, ask the prescriber whether another generic diabetes medicine, such as glipizide or metformin, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Glimepiride

1. 1.What should I do about my dose if I skip a meal or I am sick?
2. 2.How do I recognize and treat low blood sugar, and should my family know the signs?
3. 3.Do any of my medicines, such as fluconazole, a beta blocker or colesevelam, interact with it?
4. 4.Is it safe with my sulfa allergy or G6PD deficiency?

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