Amaryl

Action

Lowers blood glucose level by stimulating insulin release from pancreas, increasing insulin sensitivity at receptor sites, and decreasing hepatic glucose production. Also increases peripheral tissue sensitivity to insulin and causes mild diuresis.

Availability

Tablets: 1 mg, 2 mg, 4 mg

Indications and dosages

➣ Adjunct to diet and exercise to lower blood glucose level in type 2 (non-insulin-dependent) diabetes mellitus

Adults: Initially, 1 to 2 mg P.O. daily given with first main meal; usual maintenance dosage is 1 to 4 mg P.O. daily. When patient reaches 2 mg/day, increase no more than 2 mg q 1 to 2 weeks, depending on glycemic control. Maximum dosage is 8 mg/day.

Dosage adjustment

• Renal or hepatic impairment

• Adrenal or pituitary insufficiency

Contraindications

• Hypersensitivity to drug

• Diabetic coma or ketoacidosis

• Severe renal, hepatic, or endocrine disease

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• mild to moderate hepatic or renal disease; cardiovascular disease; impaired thyroid, pituitary, or adrenal function

• elderly patients.

Administration

• Check baseline creatinine level for normal renal function before giving first dose.

• Give with first meal of day.

Adverse reactions

CNS: dizziness, drowsiness, headache, weakness

CV: increased CV mortality risk

EENT: blurred vision

GI: nausea, vomiting, diarrhea, constipation, cramps, heartburn, epigastric distress, anorexia

Hematologic: aplastic anemia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis

Hepatic: cholestatic jaundice, hepatitis

Metabolic: hyponatremia, hypoglycemia

Skin: rash, erythema, maculopapular eruptions, urticaria, eczema, angioedema, photosensitivity

Other: increased appetite

Interactions

Drug-drug. Androgens (such as testosterone), chloramphenicol, clofibrate, guanethidine, MAO inhibitors, nonsteroidal anti-inflammatory drugs (except diclofenac), salicylates, sulfonamides, tricyclic antidepressants: increased risk of hypoglycemia

Beta-adrenergic blockers: altered response to glimepiride, necessitating dosage change; prolonged hypoglycemia (with nonselective agents)

Calcium channel blockers, corticosteroids, estrogens, hydantoins, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin, rifampin, sympathomimetics, thiazide diuretics, thyroid preparations: decreased hypoglycemic effect of glimepiride

Warfarin: initially increased, then decreased, effects of both drugs

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, cholesterol, liver function tests: increased values

Glucose, granulocytes, hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Agoral marshmallow, aloe (oral), bitter melon, burdock, chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek: additive hypoglycemic effects

Glucosamine: impaired glycemic control

Drug-behaviors. Alcohol use: disulfiram-like reaction

Sun exposure: increased risk of photosensitivity

Patient monitoring

• Monitor CBC with white cell differential, electrolyte levels, and blood chemistry results.

• Monitor blood glucose level regularly. Assess glycosylated hemoglobin level every 3 to 6 months.

• Evaluate kidney and liver function test results frequently, especially in patients with impairments.

• Assess neurologic status. Report cognitive or sensory impairment.

Patient teaching

• Instruct patient to self-monitor his blood glucose level as prescribed.

• Teach patient how to recognize signs and symptoms of hypoglycemia and hyperglycemia.

• Stress importance of diet and exercise to help control diabetes.

• Instruct patient to wear or carry medical identification describing his condition.

• Advise patient to keep sugar source readily available at all times in case of hypoglycemia.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Tell patient he will undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.