Amaryl M (glimepiride, metformin) is a dual-action medication for type 2 diabetics. It is not effective for type 1 diabetes.

While both Amaryl M's active ingredients can be bought on their own, many patients need more than one medication to manage blood sugar effectively and buying the two combined in one tablet is more convenient, and sometimes lowers cost as well. The two active ingredients in this product are:

• Glimepiride promotes insulin production by the pancreas, thereby lowering blood sugar.
• Metformin lowers blood sugar by reducing its production in the liver, inhibiting glucose absorption, and increasing glucose uptake by muscle and fat.

Lifestyle changes will almost certainly also be advised to any patient prescribed Amaryl M. While these changes may be unpleasant at first, patients are strongly advised to try to comply with them to as great an extent as possible. In most cases, lifestyle changes are the only way to minimize or eventually eliminate dependency on medications to manage blood sugar levels.

Metformin's effectiveness is not as dependent on lifestyle changes as glimepiride, however. Patients unable to make significant changes, for whatever reason, will likely have better results from this medication than from glimepiride-only medications, such as regular Amaryl or Zoryl.

Starting Treatment

Patients starting Amaryl M treatment for the first time are typically started on lower doses, though there are rare exceptions. In most cases treatment looks like:

• Patients are started on lower doses of 1 or 2 mg glimepiride and 500 mg metformin.
• Treatment should continue for one or two weeks for maximum benefit to be seen.
• After one or two weeks dosage may be increased if needed, usually in small increments.
• Doses are typically taken once per day, usually in the morning.
• Each dose should be taken with a meal and a beverage.
• Blood sugar should be monitored closely at the start of treatment and following any dosage adjustments.

Patients already taking the two medications independently will likely be converted to a similar dose of Amaryl M; for instance, if taking 4 mg glimepiride and 1000 mg metformin each day, patients will be started on an equivalent dose of Amaryl M.

In all cases:

• Do not exceed 8 mg glimepiride per day.
• Do not exceed 2000 mg metformin per day.

For best results a doctor will be involved, who can help find the ideal dose strength. Doctor instructions occasionally vary a bit; while most patients take the medication just once per day, a doctor will sometimes advise a patient---usually taking higher doses---to divide the daily dose into two or more smaller doses taken throughout the day. Very rarely the maximum doses will be exceeded a little bit, but this should not be attempted without explicit doctor approval.

Who Should Not Take Amaryl M

Patients with certain preexisting conditions should definitely consult a doctor prior to starting treatment with Amaryl M, including those with a history of:

• Kidney or liver issues
• Severe respiratory issues
• Severe cardiac issues
• Hypoglycemia (low blood sugar)

As mentioned above, Amaryl M will not provide benefit in type 1 diabetes. It also should not be used in patients with diabetic ketoacidosis.

Glimepiride is associated with fetal defects in animal studies, though no human studies have been done. Both medications may cause harm if taken while pregnant, though diabetes also presents serious risks and it may be determined that benefits outweigh the risks. Speak with a trusted doctor about the issue if pregnant.

Low Blood Sugar

Both metformin and glimepiride can cause a patient to experience hypoglycemia, also known as low blood sugar. The risk is highest when treatment starts, when dosage is increased, or when sudden, radical changes are made to diet or exercise. All patients should be alert for symptoms, which include:

• Pale skin
• Hunger
• Shakiness
• Sweating
• Weakness
• Confusion
• Seizures
• Loss of consciousness

Careful monitoring of blood sugar can often help a patient avert seriously low blood sugar; consuming a fast-acting sugar, such as hard candies, fruit juice, glucose tablets, or something similar, should quickly resolve the issue. Sometimes, however, emergency medical attention is called for. In either case, patients experiencing hypoglycemia should consult a doctor; Amaryl M's dosage may need to be modified.

Other Side Effects

Most patients take Amaryl M without any serious side effects, though minor side effects are relatively common, particularly at the start of treatment. Patients may experience:

• Bloating
• Gas
• Diarrhea
• Constipation
• Heartburn
• Gastrointestinal discomfort
• Headache
• Mild dizziness

The above are not cause for concern unless severe or persistant. In most cases they'll stop occurring within a couple weeks of starting treatment or following dose adjustments.

Rare side effects which warrant speaking with a doctor include:

• Severe gastrointestinal pain
• Severe itching
• Chest pain
• Hypoglycemia

Other side effects can also develop, usually associated with long-term use and not detectable by the patient, such as low blood cell counts or altered kidney enzymes. A doctor should periodically screen for these, and medical staff should be made aware that Amaryl M is being taken prior to laboratory tests for unrelated purposes.

Always consult a doctor or pharmacist before taking other medications with Amaryl M; it is known to interact with many other types, including over-the-counter varieties.