Amaryl (glimepiride) is a medication used to help manage type 2 diabetes. With appropriate dosage modifications it can be used in children as well as adults, though it is generally not recommended for use in pregnant or nursing mothers.

The medication works by promoting insulin secretion by the pancreas, which effectively lowers blood sugar and slows progression of the disease. Amaryl can be used on its own or along with other type 2 diabetes medications; both situations are normal.

Amaryl is a sulfonylurea medication, which may trigger hypersensitivity in those allergic to sulfa medications. Such patients should use with caution until effects are known, or explore alternative treatments.

As the pancreas in type 1 diabetics does not produce insulin, the medication will provide no benefit in type 1 diabetics.

There is some controversy regarding medications that encourage the pancreas to produce more insulin and pancreatic damage, including pancreatic cancer, particularly with long-term use. This issue is quite debatable and connections are unclear, with some studies indicating increased risk while others show no increased risk at all. Patients concerned about this issue can find more information about it online.

Taking Amaryl

Amaryl comes in tablets, available in strengths of 1 mg, 2 mg, 3 mg, 4 mg, and 8 mg. Tablets should be taken with a meal and a beverage. Most patients take Amaryl just once per day, usually with breakfast, though a doctor may advise dividing larger daily doses into two or more smaller doses taken throughout the day.

A general treatment plan looks like:

• Adults typically start with 1 or 2 mg taken once per day.
• After one or two weeks, dosage may be increased if needed.
• Do not exceed 8 mg per day.

It takes one to two weeks for maximum benefit to be seen, hence the wait between dose adjustments. Blood sugar must be checked frequently when treatment begins or dosage modifications are made.

Patients taking Amaryl are at a real risk for hypoglycemia (low blood sugar), particularly when treatment starts, when dosage is increased, or when radical changes are made to diet or exercise. The excess insulin produced by the pancreas can cause blood sugar to become too low, which, if untreated, can be as dangerous as blood sugar that is too high. Patients should be alert for symptoms, the more common of which include:

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

Depending on severity, if symptoms of hypoglycemia are experienced a doctor should be consulted or emergency medical attention sought.

Lifestyle Changes

Patients given a prescription for Amaryl will almost certainly also be given guidelines for dietary and exercise changes, individualized for a given patient's lifestyle. It is important to try to follow these guidelines as much as possible; they'll not only help Amaryl work better, but in the majority of cases are the only way to control the disease without dependency on medications. It takes some time---and it can be quite difficult at the start---but it is ultimately worth it.

Basic lifestyle changes that are universal across all patients include:

• Reach and maintain a healthy weight
• Get regular exercise
• Control blood sugar
• Control blood cholesterol
• Quit smoking

Though rare, some patients make all the appropriate lifestyle changes but experience little improvement in type 2 diabetes. These patients---as well as those unwilling to make such changes---will need to take Amaryl or similar medications indefinitely, likely for the remainder of life.

Potential Complications

With the exception of the risk of hypoglycemia, the most commonly experienced side effect associated with Amaryl is hypersensitivity. While this includes true allergic reactions, it also includes lesser reactions in patients that aren't technically allergic. They can be very severe, calling for emergency medical attention, or they can be very mild and intermittent. Symptoms can include:

• Hives
• Rashes
• Itching
• Swelling of face, tongue, or throat
• Rapid or erratic heart beat
• Confusion
• Difficulty breathing

Severity is very important here, and symptoms can progress very rapidly once begun. A mild rash or itching is not terribly concerning; difficulty breathing can be life-threatening. A severe or persistant rash or itching is likewise worrisome. All patients who experience hypersensitivity to Amaryl are advised to speak to the prescribing doctor, even if emergency medical attention has previously been sought; dosage adjustments or a change in treatment type may be required.

Most patients do not experience serious side effects, however; more common are mild symptoms that should stop occurring in the first few weeks of treatment, such as:

• Headache
• Gastrointestinal discomfort
• Mild dizziness
• Diarrhea

To be clear, side effects which warrant speaking with a doctor include:

• Severe gastrointestinal pain
• Hypoglycemia
• Hypersensitivity or allergic reaction

Amaryl is associated with a range of side effects not detectable by the average patient, including:

• Low red or white blood cell counts
• Low blood platelets
• Altered kidney or liver enzymes
• Low sodium
• Lowered immunity
• Impaired bile flow

Doctors may periodically screen for the above, and medical staff should be made aware that Amaryl is being taken if laboratory tests are preformed for unrelated reasons.

Amaryl can interact with a wide range of other drugs, including other medications used to treat type 2 diabetes, non-prescription drugs, and recreational drugs like alcohol. Sometimes the interactions are considered worth the risk---such as with antidiabetic treatments---but other times not, and one of the medications should stop. Always be sure the prescribing doctor is aware of all other medications being taken throughout treatment, and do not use any to excess (such as alcohol).

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.