glimepiride (Rx)

Brand and Other Names:Amaryl
  • Print

Dosing & Uses


Dosage Forms & Strengths


  • 1mg
  • 2mg
  • 4mg

Type 2 Diabetes Mellitus

Initial: 1-2 mg PO qAM after breakfast or with first meal; may increase dose by 1-2 mg every 1-2 weeks; not to exceed 8 mg/day

Conversion from other oral hypoglycemic agents

  • Observe patients carefully for 1-2 weeks when being converted from long half-life sulfonylureas to glimepiride, because of potential for overlapping of hypoglycemic effects

Dosing considerations

  • Use in monotherapy or, if glycemic response to glimepiride is inadequate at maximum dose, with insulin or metformin

Dosing Modifications

Renal impairment: 1 mg PO qDay; titrate dose based on fasting blood glucose levels

Hepatic impairment: Not studied; not recommended in severe impairment; initiate therapy with 1 mg PO qDay and titrate carefully

Safety and efficacy not established

Prolonged hypoglycemia reported with use; titrate dose conservatively; monitor for hypoglycemic or hyperglycemic symptoms

Type 2 Diabetes Mellitus

1 mg PO qDay; titrate dose at weekly intervals to avoid hypoglycemia



Interaction Checker

and glimepiride

No Results

     activity indicator 
    No Interactions Found
    Interactions Found


      Serious - Use Alternative

        Significant - Monitor Closely


            All Interactions Sort By:
             activity indicator 

            Adverse Effects


            Hypoglycemia (4-20%)


            Dizziness (1.7%)

            Asthenia (1.6%)

            Headache (1.5%)

            Nausea (1.1%)


            Allergic skin reactions


            Morbilliform or maculopapular eruptions




            Gastrointestinal pain




            Aplastic anemia



            Thrombocytopenia, hemolytic


            Elevation of liver enzyme levels

            Hepatic porphyria reactions

            Jaundice (rare)

            Disulfiram-like reactions


            Postmarketing Reports

            Serious hypersensitivity reactions, including anaphylaxis, angioedema, and Stevens- Johnson Syndrome

            Hemolytic anemia in patients with and without G6PD deficiency

            Hepatic impairment (eg, cholestasis, jaundice), as well as hepatitis, which may progress to liver failure

            Porphyria cutanea tarda, photosensitivity reactions and allergic vasculitis

            Leukopenia, agranulocytosis, aplastic anemia, and pancytopenia

            Thrombocytopenia (including severe cases with platelet count <10,000/mcL) and thrombocytopenic purpura

            Hepatic porphyria reactions and disulfiram-like reactions

            Hyponatremia and SIADH, most often in patients on other medications or have medical conditions known to cause hyponatremia or increase release of antidiuretic hormone






            Hypersensitivity; sulfa allergy

            Type 1 diabetes

            Diabetic ketoacidosis (with or without coma)

            Complicated gestational diabetes mellitus


            Patients with risk of severe hypoglycemia: Elderly, debilitated, or malnourished; adrenal or pituitary insufficiency; patients with stress due to infection, fever, trauma, or surgery

            If patient is exposed to stress, it may be necessary to discontinue glimepiride and initiate insulin

            Use caution in hepatic/renal impairment

            Pregnancy, lactation

            Increased risk of cardiovascular mortality

            Persons allergic to other sulfonamide derivatives may develop allergic reaction to glimepiride

            Hypoglycemia may be difficult to recognize in patients with autonomic neuropathy

            Hemolytic anemia may occur with glucose 6-phosphate dehydrogenase (G6PD) deficiency when treated with sulfonylurea agents

            Fluid retention, which may exacerbate or lead to heart failure, may occur

            Combination use with insulin and use in congestive heart failure NYHA Class I and II may increase risk of other cardiovascular effects

            Potential risk of ischemic cardiovascular (CV) events relative to placebo reported in meta-analysis studies, but not confirmed in long-term CV outcome trial versus metformin or sulfonylurea

            Dose-related edema, weight gain, and anemia may occur

            Macular edema reported

            Increased incidence of bone fracture reported

            Postmarketing reports for glimepiride include anaphylaxis, angioedema, and Stevens-Johnson syndrome; promptly discontinue glimepiride, assess for other causes, institute appropriate monitoring and treatment, and initiate alternative treatment for diabetes


            Pregnancy & Lactation


            Available data from a small number of published studies and postmarketing experience in pregnancy over decades have not identified any drug associated risks for major birth defects, miscarriage, or adverse maternal outcomes. However, sulfonylureas (including glimepiride) cross the placenta and have been associated with neonatal adverse reactions such as hypoglycemia; therefore, therapy should be discontinued at least two weeks before expected delivery; poorly controlled diabetes in pregnancy is also associated with risks to mother and fetus

            Animal data

            • In animal studies (see Data), there were no effects on embryo-fetal development following administration of glimepiride to pregnant rats and rabbits at oral doses approximately 4000 times and 60 times maximum human dose based on body surface area, respectively; however, fetotoxicity was observed in rats and rabbits at doses 50 times and 0.1 times the maximum human dose, respectively
            • Poorly controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, and delivery complications; poorly controlled diabetes increases fetal risk for major birth defects, still birth, and macrosomia- related morbidity

            Fetal neonatal adverse reactions

            • Neonates of women with gestational diabetes who are treated with sulfonylureas during pregnancy may be at increased risk for neonatal intensive care admission and may develop respiratory distress, hypoglycemia, birth injury, and be large for gestational age; prolonged severe hypoglycemia, lasting 4–10 days, reported in neonates born to mothers receiving a sulfonylurea at time of delivery and has been reported with use of agents with prolonged half-life; observe newborns for symptoms of hypoglycemia and respiratory distress and manage accordingly

            Dose adjustments during pregnancy and postpartum period

            • Due to reports of prolonged severe hypoglycemia in neonates born to mothers receiving sulfonylurea at time of delivery, therapy should be discontinued at least two weeks before expected delivery


            Breastfed infants of lactating women in therapy should be monitored for symptoms of hypoglycemia; not known whether drug is excreted in human milk and there are no data on effects of drug on milk production; drug is present in rat milk; developmental and health benefits of breastfeeding should be considered along with mother's clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition

            Monitor breastfed infants for signs of hypoglycemia (e.g., jitters, cyanosis, apnea, hypothermia, excessive sleepiness, poor feeding, seizures)

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.



            Mechanism of Action

            Initial effect to increase insulin secretion from beta cells; may also decrease rate of hepatic glucose production and increase insulin receptor sensitivity


            Bioavailability: 100%

            Initial effect: 1 hr

            Peak plasma time: 2-3 hr

            Max effect: 2-4 hr

            Duration: 24 hr


            Vd: 8.8 L

            Protein bound: 99.5%


            Metabolized extensively by hepatic P450 enzyme CYP2C9 to less-active metabolites

            Metabolites: Cyclohexyl hydroxy methyl derivative (M1; mildly active) and the carboxyl derivative (M2; inactive)


            Half-life: 5-9 hr

            Total body clearance: 47.8 mL/min

            Excretion: Urine (60%); feces (40%)





            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient



            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient



            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.