Sulphonylurea Pregnancy: Should not be used during the whole of pregnancy — if the patient plans to become pregnant or a pregnancy is discovered, switch to insulin therapy as soon as possible. Breast-feeding is advised against during treatment because of the risk of hypoglycaemia in nursing infants.

Glimepiride

Brand names: Amaryl

Glimepiride is a once-daily sulfonylurea used in type 2 diabetes to stimulate insulin secretion.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Starting dose 1 mg daily; if control is unsatisfactory increase in a stepwise manner, with an interval of about 1 to 2 weeks between each step, to 2, 3 or 4 mg daily

Route: Oral — tablets swallowed whole with some liquid

Frequency: Normally a single daily dose, taken shortly before or during a substantial breakfast or, if none is taken, shortly before or during the first main meal

Max: 6 mg glimepiride per day (a dose of more than 4 mg per day gives better results only in exceptional cases)

UK SPC (Glimepiride 1 mg tablets) §4.2. Dose is determined by the results of blood and urinary glucose determinations. COMBINATION: in patients not adequately controlled on the maximum daily dose of metformin, glimepiride may be added at low dose and titrated up to the maximum daily dose under close medical supervision; in patients not adequately controlled on the maximum daily dose of glimepiride, insulin may be started at low dose and titrated up under close medical supervision. SWITCHING from other oral hypoglycaemic agents: recommended starting dose 1 mg daily, taking account of the strength and half-life of the previous product — with long half-life agents (e.g. chlorpropamide) a wash-out period of a few days is advisable. If a dose is forgotten this should not be corrected by increasing the next dose. If a patient has a hypoglycaemic reaction on 1 mg daily, this indicates they can be controlled by diet alone. Requirements may fall as control improves — consider timely dose reduction or cessation. In stress situations (accidents, acute operations, febrile infections) a temporary switch to insulin may be indicated. PAEDIATRIC: there are no data below 8 years of age; for children aged 8 to 17 years there are limited data on monotherapy — available safety and efficacy data are insufficient and such use is not recommended. NOTE ON US LABELLING (cross-check only): the US label gives a starting dose of 1 mg or 2 mg once daily and a maximum of 8 mg once daily — the UK SPC maximum of 6 mg/day is the figure carried above. eMC §4.5 was not captured in the fetched bundle; the interactions listed below are from the US label and should be checked against the UK SPC §4.5.

Dose adjustments

Renal

Severe renal function disorder is a contraindication — a changeover to insulin is required. No experience has been gained in dialysis patients. Impaired renal function is a factor favouring hypoglycaemia.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Recommended starting dose is 1 or 2 mg once daily. Increase in 1 or 2 mg increments no more frequently than every 1 to 2 weeks based on glycemic response. Maximum recommended dose is 8 mg once daily ( 2.1 ). Administer with breakfast or first meal of the day ( 2.1 ). Use 1 mg starting dose and titrate slowly in patients at increased risk for hypoglycemia (e.g., elderly, patients with renal impairment) ( 2.1 ). 2.1 Recommended Dosing Glimepiride tablets should be administered with breakfast or the first main meal of the day. The recommended starting dose of glimepiride tablets are 1 mg or 2 mg once daily. Patients at increased risk for hypoglycemia (e.g., the elderly or patients with renal …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-11-13. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to glimepiride, other sulfonylureas or sulfonamides, or to any of the excipients
Diabetes mellitus type 1
Diabetic coma
Ketoacidosis
Severe renal or hepatic function disorders (changeover to insulin is required)

Side effects

Hypoglycaemia (rare) — may be severe, not always easy to correct, and may recur despite initially successful countermeasures
Visual disturbances, transient, especially on initiation of treatment, due to changes in blood glucose levels (frequency not known)
Nausea, vomiting, diarrhoea, abdominal distension, discomfort and pain (very rare); dysgeusia (rare)
Blood disorders — thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, erythropenia, haemolytic anaemia and pancytopenia (rare), generally reversible on discontinuation
Hepatic enzymes increased (not known); abnormal hepatic function with cholestasis and jaundice, hepatitis and hepatic failure (very rare)
Hypersensitivity skin reactions — pruritus, rash, urticaria and photosensitivity (not known); weight gain (rare)

Interactions

Drugs affecting glucose metabolism may require dose adjustment and close glucose monitoring (US label §7.1)
Miconazole — severe hypoglycaemia can occur when glimepiride and oral miconazole are used concomitantly (US label §7.2)
CYP2C9 inhibitors and inducers may affect glycaemic control by altering glimepiride plasma concentrations (US label §7.3)
Colesevelam reduces glimepiride absorption — administer glimepiride at least 4 hours before colesevelam (US label §7.4)
Agents increasing the glucose-lowering effect include other oral antidiabetics, insulin, pramlintide, ACE inhibitors, H2 receptor antagonists, fibrates, pentoxifylline, somatostatin analogues, fluconazole, sulfinpyrazone, tetracyclines, clarithromycin, disopyramide and quinolones (US label §7.1)

Clinical monograph

How it works

It closes ATP-sensitive potassium channels on pancreatic beta cells, triggering insulin release — so it requires residual beta-cell function.

Prescribing in practice

Hypoglycaemia is the main risk and can be prolonged — greater in older people, renal impairment, missed meals and with alcohol.
It tends to cause weight gain.
Use caution and lower doses in renal or hepatic impairment.

Monitoring

Monitor glucose/HbA1c, hypoglycaemia awareness and weight.

Counselling the patient

Learn to recognise and treat hypos — carry a fast-acting sugar.
Don't skip meals; be careful with alcohol.
Hypoglycaemia can affect driving — follow DVLA advice.

Evidence & guidelines

An option when metformin is insufficient or unsuitable (NICE NG28), balancing efficacy against hypoglycaemia and weight gain.

Reference: NICE NG28 (Type 2 DM); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways