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).