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Amaryl M: instructions for use of tablets. Amaryl new generation drug Amaryl for type 2 diabetes

One tablet of the drug contains the active substance - glimepiride – 1-4 mg and auxiliary components: lactose monohydrate, povidone, sodium carboxymethyl starch, microcrystalline cellulose, indigo carmine and magnesium stearate.

Release form

Amaryl is available in tablets containing 1-4 mg, which are packaged in 15 pieces per blister. One pack of the drug may include 2, 4, 6 or 8 blisters.

Pharmacological action

Amaryl tablets have a hypoglycemic effect.

Pharmacodynamics and pharmacokinetics

Contraindications for use

There is a fairly large list of contraindications for taking Amaryl:

  • 1 type;
  • severe disorders of the liver and kidneys;
  • , precoma and coma;
  • , ;
  • the presence of rare hereditary diseases, for example, galactose intolerance, glucose-galactose malabsorption or lactase deficiency;
  • childhood;
  • intolerance or sensitivity to the drug, and so on.

Caution is required during the initial treatment of patients, as at this time there is a risk of developing hypoglycemia. If hypoglycemia remains a possibility, dosage adjustments often have to be made. glimepiride or therapeutic regimen. In addition, the presence of intercurrent and other diseases, lifestyle, nutrition, and so on requires special attention.

Side effects

When treated with Amaryl, a wide variety of undesirable phenomena can develop, one way or another affecting the activity of almost all body systems. Quite often, side effects are manifested by hypoglycemia, the symptoms of which are expressed by: , feeling of hunger, nausea , vomiting , , , , and many other symptoms. Sometimes the severe clinical picture of hypoglycemia resembles a stroke. After its elimination, the unwanted symptoms completely disappear.

At the initial stage of treatment, problems with vision, the functioning of the digestive system, and hematopoiesis may occur. It is also possible to develop which can lead to complications. Therefore, if unwanted symptoms appear, you should immediately consult a doctor.

Instructions for Amaryl (Method and dosage)

The tablets are intended for internal use in their entirety, without chewing and with plenty of liquid.

Typically, the dose of the drug is determined by the concentration of glucose in the blood. For treatment, the lowest dose is prescribed that helps achieve the necessary metabolic control

Also, the instructions for use of Amaryl indicate that treatment requires regular determination of the concentration of glucose in the blood and the level of glycosylated hemoglobin.

It is not recommended to make up for any incorrect taking of tablets, as well as missing the next dose, with an additional dosage. Such situations should be discussed in advance with your doctor.

At the beginning of treatment, patients are prescribed a daily dose of 1 mg. If the need arises, the dosage is gradually increased, regularly monitoring the concentration of glucose in the blood according to the following scheme: 1 mg−2 mg−3 mg−4 mg−6 mg−8 mg. The usual daily dosage in well-controlled patients is 1–4 mg of the active substance. A daily dose of 6 mg or more produces an effect in only a small number of patients.

The daily dosage regimen of the drug is established by the doctor, since various factors must be taken into account, for example, meal times, the amount of physical activity, etc.

A single daily dose of the drug is often prescribed, before a full breakfast or the first main meal. It is important that you do not skip meals after taking the pills.

It is known that improved metabolic control is related to increased insulin sensitivity, and during treatment the need for glimepiride may decrease. The development of hypoglycemia can be avoided by timely reducing the dosage or stopping taking Amaryl.

During the therapeutic process, dosage adjustment glimepiride can be performed when:

  • reducing the patient's weight;
  • lifestyle changes;
  • the occurrence of other factors leading to a predisposition to hypoglycemia or hyperglycemia.

As a rule, treatment with Amaryl is carried out for a long time.

Overdose

In cases of acute overdose or prolonged use of high doses glimepiride severe hypoglycemia may develop, which is life-threatening.

If an overdose is detected, you should immediately consult a doctor. Hypoglycemia can be stopped by taking carbohydrates, for example, glucose or a small piece of any sweets. Until the symptoms of hypoglycemia are completely eliminated, the patient requires careful medical monitoring, as undesirable manifestations may recur. Further therapy depends on the symptoms.

Interaction

Concomitant use of glimepiride with certain drugs may cause hypoglycemia, for example, with Insulin and other hypoglycemic agents, ACE inhibitors, anabolic steroids And male sex hormones, derivatives Coumarin, Cyclophosphamide, Disopyramide, Fenfluramine, Pheniramidol, fibrates, Fluoxetine, Guanethidine, Ifosfamide, MAO inhibitors, para-aminosalicylic acid, Phenylbutazone, Azapropazone, Oxyphenbutazone, salicylates, Sulfinpyrazone, sulfonamides, tetracyclines and others.

Reception , barbiturates, GKS, diazoxides, diuretics, and other sympathomimetic drugs, laxatives (with long-term use), (in high dosages), estrogen And progestogens, phenothiazines, phenytoins, rifampicins,iodine-containing thyroid hormones causes a weakening of the hypoglycemic effect, and accordingly, increases the concentration of glucose in the blood.

H2-histamine receptor blockers can enhance or weaken the hypoglycemic effect of glimepiride. , and beta blockers.

Terms of sale

The drug is available in pharmacies with a prescription.

Storage conditions

To store Amaryl, you need a dark place, protected from children, with a temperature of up to 30 C.

Best before date

Amaryl's analogs

Level 4 ATX code matches:

Modern pharmacology offers many means of similar action. However, the most common analogues of Amaryl are , Glemaz, Glemauno, Diamerid And Meglimid .

Alcohol and Amaryl

During treatment with this drug, especially at first, you must stop drinking alcohol. The fact is that both single and chronic alcohol consumption can significantly enhance or weaken the hypoglycemic effect glimepiride .

Reviews about Amaril

Numerous reviews from patients and specialists indicate that in the treatment of diabetes mellitus, proper selection of dosage and therapeutic regimen is of particular importance.

At the same time, reviews of Amaryl show that this drug is not suitable for all diabetics. Quite often, at the initial stage of treatment, patients experience a sharp change in blood sugar levels. However, experts are confident that in such cases it is necessary to adjust the dose upward and this is not at all an indicator of the ineffectiveness of the drug.

Of course, any adjustments associated with either increasing or decreasing the dosage should be carried out under the close supervision of a specialist. It has been established that improper use of Amaryl can cause complications of the disease.

Amaryl price, where to buy

In pharmacies, this drug is offered in several versions, with different contents of the active substance. The average cost of the drug is 238-286 rubles, the price of Amaryl 4 mg is 868-1080 rubles, 3 mg is 633-829 rubles. and 2 mg – 453-562 rubles.

  • Online pharmacies in Russia Russia
  • Online pharmacies in Ukraine Ukraine
  • Online pharmacies in Kazakhstan Kazakhstan

ZdravCity

    Amaryl tablets 4 mg 30 pcs.Sanofi-Aventis S.P.A.

    Amaryl tablets 1 mg 30 pcs.Sanofi-Aventis S.P.A.

    Amaryl tablets 2 mg 90 pcs.Sanofi-Aventis S.P.A.

    Amaryl tablets 3 mg 30 pcs.Sanofi-Aventis S.P.A.

    Amaryl tablets 3 mg 90 pcs.Sanofi-Aventis S.P.A.

Pharmacy Dialog

    Amaryl (tablet 3 mg No. 30) Sanofi-Aventis

    Amaryl (tablet 1 mg No. 30) Sanofi-Aventis

    Amaryl (tablet 3 mg No. 90) Sanofi-Aventis

    Amaryl (2 mg tablet No. 90) Sanofi-Aventis

    Amaryl (tab. 4 mg No. 30) Sanofi-Aventis

Elevated sugar levels are the cause of decreased quality of life in type 2 diabetes. Amaryl is designed to correct blood glucose due to the action of glimepiride. This substance is a sulfonylurea derivative.

Amaryl is a long-acting drug that not only reduces blood glucose concentrations, but also stimulates the beta cells of the pancreas.

This is a medicine that has passed all stages of testing and clinical trials, and not a dietary supplement.

Amaryl for diabetes

Amaryl is prescribed by an endocrinologist for elevated blood sugar levels and diagnosed type 2 diabetes.

Compound

Contains different amounts of glimepiride:

  • Pink tablets contain 1 g of active ingredient;
  • Greens – 2 g;
  • Yellow – 3g;
  • Blue – 4 g

Additionally, markings are applied to the packaging. In addition to glimepiroid, the composition contains a negligible amount of lactose, sodium starch, microcrystalline cellulose and polyvidione, as well as a dye corresponding to the drug labeling.

All substances in the composition are suitable for use in type 2 diabetes in the dosages contained in the tablet.

The release form is tablets, the international name is Glimepiride, the price of Amaryl starts from 617 rubles.

Pros and cons

Advantages of the drug:

  • use of third generation derivatives;
  • speed of action;
  • protection against hypoglycemia;
  • ease of use;
  • prolonged action.
  • the dosage is selected by the doctor;
  • relatively high price;
  • In case of overdose, side effects are possible;
  • not suitable for diabetics with ketoacidosis;
  • not suitable for lactose intolerance;
  • not compatible with alcohol.

Indications

Amaryl is designed to “restart” the functioning of the pancreas in type 2 diabetes, and correct tissue sensitivity to insulin to normal.

It is used as a drug to lower blood sugar levels. Diagnosis is carried out individually, and the doctor makes a decision on prescribing the drug if the fasting sugar level is more than 6.9.

Usually the drug is prescribed along with lifestyle correction and a rational diet, and not as a pill that will “even the chances” of a diabetic and an ordinary person in the process of eating sweet foods.

The drug is not prescribed for prediabetes and temporary increases in glucose levels. It is contraindicated in type 1 diabetes.

For patients with concomitant type 2 diabetes, the drug can be prescribed along with Metformin; the doctor makes the choice between them based on the condition of the patient’s pancreas.

Operating principle

This is a “double action” drug:

  1. Stimulates the production of its own insulin by the pancreas.
  2. Reduces insulin resistance and normalizes the absorption of glucose by tissues.

Amaryl was developed as an alternative to cheaper drugs with a greater risk of hypoglycemia. Due to the active substance, it allows the pancreas to produce insulin in small doses. The risk increases if the dosage is selected incorrectly, or the dose of the drug is too high.

Amaryl has an antithrombotic and antiacidotic effect, it blocks neoglucogenesis in the liver, and corrects lipogenesis and glycogenesis.

Important: Obese diabetics must adhere to a diet. The product is not a “fat blocker” and any excess calories consumed will be stored as normal.

Instructions for use

Amaryl is taken before breakfast or together with it, without chewing and with a sufficient amount of water. The initial dosage is 1 mg.

A glucometer should be used to monitor your condition throughout the day. If the drug does not bring the desired reduction in blood sugar, an increase in dosage is required. In this case, additional doses of Amaryl may be prescribed.

The drug can be used together with, if the latter does not reduce sugar levels to normal. In this case, the dosage of Metformin is left the same, and Amaryl is increased.

Compatibility

Amaryl increases the effect of all drugs that lower sugar levels. It is not recommended to independently add any dietary supplements of a similar effect to the treatment plan.

The effect of Amaryl is enhanced by anabolic steroids, MAO inhibitors, fluoxetine, tetracyclines and sulfonamides, as well as fenfluramine.

The effectiveness of the drug is reduced by laxatives, various sorbents, thyroid hormones, adrenaline, glucagon and thiazide diuretics.

The drug is not used with alcohol. Amaryl together with alcohol can cause unexpected hypoglycemia and a toxic effect. It is recommended to take a pill 18-24 hours before drinking alcohol, and the same amount after, which means that for most people it is easier to give up alcohol.

There is no scientifically based information on non-alcoholic beer and Amaryl.

Contraindications to drinking alcohol are due to the fact that Amaryl increases the toxic effect on the liver and can provoke gastric ulcers and bleeding. If dizziness, tinnitus and other symptoms of poisoning occur after drinking alcohol, call an ambulance, wash the stomach, take sorbents, and then follow the treatment plan.

How to reduce the dosage and discontinue the drug

Independent dosage reduction is not allowed. The doctor must analyze the dynamics of blood glucose levels, conduct a study of the pancreas, and take into account all the patient’s health parameters.

The patient should not discontinue the medication under any circumstances. Reducing dosages, selecting other drugs - only according to the instructions of the attending physician.

Amaryl's analogs

The cheapest analogue is the Russian-made drug Glimepiride Pharmstandard.

In addition to it, there is Diameride and Glimepiride Canon on the market.

All analogues contain the same active ingredient and are cheaper.

Contraindications, side effects

Amaryl is contraindicated:

  • for lactose intolerance, severe liver damage and ketoacidosis.
  • The drug is not prescribed for type 1 diabetes.
  • It is not used during pregnancy and lactation.

A side effect may be hypoglycemia. It manifests itself when there is an overdose of the active substance, or the wrong combination of Amaryl with other sugar-lowering drugs.

– dizziness, cold sweat, confusion, in severe cases – loss of consciousness. At the first appearance of dizziness, you should eat 20 g of sugar, or administer glucose, and call an ambulance.

Amaryl is a modern remedy designed to improve the quality of life of a diabetic. It is used for type 2 diabetes. The dosage is selected by the doctor; regarding changes in diet, and the possibility of using the drug together with other substances, as well as withdrawal, it is better to consult an endocrinologist. The drug has available analogues and can be used for a long time.

Name:

Amaryl

Pharmacological action:

Amaryl is a sulfonylurea drug, an oral hypoglycemic agent. Has a primarily prolonged effect. The mechanism of action is to stimulate the secretion and release of insulin from the beta cells of the pancreas (pancreatic effect). It also increases the sensitivity of adipose and muscle tissue to the action of insulin (extrapancreatic effect). It acts by blocking the cytoplasmic ATP-dependent potassium channels of pancreatic beta cells. This is accompanied by the opening of calcium channels in the beta cell membranes and increased penetration of calcium into them (depolarization).

Amaryl's active ingredient, glimepiride, quickly detaches and binds to beta-cell protein, which has a molecular weight of 65 kDa/SURX and is associated with adenosine triphosphate-dependent potassium channels. It differs from other sulfonylurea derivatives in that it does not interact with the beta cell protein with a molecular weight of 140 kDa/SUR1. This leads to exocytosis of insulin, and the content of released insulin is much less than with the influence of other traditional drugs. The slight stimulating effect of amaryl on insulin secretion by beta cells leads to a lower risk of hypoglycemia.

The extrapancreatic effect of amaryl leads to a decrease in insulin resistance and a slight effect on the cardiovascular system. It has antiplatelet, antiatherogenic and antioxidant effects.

Increased utilization of glucose by adipose and muscle tissue is due to the presence of specific transport proteins in cell membranes. In non-insulin-dependent diabetes, the penetration of glucose into these tissues is limited at the disposal stage. Amaryl quickly increases the activity of transport proteins, due to which glucose is absorbed better. There is also an increase in the number of transport proteins with the use of amaryl. There is virtually no blocking effect on ATP-dependent potassium channels of cardiac myocytes. The possibility of metabolic adaptation of cardiomyocytes to ischemic conditions remains. The activity of specific glycosyl-phosphatidylinositol phospholipase C increases, due to which glycogenesis and lipogenesis, correlated with amaryl intake, are observed.

Amaryl blocks hepatic glucose production by increasing the content of fructose-2,6-bisphosphate in hepatocytes (the latter also blocks gluconeogenesis).

While taking the drug, there is a blocking of COX secretion and a decrease in the transformation of arachidonic acid into thromboxane A2, due to which platelet aggregation (antithrombotic effect) decreases. Under the influence of amaryl, an increase in the concentration of alpha-tocopherol, which is formed endogenously, is observed. There is also an increase in the activity of superoxide dismutase, catalase and glutathione peroxidase, which is manifested by a decrease in the severity of oxidative reactions in diabetes mellitus.

Indications for use:

Non-insulin-dependent diabetes mellitus (type 2) - as monotherapy or in combination with insulin (or metformin).

Method of application:

Amaryl is taken orally. The tablets are not chewed, washed down with about 150 ml of water. It is important not to forget to eat after taking the drug.

The starting and maintenance dosage is set by the doctor individually, depending on the level of glucose in the blood serum and its excretion in the urine.

First, the drug is used at 1 mg/day; if necessary, you can gradually increase the daily dose to 6 mg. The dose is increased at intervals of 1-2 weeks according to the following scheme: 1 mg/day-2 mg/day-3 mg/day-4 mg/day-6 mg/day of amaryl. It is recommended not to exceed amaryl doses of more than 6 mg/day. The frequency and time of use of the drug is determined individually by the doctor, which depends on the patient’s lifestyle. As a rule, the daily dose of Amaryl is prescribed 1 time per day during or before the first large meal (breakfast). If the morning dose was not taken, then during or before the second meal. The therapy is long-term.

Using a combination of amaryl-metformin. For patients taking metformin who experience insufficient reductions in serum glucose levels, supplemental amaryl can be started. If the daily dosage of metformin does not change, then Amaryl therapy is started with a dose of 1 mg/day. Subsequently, the dose of Amaryl can be increased to achieve the desired reduction in serum glucose levels to a maximum of 6 mg/day.

Using a combination of amaryl-insulin. To stabilize blood serum glucose levels in cases where monotherapy or the use of a combination of amaryl-metformin is ineffective, a combination of insulin and amaryl is used. In this case, the dose of Amaryl is left the same, and insulin therapy is started with small doses. In the future, it is possible to increase the administered insulin. Therapy should be accompanied by monitoring of serum glucose concentrations. Treatment is carried out under the supervision of the attending physician. An insulin-amaryl regimen can reduce insulin requirements by approximately 40%.

Replacing another antidiabetic drug with amaryl. Initial treatment begins with 1 mg/day of amaryl, regardless of the dose of the previous drug (even if it was the maximum). Depending on the therapeutic effect of amaryl, you can increase the dose according to the above rules. In some cases, it is necessary to discontinue Amaryl due to possible hypoglycemia (especially if a drug with a high half-life, chlorpropramide, was used before Amaryl). Therapy is stopped for several days (due to the likely additive effect).

Replacing insulin with amaryl. In cases where patients with type 2 diabetes are prescribed insulin, but their insulin-secreting function of pancreatic beta cells remains intact, the patient can be switched to taking Amaryl with the exception of insulin. In this case, Amaryl therapy begins with a dose of 1 mg/day.

Adverse events:

Metabolism:

the occurrence of hypoglycemic reactions soon after taking amaryl (such reactions are very difficult to correct).

Nervous system:

headache, sleep disturbances, drowsiness, feeling tired, aggressiveness, anxiety, changes in concentration and speed of psycho-motor reactions, visual and speech disorders, dizziness, confusion, depression, sensory disturbances, aphasia, coordination disorders, paresis, helpless state, cerebral spasms, loss of self-control, tremors, loss or confusion, delirium, coma, restlessness, cold, clammy sweat.

Gastrointestinal tract:

vomiting, epigastric discomfort, hunger, abdominal pain, diarrhea, jaundice, cholestasis, increased liver transaminases, hepatitis, liver failure, nausea.

Cardiovascular system:

tachycardia, heart rhythm disturbances, arterial hypertension, bradycardia, angina pectoris.

Organ of vision:

transient visual impairment as a result of changes in blood glucose levels (especially at the beginning of therapy).

Respiratory system:

shallow breathing.

Hematopoietic system:

leukopenia, thrombocytopenia (moderate or severe), erythrocytopenia, aplastic or hemolytic anemia, granulocytopenia, pancytopenia, agranulocytosis.

Hypersensitivity reactions:

urticaria, itching, skin rash, allergic vasculitis. Allergic reactions are usually mild, but sometimes progression to anaphylactic shock is possible. A cross-reaction is possible with sulfonylureas and sulfonamides.

Other:

hyponatremia, photosensitivity.

Contraindications:

Ketoacidosis of diabetic origin, diabetic coma and precoma,

Insulin-dependent diabetes mellitus (type 1),

Severe renal dysfunction (including patients on hemodialysis),

Severe liver dysfunction,

Individual hypersensitivity to amaryl (glimepiride) or other components of the drug, other sulfonylureas, sulfonamides.

During pregnancy:

Amaryl should not be prescribed to pregnant women or breastfeeding women. If the patient is planning a pregnancy, then she must be switched to insulin administration with the exception of Amaryl. If the patient is breastfeeding, then insulin administration is continued or breastfeeding is stopped (since amaryl passes into breast milk).

Interaction with other drugs:

In combination with insulin, other drugs for the treatment of hypoglycemia, allopurinol, angiotensin-converting factor inhibitors, male sex hormones, anabolic steroids, coumarin derivatives, chloramphenicol, fenfluramine, fluoxetine, fibrates, pheniramidol, MAO inhibitors, guanethidine, pentoxifylline (when administered parenterally in large doses ), miconazole, azapropazone, phenylbutazone, quinolones, probenecid, oxyphenbutazone, salicylates, sulfinpyrazone, tetracyclines, long-acting sulfonamides, tritoqualine, tro-, cyclo-, and isophosphamide may increase the hypoglycemic effect of amaryl.

In combination with adrenaline (epinephrine) and sympathomimetics, acetazolamide, glucocorticosteroids, glucagon, diazoxide, barbiturates, saluretics, laxatives (with prolonged use), thiazide diuretics, nicotinic acid in large doses, phenytoin, phenothiazine, rifampicin, progestogens and chlorpromaz, otherwise , thyroid hormones, lithium salts may reduce the hypoglycemic effect of amaryl.

When amaryl is combined with reserpine, clonidine and histamine H2 receptor blockers, both a decrease and an increase in the hypoglycemic effect are possible.

It is possible to reduce or weaken the effects of coumarin and its derivatives in combination with amaryl. Long-term or single use of enthanol-containing drugs and drinks can either weaken or enhance the hypoglycemic effect of Amaryl.

Overdose:

In case of an overdose of Amaryl, hypoglycemia is possible for 12-72 hours when taking Amaryl in a high dose. Re-development of hypoglycemia is possible after restoration of blood glucose levels. Hypoglycemia is manifested by the following symptoms: increased blood pressure, increased sweating, nausea, vomiting, arrhythmia, pain in the heart, anxiety, a sharp increase in appetite, apathy, dizziness, drowsiness, headache, anxiety, palpitations, aggressiveness, impaired concentration, tremor , confusion, paresis, depression, sensory disturbances, tachycardia, convulsions of central origin. In some cases, hypoglycemia manifests itself as symptoms of a stroke. There is a risk of developing a coma. Therapy for hypoglycemia should begin with taking a piece of sugar, sweet tea or juice. The patient is warned to keep approximately 20 g of glucose with him at all times (in the form of 4 lumps of sugar, for example). Various sweeteners are ineffective in treatment. In severe cases, hospitalization is necessary. Induction of vomiting is carried out, the patient is dehydrated (water with activated carbon orally, laxative). Dextrose is administered parenterally (40% solution 50 ml intravenously). Subsequently, diluted dextrose (10% solution) is used. Treatment is accompanied by constant monitoring of serum glucose levels. Other symptoms are relieved by symptomatic treatment.

If amaryl is accidentally taken by people without diabetes (children), the development of hyperglycemia must be avoided. The dose of dextrose is carefully selected against the background of monitoring serum glucose levels.

Release form of the drug:

Amaryl - tablets, have a dividing strip, elongated in shape. Glimepiride tablets of 1 ml are pink in color. Amaryl 2 ml – green tablets. Amaryl 3 mg – light yellow tablets. Amaryl 4 mg – green. The package contains 2 blisters, each containing 15 tablets.

Storage conditions:

Amaryl is stored at a temperature of no more than 25°C. Shelf life - 3 years.

Compound:

Active ingredient: glimepiride.

Inactive components: lactose monohydrate, polyvidone 25,000, sodium starch glycolate, microcrystalline cellulose, magnesium stearate, dye (for amaryl 1 mg - iron oxide red (E172), for amaryl 2 mg - iron oxide yellow (E172) and indigo carmine (E132) , for amaryl 3 mg - yellow iron oxide (E172), for amaryl 4 mg - indigo carmine (E132).

Additionally:

When treating with Amaryl, it is necessary to remember about conditions that require transferring the patient to parenteral administration of insulin (polytraumas, surgical treatment, diseases with increased body temperature, extensive burns, changes in the absorption of food from the gastrointestinal tract in diseases - intestinal obstruction, intestinal paresis and others) .

When combining amaryl-metformin, it is necessary to take into account that taking high doses of metformin and glimepiride is accompanied by a marked improvement in metabolism in patients with uncontrolled diabetes mellitus. In the case of high doses of metformin and amaryl, if control is still insufficient, the patient can be switched to a combination of amaryl-insulin.

Factors that provoke the development of hypoglycemia: low patient compliance, inadequate, irregular nutrition, changes in the usual diet, skipping meals, alcohol consumption, fasting, changes in the balance between carbohydrate intake and physical activity, severe dysfunction of the liver and kidneys, concomitant uncompensated diseases of the endocrine system , amaryl overdose, thyroid dysfunction, adrenal insufficiency, pituitary insufficiency, combination with other drugs.

Signs of hypoglycemia are leveled out in the elderly, patients with neurocirculatory dystonia, patients taking beta-blockers, reserpine, clonidine, guanethidine, and sympatholytics.

The dose of the drug is selected individually depending on the glucose level in the blood. If the next dose is missed, it is strictly forbidden to take a higher next dose. The patient should tell the doctor if they are taking too high a dose of Amaryl. In case of diabetes compensation, an improvement in insulin sensitivity may be observed, so it is possible to reduce the dose of Amaryl (or even discontinue the drug). It is necessary to adjust the dose of Amaryl when various factors appear that can provoke hypoglycemia or hyperglycemia, as well as in case of lifestyle changes. It must be remembered that a proper diet, correction of physical activity, and weight loss are of great importance for the treatment of diabetes mellitus while taking Amaryl.

It is necessary to inform the patient that he should immediately inform the attending physician of all side effects that develop during therapy with amaryl. It is also necessary to inform him about the factors that cause both hyper- and hypoglycemia and the symptoms of these conditions.

Amaryl therapy should be accompanied by regular monitoring of glucose levels in the blood serum and urine, and determination of the concentration of glycosylated hemoglobin. Regular monitoring of these laboratory parameters helps to identify possible primary or secondary drug resistance in a timely manner.

Laboratory control also includes determination of liver function and a clinical blood test. During drug therapy, the speed of psycho-motor reactions may decrease, so working with precision machinery and driving a car is contraindicated. This is especially true for the initial stages of treatment with amaryl.

Drugs with similar effects:

Diaformin Glucovance Oltar Glucophage Maninil

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Type 2 diabetes mellitus is a common disease in which the blood sugar level exceeds the required level. Modern medicines successfully fight the disease. One of them is Amaryl, the instructions for use of which are discussed in the article. Experts classify the drug Amaryl as a group of hypoglycemic drugs that can reduce the glucose content in the blood lymph of people with type 2 diabetes.

Amaryl is usually prescribed by an endocrinologist as the main remedy for lowering glucose levels in the blood lymph. Sometimes diabetes pills are prescribed as part of complex therapy, together with insulin and metmorphine, according to indications.

According to the instructions for use, Amaryl is based on a substance that has an international nonproprietary name (INN) - glimepiride. It is responsible for the necessary production of insulin, so that it, in turn, begins to perform its main function - lowering sugar levels. This happens due to the release of insulin from pancreatic cells, which react to the action of glucose itself. More precisely, insulin production occurs due to its interaction with groups of potassium channel proteins (ATP channels), which are located on the surface of cells. Glimepiride is able to selectively bind to proteins and regulate the activity of ATP channels, they open and close in a controlled manner.

Glimepiride can have another important effect. It releases calcium from the blood, which enters tissue cells and prevents the formation of atherosclerotic plaques on the walls of blood vessels.

If the maximum dose is not sufficient for the patient, then metmorphine is added to therapy. The latter inhibits the process of gluconeogenesis in the liver and reduces the absorption of glucose from the intestine. It also increases glucose utilization and the sensitivity of the tissues themselves. As prescribed by a doctor, insulin can be added to therapy together with metmorphine or separately from it.

The active component is completely absorbed in the body. Food has a slight effect on absorption and may slightly slow down its speed. Glimepiride, like most drugs of the latest generation, is excreted through the intestines and kidneys. It was found that the substance does not remain unchanged in the urine. Studies do not determine the accumulation of glimepiride in the body.

Amaryl M is a combination of two active ingredients metformin and glimepiride, the instructions for its use indicate all the necessary characteristics of the drug. In pharmacies, the drug is usually sold: 1 mg of glimepiride + 250 mg of metformin, 2 mg of glimepiride + 500 mg of metformin.

Release forms

The medicine is available in the form of oval tablets (1–4 mg). On one side of the tablet the inscription HD125 is read. There are 15 pieces in one blister. The blisters themselves are packaged in cardboard boxes. You can buy the drug in packages of two, four, six or eight blisters. The tablets vary in color: pinkish ones contain 1 mg; green 2 mg, Amaryl 3 mg – orange in color and Amaryl 4 mg – pale blue tablets.

One tablet contains:

  • third generation glimepiride is the main component that lowers glucose, a substance isolated from sulfonamide;
  • povidone – chemical element, enterosorbent;
  • lactose with a water molecule (monohydrate);
  • microcrystalline cellulose;
  • sodium carboxymethyl starch – food additive, thickener, increasing stickiness;
  • indigo carmine is a safe food coloring
  • magnesium stearate (stabilizing defoamer).

Amaryl is easy to use; you just need to take the tablet once in the morning. Instructions for use, as well as the price, are quite affordable for anyone suffering from this endocrine disease.

Contraindications

For all its effectiveness, Amaryl has a number of contraindications when taking pills, this must be taken into account.

  1. Diabetes mellitus type 1. Unlike type 2 diabetes, it is characterized by absolute insulin deficiency, which occurs due to the destruction of pancreatic cells.
  2. Diabetic ketoacidosis is a complication of diabetes mellitus, usually type 1. Disturbances in carbohydrate metabolism due to acute lack of insulin.
  3. Diabetic coma or precoma occurs due to insulin deficiency or poor diet, abuse of fatty foods, carbohydrates and alcoholic beverages.
  4. Significant metabolic disorder.
  5. Severe diseases of the liver, as well as kidneys, with impaired functionality of these vital organs. In particular, conditions that lead to disruption of these functions are taken into account - infections, shock, etc.
  6. Carrying out hemodialysis.
  7. Ischemia, respiratory dysfunction, myocardial infarction, coronary heart disease. These conditions can lead to tissue hypoxia.
  8. Lactic acidosis is a rare complication of diabetes that causes excess lactic acid in the body.
  9. Injuries, burns, surgeries, septicemia (one of the types of blood poisoning).
  10. Exhaustion of the body, deliberate fasting - consumption of food and drinks containing less than 1000 calories per day.
  11. Intestinal obstruction, intestinal paresis, diarrhea, vomiting.
  12. Alcohol abuse, acute alcohol poisoning.
  13. Lactase deficiency (an enzyme necessary for the production of lactose), galactose intolerance (one of the sugars).
  14. Expecting a baby, breastfeeding.
  15. Age up to 18 years, due to insufficient research on this issue.
  16. Individual intolerance to one or more components of Amaryl.

Immediately after prescribing Amaryl, initial monitoring of the effect of the drug and the general condition of the patient is required.

At first, without control, hypoglycemia may occur, which can cause serious health consequences.

However, patients may not be available for medical supervision. For example, some are unwilling or unable to contact a doctor. This is especially true for older people. This also includes patients who do not monitor their diet for various reasons, and alcoholics. People who perform monotonous hard physical work.

Amaryl should be taken under the supervision of a physician in patients with dysfunction of the thyroid gland, as well as the adrenal glands, and other common endocrine disorders. In this case, strict monitoring of blood glucose levels and diagnosing signs of hypoglycemia is necessary; some dose adjustment may be required.

Particular attention should be paid to taking Amaryl in a situation where patients are simultaneously taking other medications. The doctor must understand their compatibility and advise patients on the rules of admission.

Dosage

The diabetes medicine Amaryl is prescribed exclusively by a specialist - an endocrinologist. He makes appointments only after determining the patient’s blood glucose level. Endocrinologists take into account how a person lives - his diet, physical activity, age, side diseases and many other factors.

The minimum dose is considered to be 1 mg. One tablet should be taken once a day in the morning before or during the first breakfast. It is not recommended to chew the tablets, however, you should drink it with water (at least half a glass). If necessary, the doctor may prescribe a larger dose - from 2 to 3 mg; 4 mg is considered a standard high dose, 6 and 8 mg are prescribed in extremely rare cases. The dose should not be increased sharply; the interval between new prescriptions should be at least seven days. While taking the diabetes drug Amaryl and especially adjusting doses, it is necessary to take control tests.

Adjustment is usually required when there are changes in the patient's lifestyle. For example, drinking alcohol, breaking a diet, sudden weight gain or loss. These include carbohydrate metabolism disorders, overdose, complications in the functioning of the kidneys and liver.

When Amaryl M is prescribed, the same principle is used to determine the dosage. Usually this drug is also taken once a day. Particular attention is paid to the selection of doses for patients over 65 years of age. The medicine is prescribed after carefully studying the side diseases of older people, especially with regard to the functioning of the liver and kidneys.

The dose of Amaryl is not increased at subsequent doses if the patient has forgotten to take the daily pill. This day is left without taking the medicine, and the next day you need to take the standard dose.

After taking the pills, the patient must eat, otherwise the sugar level will drop below normal. The following meals should also not be skipped, otherwise the opposite effect of therapy may be observed. Drugs of this type are indicated for use over a long period of time. If the diabetes medication does not have the desired effect, the combined Amaryl M is prescribed, or other glucose-lowering medications are administered - metformin and insulin.

Side effects

Recent clinical studies of glimepiride, the main active ingredient in Amaryl, have revealed side effects. They can manifest themselves in metabolism, digestion, vision, cardiovascular and immune systems. In addition, photosensitivity (increased sensitivity of the body to ultraviolet rays) and hyponatremia (decrease in the amount of sodium ions in the blood) are possible.

Hypoglycemia can manifest itself for a long time; in case of metabolic disorders, its symptoms are:

  • migraines, dizziness, loss of consciousness, sometimes to the development of coma;
  • constant desire to eat;
  • nausea and vomiting;
  • weakness, insomnia or constant desire to sleep;
  • sudden manifestation of aggression;
  • decreased attentiveness, slowdown of basic reactions;
  • delirium (mental disorder with impaired consciousness);
  • depression;
  • confusion;
  • speech disorders (aphasia)
  • blurred vision;
  • tremor, convulsions;
  • impaired sensitivity of organs;
  • loss of self-control;
  • difficulty breathing;
  • severe sweating, sticky skin;
  • anxiety attacks;
  • increased heart rate;
  • increased blood pressure;
  • heart rhythm disturbances, sinus rhythm disturbances.

Vision. Significant deterioration of vision, usually at the beginning of taking Amaryl. This occurs due to impaired swelling of the lenses; this process directly depends on the amount of glucose in the blood. The refractive index of the lenses is disrupted, and vision becomes worse.

Digestion. The patient may feel nauseous, vomiting, a feeling of fullness in the stomach, acute pain in the stomach, bloating, and diarrhea. You may develop aversion to food.

Liver, bile ducts. The development of hepatitis, cholestasis and jaundice is possible; they can significantly worsen the patient’s health and even threaten life, due to the progression of liver failure. However, after discontinuation of Amaryl, a rapid restoration of liver function may occur.

Immune system. Allergic manifestations (urticaria, rash) are observed. These reactions are usually easily tolerated, however, in some cases severe shortness of breath occurs. Blood pressure decreases, anaphylaxis (acute reaction to an allergen) is possible. Allergic vasculitis (immune pathological inflammation of blood vessels) was detected.

Price

The price of the medicine is low, but may differ at pharmacy outlets of different companies. As an example, prices on some major online pharmacy resources where you can buy Amaryl are shown in the table.

Analogues

The medicine is used to treat type 2 diabetes. However, it may not be suitable for the patient due to his side diseases or other reasons. Amaryl analogues are also based on the active substance glimepiride. They may differ in the number of tablets in a pack, place of production, excipients and individual intolerance to them by patients. Experts consider the following drugs to be analogues of Amaryl.

  1. Glemaz. The active ingredient is similar - glimepiride. The drug is available in tablets and is prescribed when planning long-term treatment, under medical supervision. Unlike Amaryl, only 4 mg tablets are available. Average price – 650 rubles.
  2. Glemauno. The action of the medicine is similar to the action of Amaryl. It does not have a very long list of warnings for use. However, instructions are given not to engage in activities requiring alertness during the appointment. The drug is available only with a prescription. The average price of 2 mg is 476 rubles.
  3. Glimepiride. A drug similar to Amaryl can lower the sugar level in the patient’s blood lymph. Usually the tablets are also taken once a day before a heavy carbohydrate breakfast, washed down with sufficient water. If the effectiveness is insufficient, additional insulin is administered. Reviews about it are positive; the cost of the medicine is cheaper than similar drugs. Average price – 2 mg 139 rubles.

Overdose

An overdose is dangerous due to the occurrence of hypoglycemia - the concentration of glucose in the blood is critically reduced, and a hypoglycemic coma is possible. This condition can last from one day to three days. If symptoms of overdose occur, the patient is offered foods rich in carbohydrates. You can eat a piece of sugar, drink juice or sweet tea. If the patient has lost consciousness, then dextrose and glucagon are administered parenterally, bypassing the gastrointestinal tract.

If the patient’s condition worsens after an overdose, call an ambulance and, if necessary, hospitalize the patient.

In this article you can read the instructions for use of the drug Amaryl. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Amaryl in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Amaryl in the presence of existing structural analogues. Use for the treatment of non-insulin-dependent diabetes mellitus type 2 in adults, children, as well as during pregnancy and lactation. Composition of the drug.

Amaryl- oral hypoglycemic drug, 3rd generation sulfonylurea derivative.

Glimepiride (the active ingredient in Amaryl) reduces blood glucose concentrations, mainly by stimulating the release of insulin from the beta cells of the pancreas. Its effect is primarily associated with improving the ability of pancreatic beta cells to respond to physiological stimulation with glucose. Compared with glibenclamide, glimepiride at low doses causes the release of less insulin while achieving approximately the same reduction in blood glucose concentrations. This fact indicates that glimepiride has extrapancreatic hypoglycemic effects (increased tissue sensitivity to insulin and insulinomimetic effect).

Insulin secretion. Like all other sulfonylureas, glimepiride regulates insulin secretion through interaction with ATP-sensitive potassium channels on beta cell membranes. Unlike other sulfonylurea derivatives, glimepiride selectively binds to a protein with a molecular weight of 65 kilodaltons located in the membranes of pancreatic beta cells. This interaction of glimepiride with its binding protein regulates the opening or closing of ATP-sensitive potassium channels.

Glimepiride closes potassium channels. This causes depolarization of beta cells and leads to the opening of voltage-sensitive calcium channels and the entry of calcium into the cell. As a result, an increase in intracellular calcium concentration activates insulin secretion through exocytosis.

Glimepiride binds and is released from the binding protein much faster and, accordingly, more often than glibenclamide. It is assumed that this property of the high rate of exchange of glimepiride with the protein that binds to it determines its pronounced effect of sensitizing beta cells to glucose and protecting them from desensitization and premature exhaustion.

The effect of increasing tissue sensitivity to insulin. Amaryl enhances the effects of insulin on glucose uptake by peripheral tissues.

Insulinomimetic effect. Glimepiride has effects similar to those of insulin on glucose uptake into peripheral tissues and glucose output from the liver.

Glucose is absorbed by peripheral tissues by transporting it into muscle cells and adipocytes. Glimepiride directly increases the number of glucose transport molecules in the plasma membranes of muscle cells and adipocytes. An increase in the entry of glucose into cells leads to the activation of glycosylphosphatidylinositol-specific phospholipase C. As a result, the intracellular calcium concentration decreases, causing a decrease in the activity of protein kinase A, which in turn leads to stimulation of glucose metabolism.

Glimepiride inhibits the release of glucose from the liver by increasing the concentration of fructose-2,6-bisphosphate, which inhibits gluconeogenesis.

Effect on platelet aggregation. Amaryl reduces platelet aggregation. This effect appears to be due to selective inhibition of COX, which is responsible for the formation of thromboxane A, an important endogenous platelet aggregation factor.

Antiatherogenic effect. Glimepiride helps normalize lipid levels, reduces the level of malonaldehyde in the blood, which leads to a significant reduction in lipid peroxidation. In animals, glimepiride leads to a significant reduction in the formation of atherosclerotic plaques.

Reducing the severity of oxidative stress, which is constantly present in patients with type 2 diabetes. Glimepiride increases the level of endogenous alpha-tocopherol, the activity of catalase, glutathione peroxidase and superoxide dismutase.

Cardiovascular effects. Sulfonylureas also have effects on the cardiovascular system through ATP-sensitive potassium channels. Compared with traditional sulfonylurea derivatives, glimepiride has a significantly lesser effect on the cardiovascular system, which may be explained by the specific nature of its interaction with the ATP-sensitive potassium channel protein that binds to it.

In healthy volunteers, the minimum effective dose of Amaryl is 0.6 mg. The effect of glimepiride is dose-dependent and reproducible. The physiological response to physical activity (decreased insulin secretion) is preserved when taking glimepiride.

There are no significant differences in the effect depending on whether the drug was taken 30 minutes before meals or immediately before meals. In patients with diabetes mellitus, sufficient metabolic control can be achieved within 24 hours with a single dose of the drug. Moreover, in a clinical study, 12 of 16 patients with renal failure (creatinine clearance 4-79 ml/min) also achieved sufficient metabolic control.

Combination therapy with metformin. In patients with insufficient metabolic control when using the maximum dose of glimepiride, combination therapy with glimepiride and metformin may be initiated. Two studies demonstrated improved metabolic control with combination therapy compared with either drug alone.

Combination therapy with insulin. In patients with insufficient metabolic control while taking maximum doses of glimepiride, concomitant insulin therapy may be initiated. Two studies found that this combination achieved the same improvement in metabolic control as insulin alone. However, combination therapy requires a lower dose of insulin.

Compound

Glimepiride + excipients (Amaril).

Micronized glimepiride + Metformin hydrochloride + excipients (Amaril M).

Pharmacokinetics

Glimepiride

With repeated oral administration of the drug at a daily dose of 4 mg, Cmax in the blood serum is achieved in approximately 2.5 hours and is 309 ng/ml. There is a linear relationship between dose and Cmax of glimepiride in plasma, as well as between dose and AUC. When glimepiride is taken orally, its absolute bioavailability is complete. Food intake does not have a significant effect on absorption, except for a slight slowdown in its rate. Glimepiride is excreted in breast milk and penetrates the placental barrier. Glimepiride does not penetrate the blood-brain barrier (BBB) ​​well.

A comparison of single and multiple (2 times a day) administration of glimepiride did not reveal significant differences in pharmacokinetic parameters, and their variability between patients was insignificant. There was no significant accumulation of glimepiride.

Glimepiride is metabolized in the liver to form two metabolites - hydroxylated and carboxylated derivatives, which are found in urine and feces.

After a single oral dose, 58% of glimepiride is excreted by the kidneys (in the form of metabolites) and 35% through the intestines. Unchanged active substance is not detected in urine.

In patients of different sexes and different age groups, the pharmacokinetic parameters of glimepiride are the same.

Metformin

After oral administration, metformin is absorbed from the gastrointestinal tract quite completely. With simultaneous food intake, the absorption of metformin is reduced and slowed down. Metformin is quickly distributed into tissues and practically does not bind to plasma proteins. Metabolized to a very low extent. Excreted by the kidneys.

Pharmacokinetics of the drug Amaryl M with fixed doses of glimepiride and metformin

The Cmax and AUC values ​​for the fixed-dose combination (glimepiride 2 mg tablet + metformin 500 mg tablet) meet the bioequivalence criteria when compared with the same combination as separate drugs (glimepiride 2 mg tablet and metformin 500 tablet). mg).

In addition, a dose-proportional increase in the Cmax and AUC of glimepiride was shown when its dose in fixed-dose combination drugs was increased from 1 mg to 2 mg at a constant dose of metformin (500 mg) in these drugs.

In addition, there were no significant differences in safety, including the adverse effect profile, between patients taking Amaryl M 1 mg + 500 mg and patients taking Amaryl M 2 mg + 500 mg.

Indications

Treatment of type 2 diabetes (in addition to diet, exercise and weight loss):

  • non-insulin-dependent diabetes mellitus type 2 (as monotherapy or as part of combination therapy with metformin or insulin);
  • when glycemic control cannot be achieved with monotherapy with glimepiride or metformin (Amaril M);
  • when replacing combination therapy with glimepiride and metformin with one combination drug (Amaril M).

Release forms

Tablets 1 mg, 2 mg and 3 mg (Amaril).

Film-coated tablets 1 mg + 250 mg, 2 mg + 500 mg (Amaril M with Metformin).

Instructions for use and dosage

Amaryl tablets

As a rule, the dose of Amaryl is determined by the target blood glucose concentration. The drug should be used in the minimum dose sufficient to achieve the necessary metabolic control.

During treatment with Amaryl, it is necessary to regularly determine blood glucose levels. In addition, regular monitoring of the level of glycosylated hemoglobin is recommended.

Violations in taking the drug, for example, missing a dose, should not be compensated for by subsequent administration of the drug at a higher dose.

The doctor should instruct the patient in advance about the actions that should be taken in case of errors in taking the drug Amaryl (in particular, when missing a dose or skipping a meal), or in situations where it is not possible to take the drug.

Amaryl tablets should be taken whole, without chewing, with a sufficient amount of liquid (about 1/2 cup). If necessary, Amaryl tablets can be divided lengthwise into two equal parts.

The initial dose of Amaryl is 1 mg 1 time per day. If necessary, the daily dose can be gradually increased (at intervals of 1-2 weeks) under regular monitoring of blood glucose and in the following order: 1 mg-2 mg-3 mg-4 mg-6 mg (-8 mg) per day .

In patients with well-controlled type 2 diabetes mellitus, the daily dose of the drug is usually 1-4 mg. A daily dose of more than 6 mg is more effective in only a small number of patients.

The doctor determines the time of taking Amaryl and the distribution of doses during the day, taking into account the patient’s lifestyle (time of meals, amount of physical activity). The daily dose is prescribed in 1 dose, usually immediately before a full breakfast or, if the daily dose has not been taken, immediately before the first main meal. It is very important not to skip meals after taking Amaryl tablets.

Because Improved metabolic control is associated with increased insulin sensitivity, and the need for glimepiride may decrease during treatment. In order to avoid the development of hypoglycemia, it is necessary to promptly reduce the dose or stop taking the drug Amaryl.

Conditions that may also require dose adjustment of glimepiride:

  • weight loss;
  • lifestyle changes (changes in diet, meal times, amount of physical activity);
  • the occurrence of other factors that lead to a predisposition to the development of hypoglycemia or hyperglycemia.

Treatment with glimepiride is usually long-term.

Transferring a patient from taking another oral hypoglycemic drug to taking Amaryl

There is no exact relationship between the doses of Amaryl and other oral hypoglycemic drugs. When transferring from such drugs to Amaryl, the recommended initial daily dose of the latter is 1 mg (even if the patient is transferred to Amaryl from the maximum dose of another oral hypoglycemic drug). Any dose increase should be made in stages, taking into account the response to glimepiride in accordance with the above recommendations. It is necessary to take into account the intensity and duration of the effect of the previous hypoglycemic agent. Interruption of treatment may be necessary to avoid additive effects that increase the risk of hypoglycemia.

Use in combination with metformin

In patients with inadequately controlled diabetes mellitus who are taking glimepiride or metformin at maximum daily doses, treatment with a combination of these two drugs may be initiated. In this case, previous treatment with either glimepiride or metformin is continued at the same doses, and additional administration of metformin or glimepiride is started at a low dose, which is then titrated depending on the target level of metabolic control, up to the maximum daily dose. Combination therapy should be initiated under strict medical supervision.

Use in combination with insulin

In patients with poorly controlled diabetes mellitus, insulin may be prescribed concomitantly when taking glimepiride at the maximum daily dose. In this case, the last dose of glimepiride prescribed to the patient remains unchanged. In this case, insulin treatment begins with low doses, which are gradually increased under the control of blood glucose concentrations. Combined treatment is carried out under close medical supervision.

Amaryl M tablets

As a rule, the dose of Amaryl M is determined by the target concentration of glucose in the patient’s blood. The lowest dose sufficient to achieve the required metabolic control should be used.

During treatment with Amaryl M, it is necessary to regularly determine the concentration of glucose in the blood. In addition, regular monitoring of the percentage of glycosylated hemoglobin in the blood is recommended.

Incorrect use of the drug, such as missing a dose, should never be made up for by taking a subsequent higher dose.

The patient's actions in case of errors when taking the drug (in particular, when missing a dose or skipping a meal), or in situations where it is not possible to take the drug, should be discussed between the patient and the doctor in advance.

Because improvement in metabolic control is associated with increased tissue sensitivity to insulin, then during treatment with Amaryl M the need for glimepiride may decrease. In order to avoid the development of hypoglycemia, it is necessary to promptly reduce the dose or stop taking the drug Amaryl M.

Amaryl M should be taken 1 or 2 times a day with meals.

The maximum dose of metformin per dose is 1000 mg. Maximum daily dose: for glimepiride - 8 mg, for metformin - 2000 mg.

Only in a small number of patients is a daily dose of glimepiride greater than 6 mg more effective.

In order to avoid the development of hypoglycemia, the initial dose of Amaryl M should not exceed the daily doses of glimepiride and metformin that the patient is already taking. When transferring patients from taking a combination of the individual drugs glimepiride and metformin to Amaryl M, its dose is determined based on the doses of glimepiride and metformin already taken in the form of separate drugs. If it is necessary to increase the dose, the daily dose of Amaryl M should be titrated in increments of only 1 tablet of Amaryl M 1 mg + 250 mg or 1/2 tablet of Amaryl M 2 mg + 500 mg.

Treatment with Amaryl M is usually long-term.

It is known that metformin is eliminated primarily by the kidneys, and since the risk of severe adverse reactions to metformin is higher in patients with impaired renal function, it should only be used in patients with normal renal function. Due to the fact that renal function decreases with age, metformin should be used with caution in elderly patients. The dose should be carefully adjusted and renal function monitored closely and regularly.

Side effect

  • development of hypoglycemia, which can be prolonged;
  • headache;
  • acute feeling of hunger;
  • nausea, vomiting;
  • diarrhea;
  • flatulence;
  • anorexia;
  • metallic taste in the mouth;
  • weakness;
  • lethargy;
  • sleep disorders;
  • anxiety;
  • aggressiveness;
  • decreased concentration;
  • decreased vigilance and slowed psychomotor reactions;
  • depression;
  • confusion;
  • speech disorders;
  • aphasia;
  • visual impairment;
  • tremor;
  • paresis;
  • sensory disturbance;
  • dizziness;
  • helplessness;
  • loss of self-control;
  • delirium;
  • convulsions;
  • drowsiness and loss of consciousness up to the development of coma;
  • shallow breathing and bradycardia;
  • increased sweating;
  • stickiness of the skin;
  • increased anxiety;
  • tachycardia;
  • increased blood pressure;
  • feeling of increased heartbeat;
  • angina pectoris;
  • heart rhythm disturbances;
  • temporary deterioration of vision, especially at the beginning of treatment, due to fluctuations in blood glucose concentrations;
  • hepatitis;
  • thrombocytopenia, leukopenia or hemolytic anemia, erythrocytopenia, granulocytopenia, agranulocytosis or pancytopenia;
  • decrease in the concentration of vitamin B12 in the blood serum due to a decrease in its intestinal absorption;
  • allergic or pseudoallergic reactions (for example, itching, urticaria or rash);
  • anaphylactic shock;
  • allergic vasculitis;
  • photosensitivity;
  • lactic acidosis

Contraindications

  • type 1 diabetes mellitus;
  • diabetic ketoacidosis (including a history), diabetic coma and precoma;
  • acute or chronic metabolic acidosis;
  • severe liver dysfunction (lack of experience with use; treatment with insulin is necessary to ensure adequate glycemic control);
  • patients on hemodialysis (lack of experience);
  • renal failure and impaired renal function;
  • acute conditions in which renal function may be impaired (dehydration, severe infections, shock, intravascular administration of iodine-containing contrast agents);
  • acute and chronic diseases that can cause tissue hypoxia (heart or respiratory failure, acute and subacute myocardial infarction, shock);
  • tendency to develop lactic acidosis, history of lactic acidosis;
  • stressful situations (severe injuries, burns, surgeries, severe infections with fever, septicemia);
  • exhaustion, fasting, following a hypocaloric diet (less than 1000 cal per day);
  • impaired absorption of food and medications in the gastrointestinal tract (with intestinal obstruction, intestinal paresis, diarrhea, vomiting);
  • chronic alcoholism, acute alcohol intoxication;
  • lactase deficiency, galactose intolerance, glucose-galactose malabsorption;
  • pregnancy, pregnancy planning;
  • breastfeeding period;
  • children and adolescents under 18 years of age (insufficient experience in clinical use);
  • hypersensitivity to the components of the drug;
  • hypersensitivity to sulfonylurea derivatives, sulfonamide drugs or biguanides.

Use during pregnancy and breastfeeding

Amaryl and Amaryl M are contraindicated for use during pregnancy. In case of planned pregnancy or if pregnancy occurs, the woman should be transferred to insulin therapy.

It has been established that glimepiride is excreted in breast milk. During lactation, the woman should be switched to insulin or breastfeeding should be stopped.

Use in children

The safety and effectiveness of the drug has not been studied in children and adolescents under 18 years of age with type 2 diabetes mellitus. The use of the drug is contraindicated in this age group of patients.

Use in elderly patients

The drug should be used with caution in elderly patients (who often have asymptomatic decline in renal function), in situations where renal function may deteriorate, such as when they start taking antihypertensive drugs or diuretics, as well as non-seroid anti-inflammatory drugs (NSAIDs) (increased risk development of lactic acidosis and other side effects of metformin).

Special instructions

In specific clinical stress conditions, such as trauma, surgery, infections, and febrile fever, metabolic control may deteriorate in patients with diabetes, so temporary switching to insulin therapy may be necessary to maintain adequate metabolic control.

In the first weeks of treatment, the risk of developing hypoglycemia may increase, which requires particularly careful monitoring of blood glucose concentrations.

Factors that contribute to the risk of developing hypoglycemia include:

  • the patient's reluctance or inability (more often observed in elderly patients) to cooperate with the doctor;
  • malnutrition, irregular eating or skipping meals;
  • diet change;
  • drinking alcohol, especially in combination with skipping meals;
  • severe renal dysfunction;
  • severe liver dysfunction (in patients with severe liver dysfunction, transfer to insulin therapy is indicated, at least until metabolic control is achieved);
  • overdose of glimepiride;
  • some decompensated endocrine disorders that impair carbohydrate metabolism or adrenergic counterregulation in response to hypoglycemia (for example, some disorders of the thyroid gland and anterior pituitary gland, adrenal insufficiency);
  • simultaneous use of certain medications;
  • taking glimepiride in the absence of indications for its use.

Treatment with sulfonylurea derivatives, which include glimepiride, can lead to the development of hemolytic anemia, therefore, in patients with glucose-6-phosphate dehydrogenase deficiency, special care should be taken when prescribing glimepiride; it is preferable to use hypoglycemic agents that are not sulfonylurea derivatives.

If the above risk factors for hypoglycemia are present, as well as if intercurrent diseases occur during treatment or changes in the patient’s lifestyle, adjustment of the dose of Amaryl or the entire therapy may be required.

Symptoms of hypoglycemia, resulting from adrenergic counterregulation of the body in response to hypoglycemia, may be mild or absent when hypoglycemia develops gradually, in elderly patients, in patients with disorders of the autonomic nervous system, or in patients receiving beta-blockers, clonidine, reserpine , guanethidine and other sympatholytic agents.

Hypoglycemia can be quickly reversed by immediate administration of rapidly digestible carbohydrates (glucose or sucrose). As with other sulfonylureas, despite initial successful relief of hypoglycemia, hypoglycemia may recur. Therefore, patients should remain under constant monitoring. In case of severe hypoglycemia, immediate treatment and medical supervision is additionally required, and in some cases, hospitalization of the patient.

During treatment with Amaryl, regular monitoring of liver function and peripheral blood patterns (especially the number of leukocytes and platelets) is required.

Side effects such as severe hypoglycemia, serious changes in blood count, severe allergic reactions, liver failure can be life-threatening, therefore, in the event of such reactions, the patient should immediately inform the attending physician about them, stop taking the drug and not resume taking it without a doctor’s recommendation .

Impact on the ability to drive vehicles and operate machinery

At the beginning of treatment, after changing treatment, or when taking glimepiride irregularly, a decrease in concentration and speed of psychomotor reactions due to hypo- or hyperglycemia may be observed. This may adversely affect the ability to drive vehicles or operate various machines and mechanisms.

Drug interactions

Interaction of glimepiride with other drugs

When a patient taking glimepiride is simultaneously prescribed or discontinued other drugs, undesirable reactions are possible: an increase or decrease in the hypoglycemic effect of glimepiride. Based on clinical experience with glimepiride and other sulfonylureas, the following drug interactions should be considered.

With drugs that are inducers and inhibitors of the CYP2C9 isoenzyme: glimepiride is metabolized with the participation of the CYP2C9 isoenzyme. Its metabolism is affected by the simultaneous use of inducers of the CYP2C9 isoenzyme, for example, rifampicin (the risk of reducing the hypoglycemic effect of glimepiride when used simultaneously with inducers of the CYP2C9 isoenzyme and an increased risk of developing hypoglycemia if they are discontinued without adjusting the dose of glimepiride) and inhibitors of the CYP2C9 isoenzyme, for example, fluconazole ( increased risk of hypoglycemia and side effects of glimepiride when taken simultaneously with inhibitors of the CYP2C9 isoenzyme and the risk of a decrease in its hypoglycemic effect when they are discontinued without dose adjustment of glimepiride).

With drugs that enhance the hypoglycemic effect of glimepiride: insulin and oral hypoglycemic drugs, ACE inhibitors, anabolic steroids, male sex hormones, chloramphenicol, indirect anticoagulants coumarin derivatives, cyclophosphamide, disopyramide, fenfluramine, pheniramidol, fibrates, fluoxetine, guanethidine, , MAO inhibitors, miconazole, fluconazole, aminosalicylic acid, pentoxifylline (high doses parenterally), phenylbutazone, azapropazone, oxyphenbutazone, probenecid, quinolone derivative antimicrobials, salicylates, sulfinpyrazone, clarithromycin, sulfonamide antimicrobials, tetracyclines, , trofosfamide: increased risk of hypoglycemia with the simultaneous use of these drugs with glimepiride and the risk of worsening glycemic control when they are discontinued without adjusting the dose of glimepiride.

With drugs that weaken the hypoglycemic effect: acetazolamide, barbiturates, glucocorticosteroids (GCS), diazoxide, diuretics, epinephrine (adrenaline) or other sympathomimetics, glucagon, laxatives (long-term use), nicotinic acid (high doses), estrogens, progestogens, phenothiazines, phenytoin, rifampicin, thyroid hormones: the risk of worsening glycemic control when used together with these drugs and an increased risk of hypoglycemia if they are discontinued without dose adjustment of glimepiride.

With histamine H2 receptor blockers, beta-blockers, clonidine, reserpine, guanethidine: it is possible to either enhance or reduce the hypoglycemic effect of glimepiride. Careful monitoring of blood glucose concentrations is necessary. Beta-blockers, clonidine, guanethidine and reserpine, by blocking the reactions of the sympathetic nervous system in response to hypoglycemia, can make the development of hypoglycemia more invisible to the patient and the doctor and thereby increase the risk of its occurrence.

With ethanol: Acute and chronic use of ethanol can unpredictably either weaken or enhance the hypoglycemic effect of glimepiride.

With indirect coumarin-derived anticoagulants: Glimepiride can either enhance or reduce the effects of indirect coumarin-derived anticoagulants.

With bile acid sequestrants: colesevelam binds to glimepiride and reduces the absorption of glimepiride from the gastrointestinal tract. When glimepiride is administered at least 4 hours before oral administration of colesevelam, no interaction is observed. Therefore, glimepiride should be taken at least 4 hours before taking colesevelam.

Interaction of metformin with other drugs

With ethanol (alcohol): with acute alcohol intoxication, the risk of developing lactic acidosis increases, especially in the case of skipping or insufficient meals, or the presence of liver failure. Alcohol (ethanol) and drugs containing ethanol should be avoided.

With iodinated contrast agents: Intravascular administration of iodinated contrast agents may lead to the development of renal failure, which in turn may lead to accumulation of metformin and an increased risk of lactic acidosis. Metformin should be discontinued before or during the study and not restarted for 48 hours afterwards; Resumption of metformin is possible only after testing and obtaining normal kidney function tests.

With antibiotics that have a pronounced nephrotoxic effect (gentamicin): increased risk of developing lactic acidosis.

Combinations of drugs with metformin that require caution

With corticosteroids (systemic and for local use), beta2-agonists and diuretics with intrinsic hyperglycemic activity: the patient should be informed about the need for more frequent monitoring of morning blood glucose concentrations, especially at the beginning of combination therapy. It may be necessary to adjust the doses of hypoglycemic therapy during use or after discontinuation of the above drugs.

With ACE inhibitors: ACE inhibitors may reduce blood glucose concentrations. Doses of hypoglycemic therapy may need to be adjusted during use or after discontinuation of ACE inhibitors.

With drugs that enhance the hypoglycemic effect of metformin: insulin, sulfonylureas, anabolic steroids, guanethidine, salicylates (including acetylsalicylic acid), beta-blockers (including propranolol), MAO inhibitors: in case of simultaneous use of these drugs with metformin, careful monitoring of the patient and monitoring of blood glucose concentrations are necessary, as the hypoglycemic effect of metformin may be enhanced.

With drugs that weaken the hypoglycemic effect of metformin: epinephrine, corticosteroids, thyroid hormones, estrogens, pyrazinamide, isoniazid, nicotinic acid, phenothiazines, thiazide diuretics and diuretics of other groups, oral contraceptives, phenytoin, sympathomimetics, slow calcium channel blockers: in case of simultaneous use These drugs with metformin require careful monitoring of the patient and monitoring of blood glucose concentrations, because the hypoglycemic effect may be weakened.

Interactions to Consider

With furosemide: in a clinical study on the interaction of metformin and furosemide with a single dose in healthy volunteers, it was shown that the simultaneous use of these drugs affects their pharmacokinetic parameters. Furosemide increased metformin plasma Cmax by 22% and AUC by 15% without any significant changes in metformin renal clearance. When used with metformin, the Cmax and AUC of furosemide decreased by 31% and 12%, respectively, compared with furosemide monotherapy, and terminal T1/2 decreased by 32% without any significant changes in the renal clearance of furosemide. There is no information on the interaction of metformin and furosemide with long-term use.

With nifedipine: In a clinical study of the interaction of metformin and nifedipine with a single dose in healthy volunteers, it was shown that the simultaneous use of nifedipine increased the Cmax and AUC of metformin in blood plasma by 20% and 9%, respectively, and also increased the amount of metformin excreted by the kidneys. Metformin had a minimal effect on the pharmacokinetics of nifedipine.

With cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim and vancomycin): Cationic drugs eliminated by renal tubular secretion are theoretically capable of interacting with metformin as a result of competition for the common tubular transport system. This interaction between metformin and oral cimetidine was observed in healthy volunteers in clinical studies of the interaction of metformin and cimetidine with single and multiple doses, where there was a 60% increase in plasma Cmax and total metformin blood concentrations and a 40% increase in plasma and total AUC of metformin. There were no changes in T1/2 with a single dose. Metformin did not affect the pharmacokinetics of cimetidine. Although such interactions remain purely theoretical (with the exception of cimetidine), patients should be closely monitored and dosage adjustments of metformin and/or the interacting drug should be made when co-administering cationic drugs that are excreted by the renal proximal tubular secretory system.

With propranolol, ibuprofen: in healthy volunteers, no changes in their pharmacokinetic parameters were observed in single-dose studies of metformin and propranolol, as well as metformin and ibuprofen.

Analogues of the drug Amaryl

Structural analogues of the active substance:

  • Amaryl M;
  • Glemaz;
  • Glemauno;
  • Glimepiride;
  • Glumedex;
  • Meglimid.

Analogs by pharmacological group (hypoglycemic agents):

  • Avandamet;
  • Antidiabetes;
  • Arfazetine;
  • Astrozone;
  • Bagomet;
  • Bagomet Plus;
  • Victoza;
  • Galvus;
  • Galvus Met;
  • Gilemal;
  • Glemaz;
  • Glibenez;
  • Glibenez retard;
  • Glibenclamide;
  • Glidiab;
  • Gliclazide;
  • Glycon;
  • Glimepiride;
  • Glitisol;
  • Gliformin;
  • Glucobay;
  • Gluconorm;
  • Glucophage;
  • Glucophage Long;
  • Guarem;
  • Diabetalong;
  • Diabetes;
  • Diabepharm;
  • Diaglitazone;
  • Invokana;
  • Maniglide;
  • Maninil;
  • Meglimid;
  • Metglib;
  • Metfogamma;
  • Metformin;
  • Metformin hydrochloride;
  • NovoNorm;
  • NovoFormin;
  • Pioglite;
  • Reclid;
  • Silubin retard;
  • Siofor;
  • Starlix;
  • Formetin;
  • Formin Pliva;
  • Forxiga;
  • Chlorpropamide;
  • Euglucon;
  • Januvia.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.