Amaryl is an oral medication used to treat type 2 diabetes when diet and exercise alone fail to control abnormally high levels of blood sugar. Like other diabetes drugs classified as sulfonylureas, Amaryl lowers blood sugar by stimulating the pancreas to produce more insulin. Amaryl is often prescribed along with the insulin-boosting drug Glucophage. It may also be used in conjunction with insulin and other diabetes drugs.
Always remember that Amaryl is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan may diminish the results of Amaryl and can lead to serious complications such as dangerously high or low blood sugar levels. Remember, too, that Amaryl is not an oral form of insulin, and cannot be used in place of insulin.
Amaryl tablets contain the active ingredient Amaryl, which is a type of drug called a sulphonylurea. Amaryl is also available without a brand name, ie as the generic drug. Amaryl is used to help control blood sugar levels in people with type 2 diabetes.
People with type 2 diabetes have a deficiency of a hormone called insulin. Insulin is produced by the pancreas and is the main hormone responsible for controlling sugar levels in the blood. It normally makes the cells of the body remove excess sugar from the blood. In type 2 diabetes insulin is produced inefficiently in response to surges of blood sugar, eg following a meal. The cells of the body also become resistant to the action of insulin that is produced, which means that blood sugar levels can become too high.
Amaryl works mainly by stimulating the cells in the pancreas that produce insulin. These cells are called beta cells. Amaryl causes the beta cells to produce more insulin and this insulin removes sugar from the blood.
Amaryl also increases the uptake of sugar from the blood into muscle and fat cells and decreases the production of sugar by the liver.
All these actions help to decrease the amount of sugar in the blood of people with type 2 diabetes.
Amaryl tablets are normally taken once a day, shortly before or during the first meal of the day.
Amaryl is a first line option for treating type 2 diabetes in people who are not overweight. It is used when diet and exercise have failed to control blood sugar levels. It can also be used in combination with other antidiabetic drugs to provide better control of blood sugar.
Why is this drug prescribed?
- Type 2 diabetes, when diet has failed to fully control blood sugar.
- weight gain;
- temporary visual disturbances at start of treatment;
- low blood sugar level;
- inflammation of the liver;
- disturbances of the gut such as diarrhoea constipation nausea vomiting or abdominal pain;
- disturbance in the normal numbers of blood cells in the blood;
- disturbance in liver function;
- cholestatic jaundice;
- allergy to active ingredients;
- allergic skin reactions such as rash or itching;
The following drugs may enhance the blood sugar lowering effect of this drug and therefore increase the chance of low blood sugar:
- sulphonamides.;
- phenylbutazone;
- other antidiabetic tablets;
- miconazole;
- maoi antidepressants eg phenelzine;
- large doses of salicylates eg aspirin;
- insulin;
- fluconazole;
- fibrates eg clofibrate;
- fenfluramine;
- disopyramide;
- co-trimoxazole;
- ace inhibitors eg captopril;
Beta-blockers, eg propranolol can mask some of the signs of low blood sugar, such as increased heart rate and tremor. They also prolong episodes of low blood sugar and impair recovery back to normal glucose levels.
The warning symptoms of hypoglycaemia may also be masked by clonidine.
The following drugs may increase blood glucose levels. If you start treatment with any of these your dose of this drug may therefore need increasing:
- some antipsychotic drugs eg chlorpromazine olanzapine;
- somatropin.;
- protease inhibitors eg ritonavir;
- oestrogens and progesterones such as those contained in oral contraceptives;
- lithium;
- isoniazid;
- diuretics especially thiazide diuretics eg bendroflumethiazide;
- danazol;
- corticosteroids eg hydrocortisone prednisolone;
Rifampicin may reduce the blood level of this drug. If you are prescribed rifampicin, your dose of this drug may need to be increased to control your blood sugar.
- vomiting;
- stomach and intestinal pain;
- skin rash and eruptions;
- sensitivity to light;
- nausea;
- muscle weakness;
- liver problems and jaundice;
- itching;
- headache;
- dizziness;
- diarrhea;
- blurred vision;
- anemia and other blood disorders;
Amaryl, like all oral antidiabetics, can result in hypoglycemia. The risk of hypoglycemia can be increased by missed meals, alcohol, fever, injury, infection, surgery, excessive exercise, and the addition of other medications such as Glucophage or insulin. To avoid hypoglycemia, closely follow the dietary and exercise regimen suggested by your doctor.
Symptoms of mild low blood sugar may include:
- nervousness;
- nausea;
- light-headedness;
- hunger;
- headache;
- fatigue;
- fast heartbeat;
- dizziness;
- cold sweats;
- blurred vision;
Symptoms of more severe low blood sugar may include:
- shallow breathing;
- seizures;
- pale skin;
- disorientation;
- coma;
Why should Amaryl not be prescribed?
Avoid Amaryl if you have ever had an allergic reaction to it.
Do not take Amaryl to correct diabetic ketoacidosis. This condition should be treated with insulin.
Special warnings about Amaryl
It's possible that drugs such as Amaryl may lead to more heart problems than diet treatment alone, or treatment with diet and insulin. If you have a heart condition, you may want to discuss this with your doctor.
When taking Amaryl, you should check your blood and urine regularly for abnormally high sugar levels. The effectiveness of any oral antidiabetic, including Amaryl, may decrease with time. This may occur because of either a diminished responsiveness to the medication or a worsening of the diabetes.
Even people with well-controlled diabetes may find that stress such as injury, infection, surgery, or fever triggers a loss of control. If this happens, your doctor may recommend that you add insulin to your treatment with Amaryl or that you temporarily stop taking Amaryl and use insulin instead.
Possible food and drug interactions when taking Amaryl
If Amaryl is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Amaryl with the following:
- warfarin;
- thyroid medications such as synthroid;
- sulfa drugs such as bactrim ds septra ds;
- probenecid;
- phenytoin;
- oral contraceptives;
- nonsteroidal anti-inflammatory drugs such as advil motrin naprosyn nuprin ponstel and voltaren;
- nicotinic acid;
- miconazole;
- mao inhibitors;
- major tranquilizers such as mellaril and thorazine;
- isoniazid;
- heart and blood pressure medications called beta blockers including tenormin inderal and lopressor;
- estrogens such as premarin;
- diuretics such as hydrochlorothiazide and chlorothiazide;
- corticosteroids such as prednisone;
- chloramphenicol;
- aspirin and other salicylate medications;
- airway-opening drugs such as proventil and ventolin;
ADULTS
The usual starting dose is 1 to 2 mg taken once daily with breakfast or the first main meal. The maximum starting dose is 2 mg.
If necessary, your doctor will gradually increase the dose 1 or 2 mg at a time every 1 or 2 weeks. Your diabetes will probably be controlled on 1 to 4 mg a day; the most you should take in a day is 8 mg. If the maximum dose fails to do the job, your doctor may add Glucophage to your regimen.
Weakened or malnourished people and those with adrenal, pituitary, kidney, or liver disorders are particularly sensitive to hypoglycemic drugs such as Amaryl and should start at 1 mg once daily. Your doctor will increase your medication based on your response to the drug.
CHILDREN
Safety and effectiveness in children have not been established.
