From the Guidelines
Yes, metformin and Amaryl (glimepiride) can be taken together, and this combination is actually common in diabetes treatment. These medications work differently to lower blood sugar: metformin reduces glucose production by the liver and improves insulin sensitivity, while Amaryl stimulates the pancreas to release more insulin. When used together, they can provide better blood sugar control than either medication alone. However, this combination may increase the risk of hypoglycemia (low blood sugar), so blood glucose levels should be monitored carefully.
Key Considerations
- Typical dosing varies based on individual needs, with metformin often started at 500mg once or twice daily and Amaryl usually started at 1-2mg once daily.
- Both medications should be taken as prescribed, typically with meals to reduce stomach upset.
- It's essential to follow your doctor's specific instructions regarding timing and dosage.
- Be aware of symptoms of low blood sugar such as shakiness, sweating, confusion, or dizziness. If you experience these symptoms, consume a quick source of sugar and contact your healthcare provider.
Evidence-Based Recommendations
According to the most recent guidelines, including those from the Diabetes Care journal 1, metformin is a commonly used medication for type 2 diabetes and can be safely used in combination with other glucose-lowering agents, including sulfonylureas like glimepiride. The American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) also recommend considering the combination of metformin and an SGLT2 inhibitor for patients with chronic kidney disease and type 2 diabetes 1.
Important Warnings
- Metformin may accumulate with reduced kidney function and may increase the risk for lactic acidosis, although this risk is very low in absolute terms 1.
- Patients receiving metformin should have their eGFR monitored, and the dose should be reduced when the eGFR is less than 45 mL/min/1.73 m2 or withdrawn when the eGFR is less than 30 mL/min/1.73 m2 or kidney failure develops 1.
- Glimepiride should be initiated conservatively at 1 mg daily and titrated slowly to avoid hypoglycemia in patients with chronic kidney disease 1.
From the Research
Combination Therapy with Metformin
- Metformin is often used in combination with other antidiabetic medications, including sulphonylureas, to treat type 2 diabetes mellitus 2.
- The combination of metformin and sulphonylurea (M+S) is a widely used treatment, but its effects compared to other antidiabetic medications are still controversial 2.
- Studies have shown that M+S combination therapy may result in more hypoglycaemic episodes compared to other metformin-antidiabetic agent combinations 2.
Amaryl (Glimepiride) and Metformin
- Amaryl, also known as glimepiride, is a sulphonylurea that can be used in combination with metformin to treat type 2 diabetes 3.
- One study found that glimepiride had a better safety profile compared to other sulphonylureas, with a lower risk of all-cause mortality 3.
- However, another study found that sulphonylureas, including glimepiride, had a higher risk of hypoglycaemia and cardiovascular events compared to drugs with low hypoglycaemic potential, such as metformin and GLP-1 receptor agonists 3.
Efficacy and Safety of Combination Therapy
- The efficacy and safety of combination therapy with metformin and sulphonylureas, including Amaryl, have been evaluated in several studies 2, 4, 3.
- These studies have shown that combination therapy can be effective in improving glycemic control and reducing the risk of hypoglycaemia, but may also increase the risk of cardiovascular events and other adverse effects 2, 4, 3.
- The choice of combination therapy should be individualized based on patient characteristics, medical history, and other factors, and should be guided by evidence-based clinical guidelines 5.