Can you take metformin and Amaryl (glimepiride) together?

From the Guidelines

Yes, metformin and Amaryl (glimepiride) can be taken together as a combination therapy for type 2 diabetes. This combination is actually quite common and works well because these medications control blood sugar through different mechanisms. Metformin reduces glucose production in the liver and improves insulin sensitivity, while Amaryl stimulates the pancreas to release more insulin. When taking both medications, you should follow your doctor's specific dosing instructions, as the timing and amounts will be tailored to your individual needs. Common dosing might include metformin 500-1000 mg twice daily and Amaryl 1-4 mg once daily, typically taken with the first meal of the day. It's essential to monitor your blood sugar levels regularly when on this combination, as the dual effect can increase the risk of hypoglycemia (low blood sugar) 1.

Some key points to consider when taking metformin and Amaryl together include:

• Monitoring for symptoms of hypoglycemia, such as shakiness, sweating, confusion, or dizziness
• Being aware of potential side effects, including gastrointestinal issues with metformin and weight gain with Amaryl
• Regular follow-up appointments with your healthcare provider to assess the effectiveness of the treatment and adjust the dosing as needed
• Considering the potential benefits of combination therapy, including more rapid attainment of glycemic goals and longer durability of glycemic effect 1

It's also important to note that metformin is generally considered the first-line treatment for type 2 diabetes, due to its effectiveness, safety, and low cost 1. However, the choice of medication and dosing should always be individualized based on the patient's specific needs and circumstances. As stated in the most recent guidelines, metformin is a commonly used medication that historically has been the first-line treatment for type 2 diabetes 1.

From the FDA Drug Label

A 29-week, double -blind, placebo-controlled study of metformin hydrochloride tablets and glyburide, alone and in combination, was conducted in obese patients with type 2 diabetes mellitus who had failed to achieve adequate glycemic control while on maximum doses of glyburide (baseline FPG of approximately 250 mg/dL)

The FDA drug label does support the use of metformin and glyburide (also known as glimepiride is in the same class of sulfonylureas as glyburide, and amaryl is another name for glimepiride) in combination. Key points:

• The study showed that the combination of metformin and glyburide was effective in reducing fasting plasma glucose and HbA1c levels.
• The results are displayed in Table 8, which compares the mean change in fasting plasma glucose and HbA1c at week 29 for patients treated with metformin and glyburide (combination), glyburide alone, and metformin alone.
• The combination group showed a significant reduction in fasting plasma glucose and HbA1c levels compared to the glyburide alone group.
• Approximately 70% of the patients in the combination group were taking metformin 2000 mg/glyburide 20 mg or metformin 2500 mg/glyburide 20 mg at the end of the trial.
• Caution: The use of metformin and glimepiride (amaryl) in combination should be done under the guidance of a healthcare professional, as it may increase the risk of hypoglycemia. 2

From the Research

Combination Therapy with Metformin and Amaryl

• Metformin is often used in combination with other medications, such as sulfonylureas, to treat type 2 diabetes mellitus 3, 4.
• Amaryl, also known as glimepiride, is a sulfonylurea that can be used in combination with metformin to improve glycemic control 4.
• Studies have shown that the combination of metformin and glimepiride can be effective in reducing HbA1c levels and improving glycemic control, but may also increase the risk of hypoglycemia 4, 5.

Risks and Benefits of Combination Therapy

• The combination of metformin and glimepiride may increase the risk of hypoglycemia, particularly in patients who are prone to hypoglycemia or have renal impairment 4, 5.
• However, the combination of metformin and glimepiride may also provide benefits, such as improved glycemic control and reduced risk of cardiovascular events 3, 6.
• The choice of combination therapy should be individualized based on patient factors, such as renal function, risk of hypoglycemia, and cardiovascular risk 6.

Comparison with Other Combination Therapies

• Other combination therapies, such as metformin and thiazolidinediones, may also be effective in improving glycemic control and reducing cardiovascular risk 3, 7.
• However, the choice of combination therapy should be based on individual patient factors and the potential risks and benefits of each therapy 3, 6.