Can metformin and Amaryl (glimepiride) be taken together?

From the Guidelines

Yes, metformin and Amaryl (glimepiride) can be taken together as a combination therapy for type 2 diabetes, as recommended by the most recent guidelines 1. 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 doses may need adjustment when used together. Typically, metformin is taken twice daily with meals (500-1000 mg per dose), while Amaryl is usually taken once daily with breakfast (1-8 mg). This combination may cause a higher risk of hypoglycemia (low blood sugar), so it's essential to monitor your blood glucose levels regularly and be aware of symptoms like shakiness, confusion, or sweating. You should also maintain consistent meal timing and avoid skipping meals. The combination provides better glucose control than either medication alone, which helps prevent long-term diabetes complications affecting your eyes, kidneys, nerves, and cardiovascular system, as supported by recent studies 1. It's also important to note that metformin is generally considered a first-line treatment for type 2 diabetes due to its effectiveness, safety, and low cost 1, and combination therapy with other medications like Amaryl can be an effective way to achieve individualized glycemic goals 1. However, it's crucial to consider the potential side effects and interactions of both medications, such as the increased risk of hypoglycemia and gastrointestinal intolerance with metformin 1. Overall, the combination of metformin and Amaryl can be a valuable treatment option for type 2 diabetes, but it's essential to work closely with your healthcare provider to determine the best course of treatment for your specific needs.

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 Patients randomized to the combination arm started therapy with metformin hydrochloride tablets 500 mg and glyburide 20 mg. At the end of the trial, approximately 70% of the patients in the combination group were taking metformin hydrochloride tablets 2000 mg/glyburide 20 mg or metformin hydrochloride tablets 2500 mg/glyburide 20 mg.

Key Points:

• The study shows that metformin and glyburide can be taken together.
• The combination of metformin and glyburide was effective in reducing fasting plasma glucose and HbA1c levels.
• Approximately 70% of 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.

Amaryl is another name for glimepiride, not glyburide, however, both are sulfonylureas, and the study suggests that metformin can be taken with a sulfonylurea, such as glyburide. However, caution is advised when taking metformin with any other medication, including Amaryl, as the FDA label does not directly address this specific combination. 2

From the Research

Combination Therapy with Metformin and Amaryl

• Metformin and Amaryl (glimepiride) can be used together in the treatment of type 2 diabetes mellitus, as seen in studies such as 3 and 4.
• The combination of metformin and glimepiride has been shown to be effective in reducing HbA1c levels and improving glycemic control 3, 4.
• However, the use of sulfonylureas like glimepiride has been associated with a higher risk of hypoglycemia compared to other antidiabetic medications, including metformin 5.

Risks and Benefits

• The risk of serious hypoglycemia is higher with sulfonylureas like glimepiride compared to metformin, with a hazard ratio of 3.28 (2.98-3.62) vs metformin 5.
• The combination of metformin and glimepiride may be associated with weight gain, as seen in the study by 4, which reported a significant difference in mean changes from baseline in BMI between the glimepiride and metformin groups.
• Despite the potential risks, the combination of metformin and glimepiride may be a effective treatment option for patients with type 2 diabetes mellitus who are not adequately controlled with metformin alone, as suggested by studies such as 6 and 7.

Clinical Considerations

• The decision to use metformin and Amaryl together should be based on individual patient factors, including the severity of diabetes, the presence of comorbidities, and the patient's ability to monitor and manage their blood glucose levels.
• Patients using this combination should be closely monitored for signs of hypoglycemia and other adverse effects, and the dosage of glimepiride should be adjusted accordingly to minimize the risk of hypoglycemia 5.