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Glimepiride

AEMPS

Third-generation sulfonylurea

ATC code: A10BB12

Brand names: Glimepirida Cinfa, Glimepirida Normon, Amaryl

Updated · Methodology

Indications

B

Type 2 diabetes mellitus

Second line

Type 2 diabetes in adults with preserved beta-cell function, when is above target on metformin monotherapy. Per / 2024 and redGDPS 2024, sulfonylureas are a second-line option in patients with limited access to newer classes (GLP-1 RA, SGLT2 inhibitors) or when rapid HbA1c reduction is needed. With ASCVD, HF, or CKD – GLP-1 RA or SGLT2 inhibitor takes priority. Dose: 1–6 mg once daily with breakfast. Effect at 1–2 weeks.

Sources

  1. AEMPS: Ficha técnica de Glimepirida (2024)
  2. ADA/EASD: Management of Hyperglycaemia in Type 2 Diabetes (2022)

ICD-10: E11 · ICD-11: 5A11

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Anti-aging and longevity

Not recommended

Glimepiride is sometimes prescribed in prediabetes ( 5.7–6.4%) to prevent progression to type 2 diabetes. Per 2024, 2024, and redGDPS 2024, first-line in prediabetes is lifestyle modification, with metformin in high risk (BMI ≥35, prior GDM, age <60). Sulfonylureas at HbA1c <6.5% are not indicated – hypoglycemia and weight gain risks exceed any benefit. Prescribing for longevity or for sugar control in healthy adults is clearly off-label. If prescribed without a type 2 diabetes diagnosis, consider getting a second opinion.

Sources

  1. AEMPS: Ficha técnica de Glimepirida (2024)
  2. Cochrane: Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases (2012)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Glimepiride binds the SUR1 subunit of ATP-dependent K+ channels on pancreatic beta cells – channels close, the membrane depolarizes, voltage-gated calcium channels open, and beta cells release insulin. Onset is faster and duration shorter than glibenclamide, so prolonged hypoglycemia risk is lower. Dose 1–6 mg/day matches gliclazide or glibenclamide on .

Safety

Contraindications

  • Hypersensitivity to sulfonylureas or sulfonamides
  • Type 1 diabetes
  • Diabetic ketoacidosis or precoma
  • Severe hepatic and renal impairment
  • Pregnancy and breastfeeding
  • Children

Serious adverse effects

  • Severe prolonged hypoglycemia (especially in older adults, missed meals, alcohol use, renal impairment)
  • Hemolytic anemia in G6PD deficiency
  • Cholestatic hepatitis
  • Hypersensitivity reactions (Stevens-Johnson syndrome)

Common adverse effects

  • Hypoglycemia
  • Weight gain
  • Nausea
  • Dizziness
  • Rash

Pregnancy: can you take Glimepiride?

Contraindicated. In women with type 2 diabetes planning pregnancy, switch to insulin or metformin.

Breastfeeding: can you take Glimepiride?

Contraindicated. Infant hypoglycemia risk. In nursing women – metformin or insulin.

Calculate RIDFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take 15–30 minutes before breakfast – food after the dose prevents hypoglycemia. Skip the dose if breakfast is skipped.

Monitoring

at 3 months, then every 6 months. Educate the patient about hypoglycemia symptoms (sweating, hunger, tremor, altered consciousness) and carrying fast-acting carbohydrates.
Label mentions54 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

  • Moderateantipsychoticsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatebarbituratesclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatebeta blockersclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateChloramphenicol
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateClarithromycin
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateClonidine
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateClozapine
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatecorticosteroidsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateDisopyramide
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatediureticsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatefibratesclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateFluconazole
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatefluoroquinolonesclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateFluoxetine
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatehormonal contraceptivesclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderateinsulinclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateMAO inhibitorsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateNSAIDsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateOlanzapine
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModeratePhenytoin
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • ModerateSomatropin
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatesympathomimeticsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatetetracyclinesclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Moderatethiazide diureticsclass named in the label
    «Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»

    FDA, section 7 · Open on DailyMed

  • Allopurinol
    «alopurinol, probenecid, sulfinpirazona,»

    AEMPS, section 4.5 · Open on CIMA

  • anticoagulantesclass named in the label
    «anticoagulantes cumarínicos,»

    AEMPS, section 4.5 · Open on CIMA

  • barbitúricosclass named in the label
    «glucagón, barbitúricos y rifampicina,»

    AEMPS, section 4.5 · Open on CIMA

  • betabloqueantesclass named in the label
    «Los antagonistas H2, betabloqueantes, clonidina y reserpina pueden dar lugar a una potenciación o disminución del efecto reductor de la glucosa en sangre.»

    AEMPS, section 4.5 · Open on CIMA

  • Chloramphenicol
    «cloranfenicol, ciertas sulfonamidas de acción prolongada, tetraciclinas, antibióticos tipo quinolonas y claritromicina,»

    AEMPS, section 4.5 · Open on CIMA

  • Chlorpromazine
    «derivados de fenotiazina, clorpromazina,»

    AEMPS, section 4.5 · Open on CIMA

  • Clarithromycin
    «cloranfenicol, ciertas sulfonamidas de acción prolongada, tetraciclinas, antibióticos tipo quinolonas y claritromicina,»

    AEMPS, section 4.5 · Open on CIMA

  • Clonidine
    «Los antagonistas H2, betabloqueantes, clonidina y reserpina pueden dar lugar a una potenciación o disminución del efecto reductor de la glucosa en sangre.»

    AEMPS, section 4.5 · Open on CIMA

  • corticosteroidesclass named in the label
    «agentes estimulantes del tiroides, glucocorticoides,»

    AEMPS, section 4.5 · Open on CIMA

  • Disopyramide
    «disopiramida,»

    AEMPS, section 4.5 · Open on CIMA

  • diuréticosclass named in the label
    «saluréticos, diuréticos tiazídicos,»

    AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

  • MajorGemfibrozil
    «El perfil de interacciones de gemfibrozilo es complejo. Los estudios in vivo indican que gemfibrozilo y su metabolito gemfibrozilo 1-O-β-glucurónido son potentes inhibidores de CYP2C8 (un enzima…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateCiprofloxacin
    «DRUG INTERACTIONS: Oral antidiabetic drugs Use with caution Glucose-lowering effect potentiated Hypoglycemia sometimes severe has been reported when ciprofloxacin and oral antidiabetic agents, mainly…»

    FDA, section 7 · Open on DailyMed

  • ModerateLevothyroxine sodium
    «Antidiabéticos: Levotiroxina puede reducir la eficacia hipoglicemiante de los antidiabéticos (tales como metformina, glimepirida, glibenclamida así como insulina) . Por tanto, en los pacientes…»

    AEMPS, section 4.5 · Open on CIMA

  • Dapagliflozin
    «En los estudios de interacción realizados en sujetos sanos, usando principalmente un diseño de dosis única, sugieren que la farmacocinética de dapagliflozina no se ve alterada por la metformina…»

    AEMPS, section 4.5 · Open on CIMA

  • Empagliflozin
    «Los estudios de interacciones sugieren que la farmacocinética de empagliflozina no se vio influida por la administración conjunta de metformina, glimepirida, pioglitazona, sitagliptina, linagliptina…»

    AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Glimepiride used for?

Glimepiride is evaluated for the following indications with varying evidence strength: Type 2 diabetes mellitus (evidence tier B), Anti-aging and longevity (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Glimepiride?

Common side effects of Glimepiride (≥ 1 in 100): Hypoglycemia, Weight gain, Nausea, Dizziness, Rash. See the Safety section for uncommon and serious reactions.

Is Glimepiride safe during pregnancy?

Contraindicated. In women with type 2 diabetes planning pregnancy, switch to insulin or metformin.

Is Glimepiride compatible with breastfeeding?

Contraindicated. Infant hypoglycemia risk. In nursing women – metformin or insulin.

Who should not take Glimepiride?

Glimepiride is contraindicated in: Hypersensitivity to sulfonylureas or sulfonamides; Type 1 diabetes; Diabetic ketoacidosis or precoma; Severe hepatic and renal impairment; Pregnancy and breastfeeding. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

Other drugs in this group

Insulin, Insulin aspart, Insulin degludec, Insulin detemir, Linagliptin, Semaglutide, Vildagliptin + Metformin, Insulin glargine