Third-generation sulfonylurea
ATC code: A10BB12 (Glimepiride)
Brand names
Glimepirida Cinfa, Glimepirida Normon, Amaryl, Roname, Glimepirida Sandoz
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 .
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.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
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.
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Contraindicated. In women with type 2 diabetes planning pregnancy, switch to insulin or metformin.
Contraindicated. Infant hypoglycemia risk. In nursing women – metformin or insulin.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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.
Common side effects of Glimepiride (≥ 1 in 100): Hypoglycemia, Weight gain, Nausea, Dizziness, Rash. See the Safety section for uncommon and serious reactions.
FDA category C. Contraindicated. In women with type 2 diabetes planning pregnancy, switch to insulin or metformin.
Contraindicated. Infant hypoglycemia risk. In nursing women – metformin or insulin.
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.