Amaryl

What you should know before using

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatrics

There is little information about the use of sulfonylureas in children. Type 2 diabetes is unusual in this age group. Type 2 diabetes is unusual in this age group.

Geriatric

Some elderly patients may be more sensitive than younger adults to the effects of sulfonylureas, especially when more than one antidiabetic medicine is being taken or if other medicines that affect blood sugar are also being taken. This may increase the chance of developing low blood sugar during treatment. Furthermore, the first signs of low or high blood sugar are not easily seen or do not occur at all in older patients. This may increase the chance of low blood sugar developing during treatment.

Also, elderly patients who take chlorpropamide are more likely to hold too much body water.

Sulfonylureas are rarely used during pregnancy. The amount of insulin needed changes during and after pregnancy. For this reason, it is easier to control blood sugar using injections of insulin, rather than with the use of sulfonylureas. Close control of blood sugar can reduce the chance of having high blood sugar during the pregnancy and of the baby gaining too much weight, or having birth defects. Be sure to tell your doctor if you plan to become pregnant or if you think you are pregnant. If insulin is not available or cannot be used and sulfonylureas are used during pregnancy, they should be stopped at least 2 weeks before the delivery date (one month before for chlorpropamide and glipizide). Glimepiride should not be used at all during pregnancy. Lowering of blood sugar can occur as a rebound effect at delivery and for several days following birth and will be watched closely by your health care professionals.

Breast Feeding

Chlorpropamide and tolbutamide pass into human breast milk and glimepiride passes into the milk of rats. Chlorpropamide is not recommended in nursing mothers but, in some cases, tolbutamide has been used. Nursing mothers should not take glimepiride. It is not known if other sulfonylureas pass into breast milk. Check with your doctor if you are thinking about breast-feeding.

Drug Interactions

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

• Bosentan

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acarbose
• Alatrofloxacin
• Balofloxacin
• Ciprofloxacin
• Clinafloxacin
• Enoxacin
• Fleroxacin
• Flumequine
• Gatifloxacin
• Gemifloxacin
• Grepafloxacin
• Levofloxacin
• Lomefloxacin
• Moxifloxacin
• Norfloxacin
• Ofloxacin
• Pefloxacin
• Prulifloxacin
• Rufloxacin
• Sparfloxacin
• Temafloxacin
• Tosufloxacin
• Trovafloxacin Mesylate

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use your medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Acid in the blood (acidosis) or
• Burns (severe) or
• Diabetic coma or
• Fever, high or
• Injury, severe or
• Ketones in the blood (diabetic ketoacidosis) or
• Surgery, major or
• Any other condition in which insulin needs change rapidly—Insulin may be needed temporarily to control diabetes in patients with these conditions because changes in blood sugar may occur rapidly and without much warning. Also, your blood sugar may need to be tested more often.

• Diarrhea, continuing or
• Female hormone changes for some women (e.g., during puberty, pregnancy, or menstruation) or
• Infection, severe or
• Mental stress, severe or
• Overactive adrenal gland, not properly controlled or
• Problems with intestines, severe or
• Slow stomach emptying or
• Vomiting, continuing or
• Any other condition that causes severe blood sugar changes—Insulin may be needed temporarily to control diabetes mellitus in patients with these conditions because changes in blood sugar may occur rapidly and without much warning. Also, your blood sugar may need to be tested more often

• Heart disease—Chlorpropamide or tolbutamide causes some patients to retain (keep) more body water than usual. Heart disease may be worsened by this extra body water.

• Kidney disease or
• Liver disease—Your blood sugar may be increased or decreased, partly because of slower removal of sulfonylurea from the body. This may change the amount of sulfonylurea you need.

• Underactive adrenal gland, not properly controlled or
• Underactive pituitary gland, not properly controlled or
• Undernourished condition or
• Weakened physical condition or
• Any other condition that causes low blood sugar—Patients with these conditions may be more likely to develop low blood sugar while taking sulfonylureas.