Key takeaways:
Glimepiride (Amaryl) is an oral medication prescribed to lower blood glucose (sugar) in adults living with Type 2 diabetes. It’s usually added to metformin, but you may be prescribed glimepiride on its own.
Glimepiride can cause side effects such as headache, nausea, and hypoglycemia (low blood glucose). Some people may also experience flu-like symptoms and weight gain.
Your healthcare provider may consider multiple factors, including your hypoglycemia risk and weight management goals, when deciding if glimepiride is right for you.
Severe allergic reactions to glimepiride are rare. And if you have a sulfa allergy, you may still be able to take glimepiride. But you should still tell your healthcare provider about any drug allergies before starting treatment.
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Glimepiride (Amaryl) is an oral medication used to lower blood glucose (sugar) in adults living with Type 2 diabetes. It belongs to the group of medications known as sulfonylureas. These are among the oldest medication classes used to treat diabetes. You may be prescribed a sulfonylurea alone, but it’s most often added to another oral medication called metformin.
Glimepiride is an effective and low-cost treatment option. But it’s not the best option for some people because of its side effects. Weight gain and hypoglycemia (low blood glucose) are a few examples. Below are eight glimepiride side effects to consider, plus how to manage them.
1. Headaches
Headaches are a common glimepiride side effect. They can happen as you’re getting started on the treatment. And most of the time, the headaches should resolve as your body adjusts to your lower blood glucose levels.
But if the headaches start interfering with your daily functioning, over-the-counter (OTC) pain medications, such as acetaminophen (Tylenol), may help. Drinking plenty of water and eating at regular times can lower your chances of getting a headache.
If your headache becomes severe, or persists beyond a few weeks, make sure to talk to your healthcare provider. They can help you figure out the cause and adjust or change your medication, if needed.
2. Flu-like symptoms
Some people taking glimepiride report flu-like symptoms such as fever, chills, or body aches. But it can be hard to know if these symptoms are a glimepiride side effect or the start of an illness. Keep in mind that diabetes can also increase your risk of an infection.
If you develop flu-like symptoms, let your healthcare provider know. They can test for viral illnesses, such as the flu or COVID-19, and get you started on treatment, if appropriate. They may also recommend OTC cold and flu medications to manage your symptoms.
Keep in mind: Keeping up to date with vaccinations, including your annual flu shot and recommended COVID boosters, can help protect you against serious viral infections.
3. Nausea
Nausea, or feeling sick to your stomach, is another common glimepiride side effect. Fortunately, the nausea usually goes away once your body adjusts to the medication.
But in the meantime, there are a few things you can try to lessen the nausea from glimepiride. For example, avoiding fried or spicy foods may help since they can contribute to an upset stomach. You may also find that eating smaller and more frequent meals provides some relief.
If your nausea gets worse or persists, contact your healthcare provider. They may recommend a temporary OTC or prescription nausea medication or suggest a change to glimepiride.
4. Hypoglycemia (low blood glucose)
Glimepiride works to lower blood glucose in Type 2 diabetes. But sometimes it can cause your blood glucose levels to drop too low (less than 70 mg/dL), which is called hypoglycemia. Some common hypoglycemia symptoms include shaking, sweating, and dizziness.
Compared to other diabetes medications, sulfonylureas have a higher hypoglycemia risk. And this risk is even higher for glimepiride because it’s long-acting — meaning it stays in the body longer. For older adults (65 and older), experts often recommend a shorter-acting sulfonylurea, such as glipizide.
You’ll be more likely to have issues with low blood glucose if you take a higher glimepiride dose. Your hypoglycemia risk is also higher if you:
Are an older adult
Have liver or kidney problems
Drink alcohol
Take multiple diabetes medications
If left untreated, hypoglycemia can be life-threatening. So, it’s important to treat it quickly. If you develop hypoglycemia symptoms while taking glimepiride, check your blood glucose. If it’s below 70 mg/dL, follow the directions given to you by your healthcare team.
Eating regular meals and avoiding alcohol can help lower the risk of experiencing hypoglycemia. You should also follow your healthcare provider’s instructions for monitoring your blood glucose. This is important because some people don’t experience hypoglycemia symptoms until levels are dangerously low.
Let your healthcare team know if you’re experiencing frequent hypoglycemia episodes. They may need to adjust your medication doses or switch you to a different treatment.
5. Weight gain
All sulfonylurea medications can cause some weight gain. This is because they work by signaling your pancreas to release more insulin. When insulin is present, it can lead to storing extra glucose in your blood as fat. The average weight gain after starting glimepiride is 5 lbs.
Keep in mind, all diabetes medications — including glimepiride — should be combined with a diabetes-friendly diet and regular exercise for best results. This can also help prevent or manage weight gain from treatment.
Discuss with your healthcare provider if you’re concerned about weight gain. They may consider a different diabetes medication with a lower risk of weight gain, or one that causes weight loss.
6. Possible hair loss
Hair loss is a possible glimepiride side effect. It wasn’t seen during clinical trials, but some people reported hair loss after glimepiride hit the market. However, it’s not clear if the hair loss was from glimepiride, diabetes itself, or a different cause.
If you think glimepiride may be contributing to hair loss or thinning, report it to your healthcare team. They will decide on continuing or changing up your diabetes medication.
7. Allergic reactions
In clinical trials, less than 1% of people taking glimepiride had signs of an allergic reaction, typically presenting as a skin rash or feeling itchy. Serious (but rare) allergic reactions have also been reported. These include anaphylaxis and life-threatening rashes.
Some people have an allergy to “sulfa” medications, like Bactrim (sulfamethoxazole / trimethoprim). In these cases, they may get a mild rash or fever during the first 2 weeks after starting one.
Even though the names sound similar, sulfonylureas may not be a problem for people with a sulfa allergy. Still, it’s best to let your healthcare team know if you have a sulfa allergy prior to starting treatment.
Keep in mind that with all medications, it’s possible to have a severe allergic reaction to an ingredient. Get immediate medical attention if you experience difficulty breathing, a fast heartbeat, or swelling of the face, neck or throat after starting glimepiride.
8. Hemolytic anemia
Hemolytic anemia is a rare glimepiride side effect. This is a condition where red blood cells are destroyed more quickly than they can be replaced. People who have a particular enzyme deficiency, known as glucose-6-phosphate dehydrogenase (G6PD) deficiency, are at a higher risk of hemolytic anemia with sulfonylureas.
Symptoms of hemolytic anemia include fatigue, dizziness, and weakness. Contact your healthcare provider right away if you experience these symptoms. They can tell you if it’s safe to continue taking your glimepiride.
When should you contact your healthcare provider about glimepiride side effects?
Most of the time, glimepiride side effects will improve with time as your body adjusts to the medication. And in the meantime, OTC remedies may help with mild side effects.
Be sure to monitor your blood glucose as recommended to avoid hypoglycemia — or catch it early. If your blood glucose is frequently low, let your healthcare provider know. It’s possible that your glimepiride dosage needs to be adjusted.
Contact your healthcare provider if any side effects worsen or don’t get better. If you experience trouble breathing, or swelling of the face and throat, this could be an allergic reaction. Call 911 or get immediate medical attention.
The bottom line
Common glimepiride side effects include headache, nausea, and weight gain. Hypoglycemia is also common, especially if you take glimepiride with other diabetes medications. Older adults and people with liver or kidney problems have a higher risk for issues with low blood glucose.
While rare, some people experience serious side effects such as allergic reactions or hemolytic anemia from glimepiride. Contact your healthcare provider if you develop fatigue, dizziness, and weakness. For symptoms of a severe allergic reaction — a severe rash, trouble breathing, or swelling of the face or mouth — get immediate medical attention.
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References
American Diabetes Association. (2022). Pharmacologic treatment of hyperglycemia in adults with type 2 diabetes.
Costello, R. A., et al. (2023). Sulfonylureas. StatPearls.
Giles, A., et al. (2019). Sulfonamide allergies. Pharmacy.
Miranda, J. J., et al. (2016). Hair follicle characteristics as early marker of type 2 diabetes. Medical Hypotheses.
National Heart, Lung, and Blood Institute. (2022). Hemolytic anemia.
Preferred Pharmaceuticals, Inc. (2023). Glimepiride [package insert].
RIchardson, S. R., et al. (2022). Glucose-6-phosphate dehydrogenase deficiency. StatPearls.
