Glimepiride/Metformin

Pronunciation: pronunciation varies by local usage.

Generic name
glimepiride and metformin
Drug class
Sulfonylurea (glimepiride) and biguanide (metformin) combination
Form
Glimepiride and metformin are taken as separate tablets; no single fixed-dose combination tablet is approved in the US, UK, Canada, Australia, New Zealand, or EU.
Route
Oral
Legal status
Prescription-only medicine (both components)

Supply Rules Vary

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: No fixed-dose combination product registered · Full directory

What glimepiride and metformin is and how it works

Glimepiride/metformin is a combination of two oral diabetes medicines: glimepiride (a sulfonylurea) and metformin (a biguanide). It is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes. The combination is prescribed as two separate tablets taken together; a single fixed-dose tablet is not available in the US, UK, Canada, Australia, New Zealand, or EU. (1) (4) (5) (3) (6) (2)

Treatment is initiated and adjusted by a diabetes care team. Doses are individualized. Metformin carries a boxed warning for lactic acidosis. Glimepiride can cause serious hypoglycemia. This combination is not for type 1 diabetes or diabetic ketoacidosis.

Mechanism of action: how glimepiride and metformin works

Metformin hydrochloride is a biguanide that decreases hepatic glucose production, reduces intestinal glucose absorption, and improves insulin sensitivity. Glimepiride is a sulfonylurea that lowers blood glucose primarily by stimulating insulin secretion from pancreatic beta-cells. The two mechanisms are complementary. (1) (4) (5) (3) (2)

What glimepiride and metformin is used for

Type 2 diabetes mellitus

As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both glimepiride and metformin is appropriate. Combination therapy may be used when metformin alone or glimepiride alone does not provide adequate control. In patients not adequately controlled with maximum metformin, glimepiride can be added; conversely, metformin can be added to glimepiride. Initiation of combination therapy should be under close medical supervision. (1) (4) (5) (6) (2)

Before taking glimepiride and metformin

Do not take / not appropriate for

  • Do not take if you have severe renal impairment (metformin is contraindicated when eGFR is below 30 mL/min/1.73 m²; glimepiride requires dose reduction and is contraindicated in severe impairment). (all components) (1) (4) (5) (3) (6) (2)
  • Do not take if you have acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. (all components) (1) (4) (5) (3) (6) (2)
  • Do not take if you have known hypersensitivity to glimepiride, other sulfonylureas, sulfonamides, metformin, or any ingredient in these products. (all components) (1) (4) (5) (3) (6)
  • Do not take if you have type 1 diabetes. This combination is only for type 2 diabetes. (all components) (4) (5) (3) (6) (2)
  • Do not take during pregnancy or breastfeeding (glimepiride is contraindicated; metformin is contraindicated in some regions). Insulin is generally preferred for diabetes management during these periods. (all components) (4) (5) (6) (3) (2)

Tell your clinician about

  • All current prescription and non-prescription medicines, vitamins, and herbal supplements, especially other diabetes medicines, alcohol use, and drugs that can interact (e.g., antifungal medicines like fluconazole or miconazole, cimetidine, ranolazine, vandetanib, dolutegravir, diuretics, corticosteroids, ACE inhibitors, beta-blockers).
  • Complete medical history, including kidney or liver problems, heart failure, history of lactic acidosis, G6PD deficiency, planned surgery or radiologic studies with contrast dye, episodes of low blood sugar, and any allergies (especially to sulfa drugs).
  • Pregnancy plans, current pregnancy, or breastfeeding status.
  • Any symptoms of illness, fever, trauma, infection, or stress, as these may require temporary treatment changes.
(1) (4) (5) (3) (6) (2)

How to take glimepiride and metformin

  • Take metformin tablets with meals to reduce stomach upset. Glimepiride is usually taken once daily shortly before or with the first main meal.
  • Swallow tablets whole with water. Doses are individualized by your prescriber—never change the dose, timing, or stop taking without instruction.
  • Frequent blood sugar monitoring is required, especially when starting or changing the dose. Follow your healthcare team's monitoring plan.
  • This combination is taken as two separate tablets; there is no single fixed-dose combination tablet in the approved markets. Do not substitute one component for the other without medical advice.
(1) (4) (5) (3) (6) (2)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6) (8) (9)

Missed dose

Contact your prescriber or diabetes care team for specific instructions if you miss a dose of either medicine. Do not take a double dose to make up for a missed one.

Overdose

Metformin overdose can cause life-threatening lactic acidosis, especially with renal impairment. Glimepiride overdose can lead to severe, prolonged hypoglycemia. If an overdose is suspected, seek emergency medical attention immediately. Do not attempt to treat severe hypoglycemia at home without guidance. (1) (4) (5) (2)

Side effects

Side effects vary. Metformin commonly causes gastrointestinal symptoms. Glimepiride primarily causes hypoglycemia. The most serious risks are lactic acidosis (metformin) and severe hypoglycemia (glimepiride).

Gastrointestinal distress (from metformin)

What to notice: Diarrhea, nausea, vomiting, flatulence, abdominal discomfort, indigestion, loss of appetite, or a metallic taste. These often improve over time; taking metformin with food may help.

What to do: If symptoms are severe, persistent, or lead to dehydration, contact your diabetes team. Do not stop metformin unless advised. (1) (3) (2)

Hypoglycemia (from glimepiride, risk increased with combination)

What to notice: Headache, dizziness, sweating, shakiness, hunger, confusion, irritability, fast heartbeat, blurred vision, or weakness. Severe hypoglycemia may cause loss of consciousness or seizures.

What to do: Always carry a fast-acting sugar source. Treat mild lows as instructed. If symptoms are frequent, severe, or not relieved, contact your prescriber immediately. Do not skip meals. (4) (5) (6)

Headache, weakness, or asthenia

What to notice: May occur with either drug. Could also be a sign of hypoglycemia or another condition.

What to do: Report persistent or bothersome symptoms to your diabetes care team. (1) (4) (2)

Lactic acidosis (metformin emergency)

What to notice: Unexplained muscle pain, difficulty breathing, unusual sleepiness or drowsiness, stomach pain with nausea/vomiting/diarrhea, feeling cold (especially in arms and legs), dizziness, lightheadedness, slow or irregular heartbeat.

What to do: Seek emergency medical care immediately and tell the team you take metformin. Lactic acidosis is a medical emergency that requires hospital treatment; the clinical team will decide whether to withhold or stop the medicine. (1) (2) (3)

Severe hypoglycemia

What to notice: Severe confusion, inability to eat or drink safely, loss of consciousness, seizure, or symptoms of hypoglycemia that do not respond to oral sugar.

What to do: Get emergency help. Do not attempt to force oral fluids. If prescribed glucagon, a caregiver may administer it as directed. (4) (5) (6)

Allergic or serious skin reactions

What to notice: Skin rash, hives, swelling of face/lips/tongue/throat, difficulty swallowing or breathing, blistering, peeling skin, or oral ulcers.

What to do: Seek urgent medical attention. Allergic reactions may be severe and require discontinuation. (4) (5)

Blood disorders (glimepiride)

What to notice: Unexpected bruising or bleeding, tiny red/purple spots on skin, fever, sore throat, mouth ulcers, extreme tiredness (signs of thrombocytopenia or leukopenia).

What to do: Contact your prescriber immediately for assessment. (5) (6)

Serious warnings

Lactic acidosis (BOXED WARNING – Metformin) — emergency

Symptoms: Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms include malaise, myalgia, muscle cramps, respiratory distress, increasing somnolence, and non-specific abdominal distress; may progress to acidotic dyspnea, coma, and cardiovascular collapse.

Action: Seek emergency medical care immediately. Lactic acidosis requires hospital-based supportive measures, and the clinical team will decide on discontinuing metformin and whether prompt hemodialysis is needed. (1) (2) (3)

Severe hypoglycemia — emergency

Symptoms: Severe confusion, inability to swallow, loss of consciousness, seizures. Hypoglycemia can be prolonged and may resemble a stroke.

Action: Administer fast-acting sugar if conscious and able to swallow; otherwise, use prescribed glucagon and call emergency services. Do not give food or drink if unconscious. (4) (5) (6)

Vitamin B12 deficiency (Metformin) — important

Symptoms: Tiredness, pale skin, sore red tongue, numbness or tingling in hands and feet, memory problems. Approximately 7% of metformin users may develop subnormal vitamin B12 levels over time.

Action: Discuss annual B12 monitoring with your clinician. Do not self-treat without guidance. (1) (2)

Hemolytic anemia in G6PD deficiency (Glimepiride) — caution

Symptoms: Sulfonylureas like glimepiride may trigger hemolysis in people with G6PD deficiency. Watch for dark urine, yellowing of skin or eyes, pallor, fatigue, or abdominal pain.

Action: Before starting, inform your clinician if you have G6PD deficiency. A non-sulfonylurea alternative may be considered. (4) (5) (6)

Interactions

Medicine or testEffectAction
AlcoholIncreases risk of hypoglycemia (glimepiride) and lactic acidosis (metformin). Chronic or binge drinking may alter blood sugar control unpredictably.Avoid or strictly limit alcohol. Discuss safe limits with your diabetes team. (1) (4) (2)
Iodinated contrast media (e.g., for CT scans)Metformin must be temporarily withheld before and after exposure to reduce risk of lactic acidosis.Tell your radiologist and prescriber that you take metformin. Usually stop metformin 48 hours before the procedure and restart only after renal function is rechecked (at least 48 hours after). (1) (2) (3)
Other antidiabetic agents (including insulin, sulfonylureas, repaglinide, etc.)Additive hypoglycemic effect; combination requires close monitoring and dose adjustment.All glucose-lowering drug changes must be managed by your prescriber. Do not add or switch agents yourself. (1) (4) (2) (5)
Drugs that reduce renal clearance of metformin (e.g., cimetidine, ranolazine, vandetanib, dolutegravir, some NSAIDs)May increase metformin levels, raising lactic acidosis risk.Ensure your prescriber knows all medicines you take. Dose adjustments or closer monitoring of renal function may be needed. (1) (3) (2)
Azole antifungals (e.g., fluconazole, miconazole)Potentiate the effect of glimepiride, leading to severe hypoglycemia; miconazole (even topical oral gel) may cause severe, hard-to-correct hypoglycemia.Avoid concomitant use if possible. If prescribed, discuss glucose monitoring and possible glimepiride dose reduction with your clinician. (4) (5)
Beta-blockers and other sympatholytic agentsMay mask some warning symptoms of hypoglycemia (e.g., palpitations, tremor), making hypoglycemia harder to detect.More frequent blood glucose monitoring is essential. Be aware of other hypoglycemia signs such as sweating (unmasked), hunger, or confusion. (6) (2)
Medicines that can raise blood glucose (e.g., corticosteroids, thiazide diuretics, thyroid hormones, estrogens, phenytoin)May reduce the effectiveness of both glimepiride and metformin, possibly requiring dose increases.Inform your prescriber; dose adjustment of diabetes medicines may be needed when starting or stopping these drugs. (4) (5) (3) (2)
ColesevelamReduces glimepiride absorption if taken at the same time.Take glimepiride at least 4 hours before colesevelam. (4)

Pregnancy, breastfeeding, kidney/liver function, age

Renal impairment

Metformin is contraindicated in severe renal impairment (eGFR <30 mL/min/1.73m²) and not recommended to start when eGFR is 30–45. Glimepiride is contraindicated in severe impairment; if used in mild–moderate impairment, start at 1 mg and titrate cautiously. Both components require dose adjustment; your prescriber will determine individual dosing based on kidney function. Frequent renal monitoring is essential. (1) (4) (5) (3) (2)

Hepatic impairment

Metformin should be avoided in hepatic impairment due to reduced lactate clearance, increasing lactic acidosis risk. Glimepiride is contraindicated in severe hepatic impairment; conversion to insulin is recommended. Do not use this combination if you have significant liver disease unless specifically advised by your specialist. (1) (4) (5) (3) (2)

Pregnancy and breastfeeding

Glimepiride is contraindicated in pregnancy and breastfeeding in many regions; insulin is the standard of care. Metformin is contraindicated in pregnancy in some labels (Canada, NZ), though it is used off-label in gestational diabetes elsewhere. This combination should not be used during pregnancy unless clearly necessary and under specialist supervision. Breastfeeding is generally not recommended because glimepiride may cause neonatal hypoglycemia and metformin is excreted in breast milk. Discuss all options with your healthcare team before conceiving or if pregnancy is suspected. (1) (4) (5) (3) (6) (2)

Elderly patients

Elderly individuals are more susceptible to hypoglycemia and lactic acidosis. Start with the lowest effective doses (glimepiride 1 mg, metformin at the lower end of the range) and monitor renal function more frequently. Metformin should only be used in those ≥80 years if renal function is confirmed normal. Report any unusual symptoms promptly. (1) (4) (3) (2)

Children and adolescents

The combination has not been studied in children. Metformin is approved for type 2 diabetes in children ≥10 years; glimepiride is not recommended in pediatric patients. Use only under a pediatric endocrinologist’s guidance. (1) (4) (6)

G6PD deficiency

Sulfonylureas, including glimepiride, can cause hemolytic anemia in patients with G6PD deficiency. Before starting, discuss with your clinician whether a non-sulfonylurea alternative would be safer for you. (4) (5) (6)

Monitoring

Before starting

  • Confirm diagnosis of type 2 diabetes and assess suitability of oral combination therapy.
  • Measure renal function (eGFR and serum creatinine) to determine metformin dose and safety. Do not start metformin if eGFR is below 30, and carefully weigh risks if eGFR is 30–45.
  • Check liver function tests; avoid combination in severe hepatic impairment.
  • Screen for G6PD deficiency before starting glimepiride, especially in populations with higher prevalence.
  • Review all concurrent medications for potential interactions.
  • Assess risk factors for lactic acidosis, including age, cardiovascular status, alcohol use, and planned procedures.
  • Establish baseline blood glucose and HbA1c, and set individualized glycemic targets.

During treatment

  • Monitor renal function at least annually (more frequently in elderly or those with impaired function). Metformin dose must be adjusted or discontinued if renal function declines.
  • Check serum vitamin B12 levels annually due to risk of metformin-induced deficiency.
  • Regular blood glucose monitoring as directed by your care team; more frequent monitoring during dose changes, illness, or when adding new drugs.
  • Be vigilant for symptoms of hypoglycemia and lactic acidosis; teach patient and caregivers to recognize them.
  • Reassess liver function if symptoms suggest hepatic injury.
  • Monitor for signs of hematologic or serious skin reactions (e.g., unexplained bruising, rash).
  • If intercurrent illness, trauma, surgery, or radiologic contrast exposure occurs, metformin may need temporary cessation.
  • Periodically review the need for continued combination therapy and consider step-down or insulin substitution as appropriate.
(1) (4) (5) (3) (2)

Storage

Store glimepiride and metformin tablets at room temperature away from moisture, heat, and light. Keep each medicine in its original container unless your pharmacist provides an alternative. Follow any specific storage instructions on the pharmacy label.

Professional information

This information is derived from the separate approved labels for glimepiride and metformin, as no fixed-dose combination product is marketed in the US, UK, Canada, Australia, New Zealand, or EU. Always consult the current local product information for each individual component. This page does not replace clinical judgment.

All regions

Indication: Type 2 diabetes mellitus – combination therapy

Dose summary: Dosing is with two separate oral tablets; no single fixed-dose combination exists. Typical guidance: Metformin: start 500 mg twice daily or 850 mg once daily with meals, titrate upward every 1–2 weeks; maximum 2000–2550 mg/day in divided doses (max 3000 mg/day only if CrCl >120 mL/min per some labels). Glimepiride: start 1–2 mg once daily with breakfast or first main meal, titrate by 1–2 mg every 1–2 weeks; usual maximum 8 mg/day (UK SmPC max 6 mg/day). When adding glimepiride to existing metformin, start glimepiride at low dose (1 mg) and titrate. When adding metformin to glimepiride, maintain glimepiride dose and titrate metformin. Combination therapy initiation should be under close medical supervision due to hypoglycemia risk.

Renal context: Metformin: contraindicated if eGFR <30; not recommended to start if eGFR 30–45; reassess risk-benefit if eGFR falls below 45. Glimepiride: contraindicated in severe renal impairment; start 1 mg in any degree of impairment and titrate cautiously. Combined use in moderate renal impairment greatly increases risk of lactic acidosis and hypoglycemia. (1) (4) (5) (3) (2)

Mechanism of action

Hepatic guidance

Metformin is avoided in hepatic insufficiency due to impaired lactate clearance. Glimepiride is contraindicated in severe hepatic impairment. In mild-to-moderate hepatic disease, individual risk-benefit assessment is required; insulin may be safer.

Overdose note

Metformin overdose may cause life-threatening lactic acidosis, especially with concurrent renal impairment. Prompt hemodialysis is effective. Glimepiride overdose results in prolonged hypoglycemia, managed with oral or intravenous glucose and hospital monitoring for 24–48 hours due to risk of recurrence. (1) (4) (5) (3) (2)

Frequently asked questions

Is there a single pill that combines glimepiride and metformin?

No fixed-dose combination tablet containing both glimepiride and metformin is currently approved in the United States, United Kingdom, Canada, Australia, New Zealand, or the European Union. In these regions, your doctor will prescribe glimepiride and metformin as two separate tablets that you take together. (8) (9)

Why do I need to be careful about lactic acidosis?

Metformin, one of the components, carries a boxed warning for lactic acidosis—a rare but potentially fatal condition. Risk is higher with kidney problems, alcohol use, age over 65, certain medications, and during events like surgery or contrast dye studies. Know the warning signs (unexplained muscle pain, breathing difficulty, drowsiness, stomach pain) and seek emergency care if they occur. (1) (2)

Can I drink alcohol while taking glimepiride and metformin?

Alcohol can increase the risk of both lactic acidosis (from metformin) and severe hypoglycemia (from glimepiride). It is safest to avoid alcohol or discuss strict limits with your diabetes care team. (1) (4) (2)

What should I do if I need a CT scan or surgery?

Tell your doctor and radiologist that you take metformin. You will likely need to stop metformin 48 hours before the procedure and not restart until your kidney function is checked, usually at least 48 hours afterward. Glimepiride may also need to be adjusted. Follow your team's instructions precisely. (1) (2) (3)

Can I take this combination during pregnancy?

Most labels advise against using glimepiride/metformin during pregnancy. Insulin is generally the treatment of choice for diabetes in pregnancy. If you are planning pregnancy or become pregnant, contact your doctor immediately—do not stop your medicines without guidance. (4) (5) (6) (3)

What is the mechanism of action of glimepiride and metformin?

Metformin hydrochloride is a biguanide that decreases hepatic glucose production, reduces intestinal glucose absorption, and improves insulin sensitivity. Glimepiride is a sulfonylurea that lowers blood glucose primarily by stimulating insulin secretion from pancreatic beta-cells. The two mechanisms are complementary. (1) (4) (5) (3) (2)

What is the generic name of Glimepiride/Metformin?

The generic name is glimepiride and metformin. (1) (2) (3) (4) (5) (6) (8) (9)

What class of drug is glimepiride and metformin?

Glimepiride/Metformin is classed as: Sulfonylurea (glimepiride) and biguanide (metformin) combination. (1) (2) (3) (4) (5) (6) (8) (9)

References

  1. Metformin Hydrochloride Tablets — prescribing informationU.S. National Library of Medicine, DailyMed · United States · accessed 2025-04-09 · source 1
  2. Metformin (Apotex NZ Ltd) data sheetNew Zealand Medicines and Medical Devices Safety Authority (Medsafe) · New Zealand · accessed 2025-04-09 · source 2
  3. TEVA-METFORMIN (metformin hydrochloride) Product MonographHealth Canada · Canada · dated 2013-07-25 · accessed 2025-04-09 · source 3
  4. Glimepiride Tablets, USP — prescribing informationU.S. National Library of Medicine, DailyMed · United States · accessed 2025-04-09 · source 4
  5. Glimepiride 4 mg Tablets — Summary of Product Characteristicselectronic Medicines Compendium (UK) · United Kingdom · accessed 2025-04-09 · source 5
  6. AMARYL (glimepiride) Product MonographHealth Canada · Canada · dated 2016-12-29 · accessed 2025-04-09 · source 6
  7. AMARYL and generic glimepiride entries on the Australian Register of Therapeutic GoodsTherapeutic Goods Administration · Australia · accessed 2025-04-09 · source 7
  8. Metformin ARTG entries and safety alert for lactic acidosisTherapeutic Goods Administration · Australia · accessed 2025-04-09 · source 8
  9. Metformin and metformin‑containing medicines referral and updateEuropean Medicines Agency · European Union · accessed 2025-04-09 · source 9

Brand names by country

Single-ingredient glimepiride and metformin names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • No fixed-dose combination product registeredgap verified · Not applicable - separately approved mono-component tablets (glimepiride, metformin) available · Not applicable - see individual mono-component labels

United Kingdom

  • No fixed-dose combination product registeredgap verified · Not applicable - separately approved mono-component tablets (glimepiride, metformin) available · Not applicable - see individual mono-component labels

Canada

  • No fixed-dose combination product registeredgap verified · Not applicable - separately approved mono-component tablets (glimepiride, metformin) available · Not applicable - see individual mono-component labels

Australia

  • No fixed-dose combination product registeredgap verified · Not applicable - separately approved mono-component tablets (glimepiride, metformin) available · Not applicable - see individual mono-component labels

New Zealand

  • No fixed-dose combination product registeredgap verified · Not applicable - separately approved mono-component tablets (glimepiride, metformin) available · Not applicable - see individual mono-component labels
View brands in additional countries.

European Union

No fixed-dose combination product registered

This page provides general medicine information, not a diagnosis, prescription, or substitute for the specialist and current local product information. It is based on separate approved labels for glimepiride and metformin; no fixed-dose combination product is registered in the six referenced markets. Always consult your prescriber or pharmacist for individual advice.

Related medicines