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Talk to the doctor or pharmacist before taking the medicine if: The patient is recovering from an injury, operation, infections with fever, or from other forms of stress, inform the doctor as temporary change of treatment may be necessary.
The patient has a severe liver or kidney disorder.
If not sure if any of these apply to the patient, talk to the doctor or pharmacist before taking Amaryl.
Lowering of the haemoglobin level and breakdown of red blood cells (haemolytic anaemia) can occur in patients missing the enzyme glucose-6-phosphate dehydrogenase.
The information available on the use of Amaryl in people under 18 years of age is limited. Therefore, its use in these patients is not recommended.
Important information about hypoglycaemia (low blood sugar): When taking Amaryl, the patient may get hypoglycaemia (low blood sugar). Please see below for additional information about hypoglycaemia, its signs and treatment.
Following factors could increase the patient's risk of getting hypoglycaemia: Undernourishment, irregular meal time, missed or delayed meal or period of fasting.
Changes to the diet.
Taking more Amaryl than needed.
Having kidneys that do not work properly.
Having severe liver disease.
If the patient suffers from particular hormone-induced disorders (disorders of the thyroid glands, of the pituitary gland or adrenal cortex).
Drinking alcohol (especially when skipping a meal).
Taking certain other medicines (see Interactions).
If the patient increases the amount of exercise and doesn't eat enough or eat food containing less carbohydrate than usual.
Signs of hypoglycaemia include: Hunger pangs, headache, nausea, vomiting, sluggishness, sleepiness, problems, sleeping, restlessness, aggression, problems with concentration, reduced alertness and reaction time, depression, confusion, problems with speech and sight, slurred speech, shakiness, partial paralysis, dizziness, helplessness.
The following signs may also occur: sweating, clammy skin, anxiety, fast or increased heart beat, high blood pressure, awareness of heart beat, sudden strong pain in the breast that may radiate into neighbouring areas (angina pectoris and cardiac arrhythmias). If blood sugar levels continue to drop, the patient may suffer from considerable confusion (delirium), develop fits, lose self control, breathing may be shallow and heart beat slows down, the patient may fall into unconsciousness. The clinical procedure of a severe reduced blood sugar level may resemble that of a stroke.
Treating hypoglycaemia: In most cases the signs of reduced blood sugar vanish very quickly when the patient consumes some form of sugar, e.g. sugar cubes, sweet juice, sweetened tea.
The patient should therefore always keep some form of sugar (e.g. sugar cubes). Remember that artificial sweeteners are not effective. Please contact the doctor or go to the hospital if taking sugar does not help or if the symptoms recur.
Laboratory tests: The level of sugar in the blood or urine should be checked regularly. The doctor may also take blood tests to monitor the blood cell levels and liver function.
Amaryl contains lactose: If the patient has been told by the doctor that some sugars cannot be tolerated, contact the doctor before taking this medicine.
Driving and using machines: The ability to concentrate or react may be reduced if blood sugar is lowered (hypoglycaemia), or raised (hyperglycaemia) or if visual problems develop as a result of such conditions. Bear in mind that the patient could endanger himself/herself or others (e.g. when driving a car or using machines). Please ask the doctor whether the patient can drive a car if the patient: has frequent episodes of hypoglycaemia; has fewer or no warning signals of hypoglycaemia.
Use in Children: Amaryl is not recommended for use in children under 18 years of age.
