Amaryl M Usage And SafetyDosageGlimepiride, Metformin HClSide EffectsDiarrhea, vomiting, metallic taste, rash, isolated transaminase elevations, cholestatic jaundice, allergic skin reactions, photosensitivity reactions, leukopenia, agranulocytosis, thrombocytopenia, hemolyticanemia, aplastic anemia, pancytopenia and blurred vision. Glimepiride appears to be associated with a low incidence of hypoglycemia.Drug InteractionsGlimepiride: Salicylates, sulfonamides, chloramphenicol, coumarins, probenecid, monoamine oxidase inhibitors , thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics and isoniazid , rifampicin, fluconazole, amiodarone, tolbutamide, diclofenac, ibuprofen, naproxen , clonidine and reserpine. Metformin HCl: Phenprocoumon, hyperglycemic agent (e.g. – thiazides, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channelblocking drugs and isoniazid), alcohol, furosemide, nifedipine and cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim and cimetidine, vancomycin). IndicationGlimepiride + Metformin HCl is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes whose diabetes is not adequately controlled with glimepiride or metformin HCl alone, or for those patients who have initially responded to glimepiride or metformin HCl alone and require additional glycemic control.When not to UseGlimepiride + Metformin HCl combination is contraindicated in:- Patients with known hypersensitivity to sulfonylurea or biguanide or any component of the drug.- Insulin-dependent diabetes mellitus.- Renal or hepatic failure.- Alcoholism.- NIDDM complicated by severe ketosis and acidosis.- Diabetic pre-coma and coma.- Patients undergoing surgery, after severe trauma or during infections.- Chronic obstructive pulmonary disease.- Coronary heart disease, cardiac failure.