Hypoglycaemia, nausea, diarrhoea, abdominal pain, flatulence, bloating, headache, dizziness, metallic taste

Risk of hypoglycaemia (higher with missed meals, alcohol, heavy exercise); carry glucose. Metformin may rarely cause lactic acidosis—seek urgent care for rapid breathing, severe weakness, abdominal pain, excessive sleepiness. Use with caution/avoid in severe kidney impairment, severe liver disease, dehydration, severe infection, shock, or heart/respiratory failure; kidney function monitoring required. Stop temporarily before/after iodinated contrast procedures and major surgery as advised. Not for type 1 diabetes or diabetic ketoacidosis. May cause vitamin B12 deficiency with long-term use.

Alcohol (increases hypoglycaemia and lactic acidosis risk), insulin/other antidiabetics (additive hypoglycaemia), beta-blockers (mask hypoglycaemia symptoms), corticosteroids/thiazide diuretics (raise glucose), ACE inhibitors (may increase hypoglycaemia risk), rifampicin (may reduce glimepiride effect), azole antifungals/macrolides (may increase sulfonylurea levels), iodinated contrast media (metformin—lactic acidosis risk), cimetidine (increases metformin levels)

Store below 25°C in a cool, dry place away from moisture and direct light; keep in original blister pack; keep out of reach of children.

Glycomet-GP 1 Forte (SR), Glimestar-MV 1, Glimepiride+Metformin+Voglibose 1 mg/500 mg/0.3 mg tablets (various brands), Vobit-MG 1 (where available), Tripride-MV 1 (where available)