ZORYL MS IR 2/1000

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Type 2 diabetes mellitus: to improve blood glucose control in adults when diet and exercise alone are not sufficient, or when dual therapy with sulfonylurea and metformin is appropriate

Glimepiride (a sulfonylurea) stimulates pancreatic beta cells to release insulin and improves peripheral glucose utilization. Metformin (a biguanide) decreases hepatic glucose production and improves insulin sensitivity, reducing intestinal glucose absorption.

Oral tablet. Take exactly as prescribed, usually with food to reduce stomach upset (commonly with breakfast or the first main meal). Swallow with water; do not skip meals as it may increase risk of low blood sugar. Dose is individualized based on blood glucose/HbA1c and kidney function.

Hypoglycaemia, nausea, vomiting, diarrhoea, abdominal pain, loss of appetite, metallic taste, headache, dizziness, weight gain, skin rash

Risk of hypoglycaemia (higher with missed meals, alcohol, excessive exercise, elderly, kidney/liver impairment); carry glucose and monitor sugars regularly. Metformin can rarely cause lactic acidosis—risk increases with severe kidney impairment, dehydration, sepsis, hypoxia/heart failure, excessive alcohol; stop and seek urgent care if rapid breathing, severe weakness, drowsiness, abdominal pain occur. Avoid/use with caution in renal impairment; monitor eGFR periodically and consider withholding around major surgery or severe illness. Temporarily stop metformin before/at time of iodinated contrast studies in patients at risk of renal impairment, and restart after renal function is stable. Long-term metformin may cause vitamin B12 deficiency; consider periodic monitoring. Use caution in hepatic disease and in G6PD deficiency (risk of haemolysis with sulfonylureas).