Based on experience with Amaryl and on what is known of other sulfonylureas, the following adverse effects must be considered:
As a result of the blood sugar-lowering action of Amaryl, hypoglycaemia may occur and may also be prolonged.
Possible symptoms of hypoglycaemia include headache, ravenous hunger, nausea, vomiting, lassitude, sleepiness, disordered sleep, restlessness, aggressiveness, impaired concentration, impaired alertness and reactions, depression, confusion, speech disorders, aphasia, visual disorders, tremor, paresis, sensory disturbances, dizziness, helplessness, loss of self-control, delirium, cerebral convulsions, somnolence and loss of consciousness up to and including coma, shallow respiration and bradycardia. In addition, signs of adrenergic counter-regulation may be present eg, sweating, clammy skin, anxiety, tachycardia, hypertension, palpitations, angina pectoris and cardiac arrhythmias. The clinical picture of a severe hypoglycaemic attack may resemble that of a stroke. Once hypoglycaemia has been corrected, all of the previously mentioned symptoms almost always subside.
Especially at the start of treatment, temporary visual impairment may occur due to the change in blood sugar levels.
Occasionally, gastrointestinal symptoms such as the following may occur: Nausea, vomiting, sensations of pressure or fullness in the epigastrium, abdominal pain and diarrhoea.
In isolated cases, liver enzyme levels may increase and impairment of liver function (eg, with cholestasis and jaundice) and hepatitis may develop, possibly resulting in liver failure.
Severe changes in the blood picture may occur: Rarely, thrombopenia and, in isolated cases, leucopenia, haemolytic anaemia, or eg, erythrocytopenia, granulocytopenia, agranulocytosis and pancytopenia (eg, due to myelosuppression) may develop.
Occasionally, allergic or pseudoallergic reactions may occur eg, in the form of itching, urticaria or rashes. Such reactions are mild but may become more serious and accompanied by dyspnoea and a fall in blood pressure, sometimes progressing to shock. If urticaria occurs, a physician must be notified immediately.
In isolated cases, the following may occur: Allergic vasculitis, hypersensitivity of the skin to light and a decrease in serum sodium.
Consult a physician if any of these adverse effects or any other undesired effects or unexpected changes are noticed.
Since some adverse effects eg, severe hypoglycaemia, certain changes in blood picture, severe allergic or pseudoallergic reactions, or liver failure, may under certain circumstances, become life-threatening, it is essential, if sudden or severe reactions do occur, to inform a physician at once, and on no account continue taking the drug without a physician's express guidance.