Glimepiride / Rosiglitazone Side Effects

Medically reviewed by Drugs.com. Last updated on Feb 13, 2024.

Applies to glimepiride / rosiglitazone: oral tablet.

Important warnings This medicine can cause some serious health issues

You should not use glimepiride and rosiglitazone if you have severe or uncontrolled heart failure, or if you are allergic to sulfa drugs. Do not use this medicine if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• shortness of breath (even with mild exertion), swelling, rapid weight gain;

• chest pain or heavy feeling, pain spreading to the arm or jaw, nausea, sweating, general ill feeling;

• pale skin, easy bruising or bleeding, weakness;

• upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• changes in your vision; or

• severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

• headache; or

• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

For healthcare professionals

Applies to glimepiride / rosiglitazone: oral tablet.

General adverse events

The most commonly reported adverse reports included headache, hypoglycemia, and nasopharyngitis.^[Ref]

Cardiovascular

Glimepiride-Rosiglitazone:

• Common (1% to 10%): Edema, hypertension
• Uncommon (0.1% to 1%): Congestive heart failure

Glimepiride: Common (1% to 10%): Edema, hypertension

Rosiglitazone:

• Common (1% to 10%): Edema, hypertension
• Uncommon (0.1% to 1%): Congestive heart failure
• Frequency not reported: Cardiovascular deaths, myocardial infarction, angina, angina pectoris, angina dyspnea, myocardial infarction, coronary thrombosis, myocardial ischemia, coronary artery disease, coronary artery disorder^[Ref]

Major Adverse Cardiovascular Events:

Overall data from rosiglitazone long-term trials including the RECORD, ADOPT, and DREAM trials (rosiglitazone n=6311; control n=7756) showed no difference in overall mortality or major adverse cardiovascular events; however, a meta-analysis of shorter-term trials suggests and increased risk for myocardial infarction with rosiglitazone compared with placebo.

The RECORD trial (Rosiglitazone evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes; mean age 58 years; 52% male) revealed no significant difference in cardiovascular hospitalization or cardiovascular death (primary outcome) among patients with type 2 diabetes receiving rosiglitazone add-on therapy (n=2220) compared with active control (n=2227); however, there was a significant difference in the incidence of congestive heart failure (secondary endpoint). Patients who had failed metformin or sulfonylurea monotherapy were randomized to add-on rosiglitazone or active control (add-on metformin for those inadequately controlled on sulfonylurea or add-on sulfonylurea for those inadequately controlled on metformin). Patients were treated to a target glycosylated hemoglobin (HbA1c) of 7% or less. Heart failure was reported in 61 patients receiving add-on rosiglitazone and 29 patients receiving active control.

In a retrospective analysis of 42 clinical trials (mean duration 6 months), rosiglitazone was associated with an increased risk of myocardial ischemia compared with combined active or placebo control (2% versus 1.53%). These events included angina pectoris, angina dyspnea, myocardial infarction, coronary thrombosis, myocardial ischemia, coronary artery disease, and coronary artery disorder. There was an increased risk with combination insulin therapy and in patients receiving nitrates for known coronary heart disease.

Cardiovascular Events in Patients with NYHA Class I and II Heart Failure:

An increased risk of cardiovascular events was observed in a 52-week trial in patients with NYHA Class I and II Heart Failure receiving rosiglitazone (n=110) compared with placebo (n=114). These events included: cardiovascular deaths (5% vs 4%), worsening CHF (6% vs 4%), new or worsening edema (25% vs 9%), new or worsening dyspnea (26% vs 17%), increases in CHF medication (33% vs 18%), and cardiovascular hospitalization (19% vs 13%).

Edema:

Dose-related edema was reported in rosiglitazone clinical trials. In patients receiving rosiglitazone 8 mg in combination with a sulfonylurea, the incidence of edema was 12.4%. In monotherapy trials, edema was reported in 4.8% of patients receiving rosiglitazone (dose not specified). Healthy volunteers receiving rosiglitazone 8 mg once daily for 8 weeks experienced a statistically significant increase in median plasma volume compared with placebo.

Concomitant Administration with Insulin:

Edema was reported with higher frequency in the rosiglitazone plus insulin combination trials (insulin, 5.4%; and rosiglitazone with insulin 14.7%). Reports of new onset or exacerbation of congestive heart failure occurred at a rate of 1% for insulin alone, 2% (4 mg) and 3% (8 mg) for insulin in combination with rosiglitazone. The coadministration of rosiglitazone and insulin is not recommended.^[Ref]

Respiratory

Glimepiride-Rosiglitazone:

• Common (1% to 10%): Nasopharyngitis

Rosiglitazone:

• Common (1% to 10%): Upper respiratory infection
• Postmarketing reports: Pulmonary edema, pleural effusions^[Ref]

Nervous system

Glimepiride-Rosiglitazone:

• Common (1% to 10%): Headache, dizziness

Glimepiride:

• Common (1% to 10%): Headache, dizziness

Rosiglitazone:

• Common (1% to 10%): Headache
• Frequency not reported: Stroke^[Ref]

Endocrine

• Frequency not reported: Resumption of ovulation in premenopausal, anovulatory women, hormonal imbalance^[Ref]

Gastrointestinal

Glimepiride:

• Common (1% to 10%): Nausea
• Rare (less than 0.1%): Vomiting, gastrointestinal pain, diarrhea

Rosiglitazone:

• Common (1% to 10%): Diarrhea^[Ref]

Hepatic

Glimepiride:

• Rare (less than 0.1%): Liver enzyme elevations,
• Frequency not reported: Liver function impairment, e.g., cholestasis, jaundice, hepatitis, hepatic porphyria reactions and disulfiram-like reactions

Rosiglitazone:

• Postmarketing reports: Hepatitis, hepatic enzyme elevations greater than 3 times the upper limit of normal, hepatic failure^[Ref]

Hypersensitivity

Rosiglitazone:

• Postmarketing reports: Anaphylactic reaction^[Ref]

Dermatologic

Glimepiride:

• Rare (less than 0.1%): Allergic skin reactions, e.g. pruritus, erythema, urticaria, and morbilliform or maculopapular eruptions
• Frequency not reported: Porphyria cutanea tarda, photosensitivity reactions, allergic vasculitis

Rosiglitazone:

• Postmarketing reports: Rash, pruritus, urticaria, angioedema, Stevens-Johnson syndrome^[Ref]

Hematologic

Glimepiride:

• Frequency not reported: Leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, pancytopenia

Rosiglitazone:

• Common (1% to 10%): Anemia
• Frequency not reported: Decrease in WBC counts^[Ref]

Anemia was reported in 1.9% of patients receiving rosiglitazone as monotherapy. When taken in combination with metformin, a sulfonylurea, or metformin plus a sulfonylurea, the incidence of anemia was 7.1%, 2.3%, and 6.7%, respectively. Laboratory findings have shown dose-related decreases in hemoglobin and hematocrit; mean decreases in hemoglobin were 1 g/dL and up to 3.3% in hematocrit. These changes primarily occurred during the first 3 months or following a dose increase. They may be related to increased plasma volume.^[Ref]

Metabolic

Glimepiride-Rosiglitazone:

• Common (1% to 10%): Hypoglycemia
• Frequency not reported: Weight gain

Glimepiride:

• Common (1% to 10%): Hypoglycemia
• Frequency not reported: Hyponatremia, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, changes in serum lipids

Rosiglitazone:

• Uncommon (0.1% to 1%): Hypoglycemia^[Ref]

The mechanism of weight gain is unclear, although it probably is due to a combination of fluid retention and fat accumulation. Dose-related weight gain was observed in trials with the combination glimepiride / rosiglitazone and rosiglitazone alone. Mean weight gain in patients receiving the combination glimepiride 4 mg/rosiglitazone 4 mg was 2.2 kg and 2.9 kg for patients receiving glimepiride 4 mg/rosiglitazone 8 mg.^[Ref]

Ocular

Glimepiride:

• Uncommon (0.1% to 1%): Blurred vision

Rosiglitazone:

• Postmarketing reports: Diabetic macular edema with decreased visual acuity^[Ref]

Musculoskeletal

Rosiglitazone:

• Common: Back pain, arthralgia,
• Frequency not reported: Fractures, bone mineral density decreases^[Ref]

Large long-term clinical trials have shown an increased incidence of bone fracture in patients receiving rosiglitazone in combination with sulfonylurea or metformin as rosiglitazone alone. This increased incidence appeared after the first year and persisted. The majority of fractures were observed in women and occurred in the upper arm, hand, and foot.^[Ref]

Other

Glimepiride:

• Common (1% to 10%): Asthenia

Rosiglitazone:

• Common (1% to 10%): Injury^[Ref]

Further information

Glimepiride/rosiglitazone side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer