Indications for: Glipizide/Metformin
Adjunct to diet and exercise in type 2 diabetes, as initial therapy or as second-line therapy when response to a sulfonylurea or metformin is inadequate.
Take with meals. First-line: initially 2.5mg/250mg once daily; or, if fasting plasma glucose is 280–320mg/dL, may start at 2.5mg/500mg twice daily. May increase by 1 tab/day every 2 weeks; max 10mg/1000mg or 10mg/2000mg per day in divided doses. Second-line: (previously treated with sulfonylurea or metformin only): 2.5mg/500mg or 5mg/500mg twice daily (AM & PM) (initial dose should not exceed previous daily doses of individual components); may increase by increments of ≤5mg/500mg up to minimum effective dose or max 20mg/2000mg per day. Previously treated with combination therapy (sulfonylurea plus metformin): may be switched to 2.5mg/500mg or 5mg/500mg (initial dose should not exceed previous daily doses of individual components). Elderly: avoid max doses.
Renal disease or dysfunction. Metabolic acidosis, diabetic ketoacidosis with or without coma. Concomitant intravascular iodinated contrast agents (suspend during and for 48hrs).
Increased risk of cardiovascular mortality. Discontinue if lactic acidosis, shock, acute CHF, acute MI, sepsis, or hypoxemia occurs. Confirm normal renal function before starting therapy (esp. in patients ≥80yrs); monitor renal function. Avoid in hepatic disease. G6PD deficiency. Suspend before surgery that requires fasting. Monitor hematology (esp. serum Vit. B12 in susceptible patients). Elderly, debilitated, uncompensated strenuous exercise, malnourished, or deficient caloric intake, adrenal or pituitary insufficiency, alcohol intoxication increases hypoglycemia risk. Pregnancy (Cat.C), nursing mothers: not recommended, consider using insulin instead.
Sulfonylurea (2nd generation) + biguanide.
Glipizide potentiated by NSAIDs, highly protein-bound drugs, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, MAOIs, β-blockers, oral miconazole (possibly), fluconazole. May be antagonized by thiazides, diuretics, steroids, phenytoin, phenothiazines, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid, thyroid products, estrogens, oral contraceptives. May be antagonized by colesevelam; administer glipizide/metformin HCl ≥4hrs prior to colesevelam. Cationic drugs eliminated by renal tubular secretion (eg, amiloride, cimetidine, digoxin, morphine, procainamide, quinidine, quinine, trimethoprim, ranitidine, triamterene, vancomycin), furosemide, nifedipine: may increase metformin levels. Avoid excessive alcohol intake (potentiates effects of metformin on lactate).
Lactic acidosis (rare, ½ the cases are fatal), GI upset, abdominal pain, upper respiratory infection, headache, dizziness, hypertension, musculoskeletal pain, hypoglycemia.
Formerly known under the brand name Metaglip.