Glipizide and Metformin

Hypoglycaemic excluding Insulin · Biguanide/Sulphonylurea

Indications

When glipizide and metformin alone cannot adequately achieve desired glycaemic control.

Dosage

Adults: Patients inadequately controlled on diet and exercise alone: Initial: 2.5 mg/250 mg once a day. FBG 280-320 mg/dL: Start treatment with 2.5 mg/500 mg two times daily. Increase dose every 2 wks according to glycaemic response. Max: 10 mg/2000 mg daily in divided doses. Patients inadequately controlled on a sulfonylurea and/or metformin: Initial: 2.5 mg/500 mg or 5 mg/500 mg two times daily, starting dose should not be more than current daily dose of glipizide (or sulfonylurea equivalent) and/or metformin. Dose should not be increased more than 5 mg/500 mg/day. Max: 20 mg/2000 mg daily in divided doses. Children: Not recommended.

Adverse Effects

GI upset, taste disturbance, rarely lactic acidosis, abnormal liver function tests, hepatitis, jaundice, blood dyscrasias, transient visual disturbances, skin reactions, reduced B12 absorptions.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Diabetic ketoacidosis or precoma, renal or hepatic impairment. Acute conditions predisposing to renal impairment. Porphyria. Cardiac or respiratory failure, recent MI, alcoholism. Administration of iodinated contrast materials. Discontinue for 48 hours before and after elective surgery. Precautions: Mild to moderate renal or hepatic impairment, obesity. Adrenal or pituitary insufficiency. Surgery, severe trauma, infections, G6PD deficiency. Elderly. Assess risk factors for lactic acidosis; discontinue immediately if metabolic acidosis suspected. Monitor renal function at least annually.

Interactions

Glipizide: NSAIDs, salicylates, phenylbutazone, oral anticoagulants, MAOIs, ACE inhibitors, beta-blockers, chloramphenicol, azole antifungals, cimetidine, corticosteroids, diuretics, phenothiazines, quinolones, alcohol. Metformin: Alcohol, iodinated contrast agents, diuretics, corticosteroids, ACE inhibitors, sympathomimetics, NSAIDs, other hypoglycaemics. Inhibitors of OCT2 (e.g., cimetidine, dolutegravir, ranolazine, trimethoprim).

Advice to Patient

Take with meals.

Pharmacokinetics

GLIPIZIDE: Duration: 12-24 hrs. Absorption: Immediate release: Rapid and complete, delayed with food. Bioavailability: 90%-100%. Metabolism: Hepatic. Half-life elimination: 2-5 hrs. Time to peak: 1-3 hrs. Extended release tab: 6-12 hrs. Excretion: Urine (90%). Faeces (10%). METFORMIN: Onset of action: Within days, max effects up to 2 wks. Metabolism: Not metabolized by the liver. Bioavailability: Absolute: Fasting: 50%-60%. Half-life elimination: Plasma: 4-9 hrs. Blood: Approx. 17.6 hrs. Time to peak, serum: Immediate release: 2-3 hrs. Extended release: 7 hrs. (Range: 4-8 hrs). Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.