Trade Names:Metaglip- Tablets 2.5 mg/250 mg- Tablets 2.5 mg/500 mg- Tablets 5 mg/500 mg
Decreases blood glucose by stimulating insulin release from pancreas and by increasing tissue sensitivity to insulin.Metformin
Decreases blood glucose by reducing hepatic glucose production and may decrease intestinal absorption of glucose and increase response to insulin.
As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes.
Patients with renal disease or renal function impairment, which also may result from conditions such as CV collapse, acute MI, and septicemia; acute or chronic metabolic acidosis, with or without coma; known hypersensitivity to any component of the product. Temporarily discontinue therapy in patients undergoing radiologic studies involving intravascular administration of iodinated contrast media.
Dosage must be individualized on the basis of both efficacy and tolerance, while not exceeding the max recommended daily dose of glipizide 20 mg or metformin 2,000 mg.Inadequate Glycemic Control on a Sulfonylurea and/or MetforminAdults
PO Recommended starting dosage is 2.5 mg/250 mg every day with a meal. For patients whose fasting plasma glucose (FPG) is 280 to 320 mg/dL, consider a starting dosage of 2.5 mg/500 mg twice daily. Make dosage increases, to achieve adequate glycemic control, in increments of 1 tablet/day every 2 wk to a max of 10 mg/1,000 mg or 10 mg/2,000 mg/day in divided doses. Efficacy in patients whose FPG is more than 320 mg/dL has not been established.Inadequate Glycemic Control on Diet and Exercise AloneAdults
PO Recommended starting dosage is 2.5 mg/500 mg or 5 mg/500 mg twice daily with morning and evening meals. To avoid hypoglycemia, starting dose should not exceed daily doses of glipizide or metformin already being taken. Titrate daily dose in increments of no more than 5 mg/500 mg up to minimum effective dose that adequately controls blood glucose but not exceeding 20 mg/2,000 mg/day. Patients previously treated with combination therapy of glipizide plus metformin may be switched to 2.5 mg/500 mg or 5 mg/500 mg; however, the starting dose should not exceed the daily dose of glipizide or equivalent dose of another sulfonylurea and metformin already being taken.
Store at controlled room temperature (59° to 86°F).
The effects of metformin on lactate metabolism may be potentiated.Beta-adrenergic blocking agents, chloramphenicol, ciprofloxacin, coumarin anticoagulants, MAOIs, miconazole, NSAIDs, probenecid, salicylates, sulfonamides
May potentiate the hypoglycemic action of glipizide.Calcium channel blocking agents, corticosteroids, estrogens, isoniazid, nicotinic acid, oral contraceptives, phenothiazines, phenytoin, sympathomimetics, thiazides and other diuretics, thyroid products
These agents tend to produce hyperglycemia and may lead to loss of blood glucose control.Cationic drugs (eg, amiloride, cimetidine, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin)
May compete with metformin for renal tubular secretion, elevating metformin concentrations and increasing the pharmacologic effects.Cyclosporine
Cyclosporine and glipizide concentrations may be elevated, increasing the pharmacologic effects and adverse reactions.Fluconazole
Glipizide concentrations may be elevated, increasing the pharmacologic effect.Furosemide
Metformin plasma levels may be elevated, while furosemide levels may be decreased.Nifedipine
Metformin plasma levels may be increased.
None well documented.
Headache (13%); dizziness (5%).
Diarrhea (18%); nausea/vomiting (8%); abdominal pain (6%).
Musculoskeletal pain (8%).
Upper respiratory tract infection (10%).
Lactic acidosis is a rare but serious metabolic complication that can occur because of metformin accumulation during treatment with glipizide/metformin. When it occurs, it is fatal in approximately 50% of cases.
Check blood sugar frequently and observe for signs of hypoglycemia. Monitor glycosylated hemoglobin (HbA 1c ) every 3 mo. Assess renal function and verify as healthy before starting therapy and at least annually thereafter. Monitor Hct, Hgb, and RBCs before starting therapy and periodically thereafter. Monitor patient for signs or symptoms of metabolic acidosis (eg, abdominal pain, malaise, myalgia, nausea, respiratory distress, unexplained drowsiness, vomiting).
Category C . However, not recommended for use during pregnancy.
Undetermined; however, some sulfonylurea drugs are known to be excreted in breast milk.
Safety and efficacy not established.
In general, elderly patients are not titrated to max dose because of age-related decreases in renal function. Determine CrCl in patients older than 80 yr of age before initiating therapy.
Metabolism and excretion of glipizide may be slowed in patients with renal function impairment. Decreased renal function results in decreased renal Cl and prolongation of the metformin half-life. Concomitant medications that affect renal function may result in hemodynamic changes or interfere with disposition of metformin (eg, cationic drugs) and should be used with caution. Avoid metformin in patients whose serum creatinine levels exceed ULN for their age or with clinical or laboratory evidence of hepatic disease. Determine CrCl in patients older than 80 yr of age before initiating therapy.
Metabolism and excretion of glipizide may be slowed in patients with hepatic function impairment. Avoid metformin in patients with clinical or laboratory evidence of hepatic disease because of increased risk of lactic acidosis.
Oral hypoglycemic agents have been associated with increased CV mortality compared with treatment with diet alone or diet plus insulin.
May occur. The risk is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use of other glucose-lowering agents or alcohol.
Hypoxemic conditions have been associated with lactic acidosis and may also cause prerenal azotemia. Promptly discontinue therapy if these events occur.
Withhold metformin therapy at the time of or prior to parenteral contrast studies with iodinated materials. Reinstitute therapy 48 h after the study and after renal function has been determined to be healthy.
Lactic acidosis can occur as a result of metformin accumulation (eg, renal function impairment) or in pathophysiologic conditions associated with tissue hypoperfusion and hypoxia. The risk of lactic acidosis increases with the degree of renal function impairment and the age of patient.
Hold therapy in patient undergoing surgical procedure until oral intake has resumed and renal function has been documented to be normal.
A decrease in vitamin B 12 levels to subnormal may occur. Supplementation may be necessary.
Coma, hypoglycemia, neurological impairment, seizures.Metformin
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