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Pharmacologic class: Sulfonylurea
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Lowers blood glucose level by stimulating insulin release from pancreas, increasing insulin sensitivity at receptor sites, and decreasing hepatic glucose production. Also increases peripheral tissue sensitivity to insulin and causes mild diuresis.
Tablets: 5 mg, 10 mg
Tablets (extended-release): 5 mg, 10 mg
Indications and dosages
➣ To control blood glucose in type 2 (non-insulin-dependent) diabetes mellitus in patients who have some pancreatic function and don't respond to diet therapy
Adults: 5 mg/day P.O. initially, increased as needed after several days (range is 2.5 to 40 mg/day). Give extended-release tablet once daily; maximum dosage is 20 mg/day. Give daily dosage above 15 mg in two divided doses.
➣ Conversion from insulin therapy
Adults: With insulin dosage above 20 units/day, start with usual glipizide dosage and reduce insulin dosage by 50%. With insulin dosage of 20 units/day or less, insulin may be discontinued when glipizide therapy starts.
• Hepatic or renal impairment
• Elderly patients
• Hypersensitivity to drug
• Severe renal, hepatic, thyroid, or other endocrine disease
• Uncontrolled infection, serious burns, or trauma
• Diabetic ketoacidosis
• Pregnancy or breastfeeding
Use cautiously in:
• mild to moderate hepatic, renal, or cardiovascular disease; impaired thyroid, pituitary, or adrenal function
• elderly patients.
• Check baseline creatinine level for normal renal function before giving first dose.
• Give daily dose (extended-release) at breakfast.
• Administer immediate-release tablets 30 minutes before a meal (preferably breakfast). If patient takes two daily doses, give second dose before dinner.
CNS: dizziness, drowsiness, headache, weakness
CV: increased CV mortality risk
EENT: blurred vision
GI: nausea, vomiting, diarrhea, constipation, cramps, heartburn, epigastric distress, anorexia
Hematologic: aplastic anemia, agranulocytosis, leukopenia, pancytopenia, thrombocytopenia
Hepatic: cholestatic jaundice, hepatitis
Metabolic: hyponatremia, hypoglycemia
Skin: rash, pruritus, erythema, urticaria, eczema, angioedema, photosensitivity
Other: increased appetite
Drug-drug. Androgens (such as testosterone), chloramphenicol, clofibrate, guanethidine, MAO inhibitors, nonsteroidal anti-inflammatory drugs (except diclofenac), salicylates, sulfonamides, tricyclic antidepressants: increased risk of hypoglycemia
Beta-adrenergic blockers: altered response to glipizide, requiring dosage change; prolonged hypoglycemia (with nonselective beta blockers)
Calcium channel blockers, corticosteroids, estrogens, hydantoins, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin, rifampin, sympathomimetics, thiazide diuretics, thyroid preparations: decreased hypoglycemic effect
Warfarin: initially increased, then decreased, effects of both drugs
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, cholesterol: increased values
Glucose, granulocytes, hemoglobin, platelets, white blood cells: decreased values
Drug-herbs. Aloe (oral), bitter melon, burdock, chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek: additive hypoglycemic effects
Glucosamine: impaired glycemic control
Drug-behaviors. Alcohol use: disulfiram-like reaction
• Monitor blood glucose level, especially during periods of increased stress.
• Evaluate CBC and renal function tests.
• If patient is ill or has abnormal laboratory values, monitor electrolyte, ketone, glucose, pH, lactate dehydrogenase, and pyruvate levels.
• Monitor cardiovascular status.
• Advise patient to take daily dose of extended-release tablets with breakfast or immediate-release tablet 30 minutes before breakfast (and second dose, if prescribed, before dinner).
• Advise patient to monitor blood glucose level as instructed by prescriber.
• Tell patient he may need supplemental insulin during times of stress or when he can't maintain adequate oral intake.
• Teach patient how to recognize signs and symptoms of hypoglycemia and hyperglycemia.
• Stress importance of diet and exercise to help control diabetes.
• Instruct patient to wear or carry medical identification describing his condition.
• Advise patient to keep sugar source at hand at all times in case of hypoglycemia.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.