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glipizide (Rx)Brand and Other Names:Glucotrol, Glucotrol XL, more...Minodiab

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg

tablet, extended-release

  • 2.5mg
  • 5mg
  • 10mg
more...

Type 2 Diabetes Mellitus

Immediate-release tablet

  • 5 mg PO qDay initially; increase by 2.5-5 mg PRN every several days based on blood glucose
  • Maintenance range: 2.5-20 mg PO qDay or q12hr; not to exceed 40 mg/day

Extended-release tablets (Glucotrol XL)

  • Initial: 5 mg/day PO given with breakfast; dose adjustment based on blood glucose should not be done more frequently than every 7 days
  • Maintenance range: 5-10 mg PO qDay; not to exceed 20 mg/day

Dosing considerations

  • Doses >15 mg: PO divided q12hr recommended

Conversion From Immediate Release to Extended Release

Administer the nearest equivalent immediate-release daily dose as extended-release tablet once daily

Alternatively, administer 5 mg PO initially; titrate as necessary

Conversion From Long Half-Life Agents

Observe patients carefully for 1-2 weeks when being converted from long half-life sulfonylureas to glipizide, because of potential for overlapping of hypoglycemic effects

Transferring From Insulin Therapy to Glipizide IR or ER

Current insulin dose <20 units: Discontinue insulin and initiate glipizide therapy at recommended dose

Current insulin dose >20 units: Decrease insulin dose by 50% and initiate glipizide at recommended dose; decrease insulin dose gradually based on patient’s response

Dosing Modifications

Hepatic impairment: 2.5 mg PO qDay initially (immediate release); extended release not studied

Renal impairment: Not studied; if GFR <50 mL/min, may decrease dose by 50% (suggested)

Safety and efficacy not established

Diabetes

2.5 mg PO qDay initially; increase by 2.5-5 mg/day every 1-2 weeks as determined by blood glucose response at intervals of several days

May switch to extended release once daily tablets at the nearest equivalent total daily dose or lower end of recommended range; not to exceed 20 mg/day

Dosing considerations

Because elderly patients are susceptible to the hypoglycemic effects of glucose-lowering drugs, the question of how tightly glucose levels should be controlled in the elderly is controversial

Recognizing hypoglycemia in elderly patients may be challenging

Monitoring other parameters associated with cardiovascular disease, such as blood pressure and cholesterol, may be more important than normalized glycemic control

Initial and maintenance dosing should be conservative

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Interactions

Interaction Checker

glipizide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Dermatologic reactions

            Abdominal pain

            Diarrhea

            Syncope

            Constipation

            Flatulence

            Dizziness

            Nervousness

            Headache

            Anxiety

            Depression

            Drowsiness

            Erythema

            Heartburn

            Maculopapular eruptions

            Hypoglycemia

            Morbilliform eruptions

            Nausea/vomiting

            Urticaria

            Cholestatic jaundice and hepatitis occur rarely but may progress to liver failure

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            Warnings

            Contraindications

            Hypersensitivity; sulfa allergy

            Type 1 diabetes

            Diabetic ketoacidosis with or without coma

            Cautions

            Patients with risk of severe hypoglycemia include the elderly, debilitated, or malnourished; adrenal or pituitary insufficiency; stress due to infection, fever, trauma, or surgery; concomitant use with beta-blockers or other sympatholytic agents may impair the patient's ability to recognize the signs and symptoms of hypoglycemia; use with caution

            If patient is exposed to stress (fever, trauma, infection, surgery), it may be necessary to discontinue glipizide and initiate insulin

            Use caution in hepatic/renal impairment

            Use with caution in pregnancy and lactation

            Increased risk of cardiovascular mortality suggested by product labeling but data is limited

            FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur; Increase in cardiovascular mortality suggested by product labeling but data is limited

            Hypoglycemia may be difficult to recognize in patients with autonomic neuropathy

            Hemolytic anemia may occur with glucose 6-phosphate dehydrogenase (G6PD) deficiency when treated with sulfonylurea agents; consider a nonsulfonylurea alternative

            Avoid using the extended-release tablets in patients with severe gastrointestinal narrowing of esophageal dysmotility

            Clinical studies have not found conclusive evidence that anti-diabetic drugs reduce macrovascular risk

            Loss of efficacy following prolonged use possible; if no contributing factors, to explain loss of efficacy identified, consider discontinuing therapy; additional antidiabetic therapy will be required

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not known if crosses into breast milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Initial effect to increase insulin secretion from pancreatic beta cells; may also decrease rate of hepatic glucose production and increase insulin receptor sensitivity

            Absorption

            Bioavailability: 100% (Glucotrol)

            Onset: Initial effect (30 min); max effect: (2-3 hr) (Glucotrol)

            Duration: 12-24 hr (Glucotrol)

            Peak plasma time: 1-3 hr (IR); 6-12 hr (ER)

            Distribution

            Protein bound: 99% (Glucotrol)

            Vd: 10-11 L (Glucotrol)

            Metabolism

            Extensively metabolized in liver to inactive metabolites

            Metabolites: Hydroxycyclohexyl derivatives (inactive)

            Elimination

            Half-life: 2-5 hr (Glucotrol)

            Excretion: Urine (63-90%); feces: (10%)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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