Brand and Other Names:Glucotrol, Glucotrol XL, more...Minodiab
- Classes: Antidiabetics, Sulfonylureas
Dosing & Uses
Dosage Forms & Strengths
Type 2 Diabetes Mellitus
- 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
- 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
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
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
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
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Cholestatic jaundice and hepatitis occur rarely but may progress to liver failure
Hypersensitivity; sulfa allergy
Type 1 diabetes
Diabetic ketoacidosis with or without coma
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 is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose-lowering drug is used
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
Drug interactions overview
- The hypoglycemic action of sulfonylureas may be potentiated by certain drugs including nonsteroidal anti-inflammatory agents, some azoles, and other drugs that are highly protein bound, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, monoamine oxidase inhibitors, quinolones and beta adrenergic blocking agents; conversely, certain drugs tend to produce hyperglycemia and may lead to loss of control, including thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid; when coadministering glipizide with such drugs, patient should be observed closely for hypoglycemia or hyperglycemia; when such drugs are withdrawn, observe patient closely for loss of control
Pregnancy & Lactation
Pregnancy category: C
Lactation: Not known if crosses into breast milk; not recommended
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.
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
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)
Protein bound: 99% (Glucotrol)
Vd: 10-11 L (Glucotrol)
Extensively metabolized in liver to inactive metabolites
Metabolites: Hydroxycyclohexyl derivatives (inactive)
Half-life: 2-5 hr (Glucotrol)
Excretion: Urine (63-90%); feces: (10%)
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
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.
|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.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
Select a box to add or remove a plan.
Select a class to view formulary status for similar drugs