Glipizide

Indications

Glipizide is used for: Type 2 DM

Adult Dose

Oral Type 2 diabetes mellitus Adult: Initially, 2.5-5 mg daily as a single dose. Adjust at intervals of several days in increments of 2.5-5 mg daily. Doses >15 mg may be given in 2 divided doses. Max: 40 mg daily. Extended-release tablets 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 Elderly: 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 Hepatic impairment: 2.5 mg PO qDay initially (immediate release); extended release not studied Severe: Contraindicated.

Child Dose

Safety and efficacy not established

Renal Dose

Renal impairment: Not studied; if GFR <50 mL/min, may decrease dose by 50% Severe: Contraindicated.

Administration

Immediate-release: Should be taken on an empty stomach. Take ½ hr before meals. Extended-release: Should be taken with food. Swallow whole, do not chew/crush/divide.

Contra Indications

Hypersensitivity. Type 1 DM; ketoacidosis; severe renal or hepatic insufficiency. Pregnancy, lactation.

Precautions

Hypoglycaemia, stress, elderly. Thyroid impairment; moderate hepatic or renal impairment. Monitor blood glucose concentration. Lactation: Not known if crosses into breast milk; not recommended

Pregnancy-Lactation

Interactions

Increased plasma concentration w/ certain antifungals (e.g. miconazole, fluconazole). Protein-bound drugs (e.g. NSAIDs, other sulfonamides, oral anticoagulants, hydantoins), probenecid, MAOIs, and chloramphenicol may potentiate hypoglycaemic action of glipizide. Diminished therapeutic effect w/ thiazides, other diuretics, phenothiazines, thyroid agents, oestrogens, OC, phenytoin, nicotinic acid, sympathomimetics, Ca channel blockers, rifampicin and isoniazid. Concomitant use w/ beta-blockers may impair glucose tolerance, increase frequency or severity of hypoglycaemia and block hypoglycaemia-induced tachycardia. Decreased serum concentration w/ colesevelam.

Adverse Effects

Side effects of Glipizide : GI upsets, diarrhoea, nausea; allergic skin reactions, leucopenia, thrombocytopenia, agranulocytosis, hyponatraemia; jaundice; haemolytic anaemia, pancytopenia. Potentially Fatal: Hypoglycaemia in presence of renal or hepatic damage and alcohol.

Mechanism of Action

Glipizide stimulates insulin release from pancreatic ?-cells and reduces glucose output from the liver. It also increases insulin sensitivity at peripheral target sites.