Glipizide/Metformin: Diabetes Drug Side Effects & Dosage

What is glipizide/metformin? What is glipizide/metformin used for?

Glipizide/metformin is a
combination antidiabetic medication that contains two commonly used glucose
(sugar)
lowering agents, glipizide (Glucotrol) and metformin (Glucophage). These agents
work in different, yet complementary ways to improve
blood glucose control in
patients with
type 2 diabetes.
- Glipizide is a second generation oral sulfonylurea that lowers blood glucose
  by stimulating the production of
  insulin from the pancreas. It is the major
  hormone responsible for regulating
  blood sugar.
- Metformin is
  an oral biguanide antidiabetic medication that decreases the production of
  glucose in the
  liver, decreases the absorption of glucose by the
  intestines, and
  increases response to insulin.
In clinical studies, glipizide/metformin therapy was superior in improving
fasting plasma glucose, postprandial plasma glucose (blood glucose levels after
a meal), and
HbA1c versus treatment with either agent alone.
Combination glipizide and metformin
was approved by the FDA in October 2002.

What brand names are available for glipizide/metformin?

There are no brand names available for glipizide/metformin in the US.
Metaglip is a discontinued brand name for glipizide/metformin.

Do I need a prescription for glipizide/metformin?

Yes

What are the uses for glipizide/metformin?

Glipizide/metformin is used as an adjunct to
diet and
exercise to improve blood glucose control in adults with
type 2 diabetes.

What are the side effects of glipizide/metformin?

The most common side effects associated with glipizide/metformin treatment are:

Side effects related to the stomach were most commonly reported by patients
who newly started treatment with glipizide/metformin and included:

Other less common but potentially serious side effects include:

Hypoglycemia
Blood disorders
Liver disease
Kidney disease
Rash
Photosensitivity (sun sensitivity)
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Ovulation induction
Low sodium levels (hyponatremia)
Hives
Disulfiram-like reactions (for example, heart
palpitations, nausea, vomiting,
dizziness, and headache)
Reduced number of platelets
Reduced number of white blood cells
Anemia
Hypersensitivity type reactions

Metformin can cause a rare but serious condition known as lactic acidosis, a
build-up of acid in the blood. Lactic acidosis can cause death and requires
immediate treatment.

Symptoms of lactic acidosis include:

Tiredness
Weakness
Unusual
muscle pain
Pain in the stomach
Difficulty breathing
Dizziness
Slow or irregular heartbeat

Patients suspected of presenting with signs or symptoms of lactic acidosis
must seek emergency medical help.

What is the dosage for glipizide/metformin?

For patients inadequately controlled on diet and exercise alone: Generally,
the recommended starting dose of glipizide/metformin is 2.5/250 mg administered
once or twice daily. A starting dose of 2.5/500 mg twice daily may be considered
for patients with fasting plasma glucose (FPG) of 280-320 mg/dL. If necessary,
dosage may be increased by 1 tablet daily every 2 weeks to achieve adequate
blood glucose control. The maximum daily dose is 20/2000 mg. Avoid starting
treatment with the 5/500 mg strength due to the risk of hypoglycemia (low blood
glucose levels).
For patients inadequately controlled on glipizide or metformin monotherapy:
Treatment may be started with either 2.5/500 mg or 5/500 mg administered by
mouth twice daily with meals. To avoid hypoglycemia, the starting dose must not
exceed the current dose of glipizide or metformin that the patient has been
already taking.
For patients who are already taking a combination of sulfonylurea/metformin
who desire to switch to a combination pill: To avoid hypoglycemia, avoid
exceeding the current dose of sulfonylurea and metformin. If necessary, the dose may
be increased gradually to the minimum dosage required to achieve adequate blood
glucose control.
Patients with liver disease: Use of glipizide/metformin in patients with
liver disease is generally not recommended. Liver disease increases the risk of
metformin associated lactic acidosis, a rare but potentially fatal condition
which causes an accumulation of acid in the body.
Patients with kidney disease: Metformin should not be used in females with
serum creatinine concentration > 1.4 mg/dL or in males with serum creatinine
concentration > 1.5 mg/dL.
Pediatrics: The safety and efficacy of glipizide/metformin has not been
established in pediatric patients. Therefore, use of glipizide/metformin in this
patient population is not recommended.

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Which drugs or supplements interact with glipizide/metformin?

Drugs which cause blood glucose levels to increase may diminish the
effectiveness of glipizide/metformin therapy. These drugs include:
- Thiazides and other diuretics
- Corticosteroids
- Phenothiazines
- Thyroid medications
- Estrogens
- Birth control pills
- Phenytoin (Dilantin)
- Nicotinic acid
- Sympathomimetics
- Calcium channel blockers (CCBs)
- Isoniazid (Nydrazid)
Cimetidine (Tagamet), by decreasing the elimination of metformin from the
body, can increase the amount of metformin in the blood by 40%. This may
increase the frequency of side effects from metformin.
Alcohol consumption increases the effect of metformin on lactate production,
increasing the risk of lactic acidosis.
Due to the risk of lactic acidosis, metformin containing products must be
temporarily discontinued prior to the administration of radiopaque contrast
dyes.
Metformin should be held for at least 48 hours after contrast dye
administration and should not be restarted until patient’s kidney function
returns back to normal.
Beta blockers may increase the blood glucose lowering actions of
sulfonylureas. Cardio-selective beta blockers such as
acebutolol (Sectral),
atenolol (Tenormin),
metoprolol (Lopressor or Toprol XL), and penbutolol
(Levatol) may be safer than their nonselective counterparts.
Colesevelam (Welchol) may reduce blood levels of glipizide. Patients are
advised to take glipizide 1 hour before or 4 hours after colesevelam
administration to minimize the risk of their interaction.
Concomitant use of systemic antifungals such as
fluconazole (Diflucan),
itraconazole (Sporanox),
ketoconazole (Nizoral),
miconazole, and
voriconazole
(VFEND) with glipizide may cause hypoglycemia.

QUESTION

______________ is another term for type 2 diabetes.
See Answer

Is glipizide/metformin safe to use during pregnancy or while breastfeeding?

Glipizide/metformin has not been adequately evaluated in
pregnant
women. Due to the lack of conclusive safety data, glipizide/metformin should be
avoided
during pregnancy if possible. Glipizide/metformin is classified as FDA
pregnancy risk category C (animal reproduction studies have shown an adverse
effect on the fetus and there are no adequate and well-controlled studies in
humans, but potential benefits may warrant use of the drug in pregnant women
despite potential risks).
It is not known if glipizide/metformin is excreted in breast
milk. Due to the lack of safety data and the potential risk for hypoglycemia in
the nursing infant, use of glipizide/metformin during
breastfeeding is not
recommended.

What else should I know about glipizide/metformin?

What preparations of glipizide/metformin are available?

Oral tablets (glipizide/metformin): 2.5/250, 2.5/500 or 5/500 mg

How should I keep glipizide/metformin stored?

Tablets should be stored at room temperature between 15 C and 30 C
(59 F and 86 F).