Glipizide + metformin

Generic Medicine Info
Should be taken with food.
Acute or chronic metabolic acidosis with or without coma (including diabetic ketoacidosis). Severe renal impairment (eGFR <30 mL/min/1.73 m2).
Special Precautions
Patient with G6PD deficiency, stable heart failure, stress-related state (fever, trauma, infection, surgery), adrenal or pituitary insufficiency; risk factors for hypoglycaemia (e.g. deficient calorie intake, doing strenuous exercise, alcohol intake). Consider discontinuing treatment prior to or at the time of iodinated contrast imaging procedure in patients with eGFR of 30-60 mL/min/1.73 m2, history of hepatic impairment, alcoholism, or heart failure; re-evaluate eGFR 48 hours after the procedure and restart therapy if renal function is stable. Not indicated for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Debilitated or malnourished patients. Hepatic and mild to moderate renal impairment. Elderly. Pregnancy and lactation. Monitoring Parameters Obtain plasma glucose (frequency depends on individual treatment regimen, hypoglycaemia risk, and other patient-specific factors); HbA1c (twice yearly for those with stable glycaemic control and are meeting treatment goals; quarterly for those who have not met the treatment goals or with change in treatment). Monitor renal function (before and annually during treatment), haematologic parameters (annually), volume status (e.g. electrolytes, haematocrit, blood pressure), and vitamin B12 serum concentrations.
Adverse Reactions
Significant: Hypoglycaemia, vitamin B12 deficiency. Gastrointestinal disorders: Diarrhoea, nausea, vomiting, abdominal pain. Musculoskeletal and connective tissue disorders: Musculoskeletal pain. Nervous system disorders: Headache, dizziness. Renal and urinary disorders: UTI. Respiratory, thoracic and mediastinal disorders: URTI. Vascular disorders: Hypertension.
Potentially Fatal: Lactic acidosis.
Drug Interactions
Increased risk of hypoglycaemia with other glucose-lowering drugs. May decrease therapeutic effect with thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, oral contraceptives, estrogen, nicotinic acid, phenytoin, sympathomimetics, Ca channel blockers, and isoniazid. Glipizide: Enhanced hypoglycaemic action with NSAIDs, certain azoles, sulfonamides, chloramphenicol, salicylates, coumarins, probenecid, MAOIs, and β-blockers. May decrease exposure with colesevelam; administer at least 4 hours before colesevelam. Metformin: May increase the risk of acute decrease in renal function and lactic acidosis with intravascularly administered iodinated contrast agents. May increase the risk of lactic acidosis with carbonic anhydrase inhibitors (e.g. topiramate, zonisamide, acetazolamide). Increased plasma concentration with nifedipine, furosemide, and organic cationic transporter-2 (OCT2)/multidrug and toxin extrusion (MATE) inhibitors (e.g. ranolazine, cimetidine, vandetanib, dolutegravir).
CIMS Class
Antidiabetic Agents
ATC Classification
A10BA02 - metformin ; Belongs to the class of biguanides. Used in the treatment of diabetes.
A10BB07 - glipizide ; Belongs to the class of sulfonylureas. Used in the treatment of diabetes.
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