Glipizide + Metformin


Concise Prescribing Info
Indications/Uses
Type 2 DM.
Dosage/Direction for Use
Adult : PO Patients inadequately controlled on diet and exercise: Initial: 2.5 mg/250 mg once daily. Patients w/ fasting plasma glucose (FPG) 280-320 mg/dL: Initial: 2.5 mg/500 mg bid, may adjust daily dose in increments of 1 tab every 2 wk. Max: Glipizide 10 mg and metformin 2,000 mg/day. Patients inadequately controlled on sulfonylurea and/or metformin: 2.5 mg/500 mg or 5 mg/500 mg bid, may adjust daily dose in increments of not more than 5 mg/500 mg. Max: Glipizide 20 mg and metformin 2,000 mg/day.
Dosage Details
Oral
Type 2 diabetes mellitus
Adult: Each tab contains glipizide (mg)/metformin (mg): 2.5/250, 2.5/500, 5/500: Patients inadequately controlled on diet and exercise: Initially, 2.5 mg/250 mg once daily. Patients w/ fasting plasma glucose (FPG) 280-320 mg/dL: Initially, 2.5 mg/500 mg bid. May adjust daily dose in increments of 1 tab every 2 wk. Max: Glipizide 10 mg and metformin 2,000 mg daily. Patients inadequately controlled on sulfonylurea and/or metformin: 2.5 mg/500 mg or 5 mg/500 mg bid. May adjust daily dose in increments of not more than 5 mg/500 mg. Max: Glipizide 20 mg and metformin 2,000 mg daily.
Renal Impairment
Serum creatinine (SCr) ≥1.5 mg/dL (males) or ≥1.4 mg/dL (females) or abnormal CrCl: Contraindicated.
Hepatic Impairment
Contraindicated.
Administration
Should be taken with food.
Contraindications
Acute or chronic metabolic acidosis w/ or w/o coma (including diabetic ketoacidosis); surgical procedures. Acute or chronic alcohol use. Serum creatinine (SCr) ≥1.5 mg/dL (males) or ≥1.4 mg/dL (females) or abnormal CrCl. Hepatic impairment. Intravascular admin of iodinated contrast materials.
Special Precautions
Patient w/ heart failure, G6PD deficiency. Pregnancy and lactation.
Adverse Reactions
Hypoglycaemia, haemolytic anaemia, upper resp infection, diarrhoea, dizziness, HTN, nausea and vomiting.
Potentially Fatal: Lactic acidosis.
MonitoringParameters
Monitor urine (glucose and ketones), FPG, HbA1c, and fructosamine; haematologic parameters (e.g. Hb/hematocrit, RBC indices), renal function; signs and symptoms of hypoglycemia; vit B12 levels.
Overdosage
Symptoms: Mild to severe hypoglycaemia which may lead to hypoglycaemic coma (glibenclamide); lactic acidosis (metformin). Management: Mild hypoglycaemia w/o loss of consciousness may be treated w/ oral glucose. Severe hypoglycaemic reactions w/ coma, seizure or other neurological impairment require immediate hospitalisation. Admin rapid IV inj of glucose 50% soln in case of hypoglycaemic coma. Haemodialysis may be useful for removal of accumulated drugs in metformin overdose.
Drug Interactions
Decreased hypoglycaemic effect w/ thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, oestrogen, OC, phenytoin, nicotinic acid, sympathomimetics, Ca channel blockers, isoniazid. Glipizide: Increased hypoglycaemic effect w/ NSAIDs and other highly protein bound drugs, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, MAOIs, β-blockers. Risk of severe hypoglycaemia w/ oral miconazole. Decreased plasma concentration w/ colesevelam. Metformin: Increased plasma concentration w/ furosemide, nifedipine and cimetidine.
Potentially Fatal: Alteration of renal function w/ iodinated contrast materials.
Food Interaction
Avoid alcohol.
Action
Description: Glipizide stimulates insulin release from pancreatic β-cells, reduces glucose output from the liver and increases insulin sensitivity at peripheral target sites. Metformin reduces hepatic glucose production, decreases intestinal glucose absorption and improves insulin sensitivity by increasing peripheral glucose uptake and utilisation.
Pharmacokinetics:
Absorption: Glipizide: Readily absorbed from the GI tract. Time to peak plasma concentration: 1-3 hr. Metformin: Slowly and incompletely absorbed from the GI tract. Bioavailability: Approx 50-60%.
Distribution: Glipizide: Plasma protein binding: Extensively bound (98-99%). Metformin: Crosses the placenta and enters breast milk (small amounts).
Metabolism: Glipizide: Extensively metabolised in the liver. Metformin: Not metabolised in the liver.
Excretion: Glipizide: Via urine, mainly as inactive metabolites. Half-life: Approx 2-4 hr. Metformin: Via urine, as unchanged drug. Elimination half-life: Approx 2-6 hr.
Chemical Structure

Chemical Structure Image
Glipizide

Source: National Center for Biotechnology Information. PubChem Database. Glipizide, CID=3478, https://pubchem.ncbi.nlm.nih.gov/compound/Glipizide (accessed on Jan. 22, 2020)


Chemical Structure Image
Metformin

Source: National Center for Biotechnology Information. PubChem Database. Metformin, CID=4091, https://pubchem.ncbi.nlm.nih.gov/compound/Metformin (accessed on Jan. 20, 2020)

Storage
Store between 20-25°C.
MIMS Class
References
Anon. Glipizide and Metformin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 22/10/2015.

Buckingham R (ed). Glipizide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/10/2015.

Buckingham R (ed). Metformin Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/10/2015.

Glipizide and Metformin HCl Tablet, Film Coated (Heritage Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 22/10/2015.

Disclaimer: This information is independently developed by MIMS based on Glipizide + Metformin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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