Glipizide Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Additional dosage information:

Usual Adult Dose for Diabetes Type 2

Immediate release:
Initial dose: 5 mg orally once a day, 30 minutes before breakfast
Maintenance dose: Up to 40 mg in divided doses 30 minutes before a meal of adequate caloric content. Doses may be increased in intervals of 2.5 to 5 mg a day according to blood glucose response.
Maximum single dose: 15 mg
Maximum daily dose: 40 mg
Comments:
-At least several days should elapse between titration steps.
-If response to a single dose is not satisfactory, dividing that dose may prove effective.

Extended Release:
Initial dose: 5 mg orally once a day, 30 minutes before breakfast
Maintenance dose: 5 to 10 mg orally once a day
Maximum daily dose: 20 mg
Patients receiving immediate release may be switched safely to extended release tablets once-a-day at the nearest equivalent total daily dose, or titrate to the appropriate extended release dose starting with 5 mg once daily.
Combination use:
-When adding other blood-glucose-lowering agents to glipizide extended release, the agent should be initiated at the lowest recommended dose. Observe for hypoglycemia.
-When adding glipizide extended release to other blood-glucose-lowering agents, glipizide extended release can be initiated at 5 mg. Start at a lower dose in patients that are more sensitive to hypoglycemia.

When transferring patients from insulin to glipizide, the following general guidelines should be considered:
-For patients with daily insulin doses of 20 units or less: Discontinue insulin and begin glipizide at usual dosages.
-For patients with daily insulin doses greater than 20 units: Insulin dose should be reduced by 50% and glipizide therapy may begin at usual dosages.
Comments:
-Several days should elapse between glipizide titration steps.
-Subsequent reductions in insulin dosage should depend on individual patient response.
-During the insulin withdrawal period, the patient should test urine samples for sugar and ketone bodies at least three times daily.
-Some patients receiving greater than 40 units of insulin daily may need to consider hospitalization during the transition period.

Patients Receiving Other Oral Hypoglycemic Agents:
-When transferring from longer half-life sulfonylureas: Observe for 1 to 2 weeks for hypoglycemia
-Glipizide extended release coadministered with colesevelam: Glipizide should be administered at least 4 hours prior to colesevelam.

Use: Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Usual Geriatric Dose for Diabetes Type 2

Initial dose: 2.5 mg orally once a day 30 minutes before breakfast

Comments:
-Maintenance dosing should be conservative to avoid hypoglycemic reactions.
-Doses can be adjusted with caution taking into account the degree of hepatic, renal, or cardiac function, and the concomitant disease or other drug therapy.

Use: Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

Renal Dose Adjustments

Caution and conservative dosing are recommended.

Liver Dose Adjustments

Patients with liver disease:
Initial dose: 2.5 mg orally once a day 30 minutes before breakfast

Dose Adjustments

-Dosage adjustments should ordinarily be in increments of 2.5 to 5 mg, as determined by blood glucose response.
-Some patients may be effectively controlled on a once-a-day regimen, while others show better response with divided dosing.
-Total daily doses above 15 mg should ordinarily be divided.

For glipizide extended release:
-A single fasting glucose determination may not accurately reflect the response to therapy. In most cases, a hemoglobin A1C level measured at three month intervals is the preferred means of monitoring response to therapy.
-If after the first three months of therapy glycemic control was inadequate, the glipizide dose may be increased.
-If no improvement is seen after three months with the higher dose, the previous dose should be resumed.
-The decision to adjust glipizide extended release should be based on at least two or more similar consecutive value obtained seven days or more after the previous dose adjustment.
Patients switched from longer acting agents, such as chlorpropamide, should be carefully monitored for hypoglycemia in the first 2 weeks of therapy.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Glipizide should be given approximately 30 minutes before a meal.
-Short-term administration of this drug may be sufficient during periods of transient loss of control in patients usually controlled well on diet.
-Tablets should not be chewed, divided or crushed.
-The extended release tablet is contained within a nonabsorbable shell that it is eliminated from the body after all the drug has been released. The patient taking this formulation should not be concerned if the empty tablet shell appears in their stool.

General:
-Patient's blood glucose should be monitored periodically to determine the minimum effective dose to detect primary or secondary failure.
-Primary failure: Inadequate lowering of blood glucose at the maximum recommended dose.
-Secondary failure: Loss of an adequate blood-glucose-lowering response after an initial period of effectiveness.

Monitoring:
-Metabolic: Glucose in blood; glucose and ketone bodies in the urine
-Hematologic: Glycosylated hemoglobin levels (A1C) measured at three months interval is preferred

Patient advice:
-Patients should be informed of potential risks and advantages of glipizide and of alternatives modes of therapy.
-Explain to patients and family members the risks of hypoglycemia, symptoms, treatment, and predisposing conditions.
-Inform patients about the importance of adhering to dietary instructions and regular exercise program.
-Patients should be aware of the symptoms of hypoglycemia and be careful about driving and the use of machinery, especially when optimum stabilization has not been achieved, e.g., during a transition from other medications or during irregular use.

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