Glipizide / Metformin Dosage
Medically reviewed by Drugs.com. Last updated on Mar 31, 2020.
Applies to the following strengths: 2.5 mg-500 mg; 5 mg-500 mg; 2.5 mg-250 mg
Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Diabetes Type 2
Doses provided as glipizide-metformin
Patients with Inadequate Glycemic Control on Diet and Exercise Alone:
-Initial dose: 2.5 mg-250 mg orally once a day
Patients with Fasting Blood Glucose (FBG) between 280 and 320 mg/dL:
-Initial dose: 2.5 mg-500 mg orally twice a day
Maintenance Dose: Increase in increments of 2.5 mg-500 mg per day every 2 weeks to the minimum effective dose to achieve adequate blood glucose control
Maximum Initial Dose: 10 mg-1000 mg or 10 mg-2000 mg per day in divided doses
Patients with Inadequate Glycemic Control on Glipizide (or another Sulfonylurea) and /or Metformin:
Initial dose: 2.5 mg-500 mg or 5 mg-500 mg orally twice a day
Maintenance Dose: Increase in increments of no more than 5 mg-500 mg to the minimum effective dose to achieve adequate blood glucose control
Maximum Dose: 20 mg-2000 mg per day
-Give with meals; initial doses should be conservative to avoid hypoglycemia largely due to glipizide and gastrointestinal side effects largely due to metformin.
-For patients who are switching to combination therapy, initial doses should not exceed the daily dose of glipizide (or equivalent sulfonylurea) and metformin already being taken; the decision to switch to the nearest equivalent dose should be based on clinical judgement.
-Monitor patients closely for signs and symptoms of hypoglycemia.
Use: As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.
Renal Dose Adjustments
Severe renal impairment (eGFR less than 30 mL/min): Contraindicated
Moderate renal impairment (eGFR 30 to 45 mL/min/1.73 m2): Therapy initiation is not recommended
Moderate to mild renal impairment (eGFR greater than 45 mL/min/1.73 m2): No dose adjustments recommended
If during therapy, renal dysfunction develops, this drug should be discontinued:
-eGFR that falls below 30 mL/min/1.73 m2 during therapy: Discontinue therapy
-eGFR that falls below 45 mL/min/1.73 m2 during therapy: Assess risks versus benefit of continued therapy
-Contraindicated in patients with conditions that may cause renal disease or renal dysfunction such as cardiovascular collapse (shock), acute myocardial infarction and septicemia.
-Not recommended in patients with serum creatinine levels above the upper limit of normal for their age.
-Do not initiate in patients 80 years or older unless measurement of CrCl demonstrates renal function is not reduced.
IODINATED CONTRAST PROCEDURE:
-See dosage adjustment section
Liver Dose Adjustments
Not recommended in patients with clinical or laboratory evidence of hepatic disease
IODINATED CONTRAST PROCEDURE:
-See dosage adjustment section
Elderly, debilitated, and malnourished patients should generally not be titrated to the maximum dose to avoid the risk of hypoglycemia
IODINATED CONTRAST PROCEDURE: Discontinue at the time of, or prior to, an iodinated contrast imaging procedure in patients:
-Receiving intra-arterial iodinated contrast
-With eGFR 30 and 60 mL/min/1.73 m2
-With a history of liver disease, alcoholism or heart failure
Re-evaluate eGFR 48 hours after the imaging procedure; restart only if renal function is stable
Concomitant Use with Colesevelam:
-This drug should be administered at least 4 hours prior to colesevelam to ensure that colesevelam does not reduce the absorption of glipizide
US BOXED WARNING: LACTIC ACIDOSIS
-Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias; onset is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (greater than 5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio, and metformin plasma levels generally greater than 5 mcg/mL.
-Risk factors include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of, and manage metformin-associated lactic acidosis in these high risk groups are provided in the package labeling.
-If metformin-associated lactic acidosis is suspected, immediately discontinue therapy and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Data not available
-Take orally with meals
Concomitant use with Colesevelam:
-Take at least 4 hours prior to colesevelam
-Temporarily stop treatment prior to radiologic studies utilizing iodinated contrast materials (see dosage adjustment section) and for surgical procedures when restricted food or fluid intake is expected; may resume once adequate renal function is confirmed.
-When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma infection, or surgery, it may be necessary to stop this drug and administer insulin.
-Consider use of a non-sulfonylurea agent in patients with G6PD deficiency.
Renal: Assess renal function baseline, repeat at least annually and more often as clinically indicated.
Hematologic: Measure hematologic parameters annually
Monitor glycemic control: Periodically measure fasting blood glucose and obtain HbA1C approximately every 3 months to assess efficacy
-Patients should be instructed to read the US FDA-approved patient labeling (Patient Information).
-Patients should be informed of the importance of adhering to a diet with a regular distribution of carbohydrates throughout the day, regular physical exercises, and regular checks on glycemic control.
-Patients should understand the risks of hypoglycemia, know how to recognize the symptoms, and be prepared to treat.
-Inform patients about the risk of lactic acidosis, conditions that might predispose them to its occurrence, and symptoms to watch for and report.
-Advise patient that this drug may need to be temporarily stopped when undergoing radiologic studies with intravascular iodinated contrast materials or surgical procedures that will limit food or fluid intake.
-Advise patients on the risks of excessive alcohol intake.
-Tell patients that while gastrointestinal symptoms might be common when initiating treatment, gastrointestinal problems after initiation should be reported.
-Advise patient to speak to healthcare provider if pregnant, intend to become pregnant, or are breastfeeding.
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