Glipizide

Glipizide is used for: Type 2 DM

Oral Type 2 diabetes mellitus Adult: Initially, 2.5-5 mg daily as a single dose. Adjust at intervals of several days in increments of 2.5-5 mg daily. Doses >15 mg may be given in 2 divided doses. Max: 40 mg daily. Extended-release tablets Initial: 5 mg/day PO given with breakfast; dose adjustment based on blood glucose should not be done more frequently than every 7 days Maintenance range: 5-10 mg PO qDay; not to exceed 20 mg/day Elderly: 2.5 mg PO qDay initially; increase by 2.5-5 mg/day every 1-2 weeks as determined by blood glucose response at intervals of several days May switch to extended release once daily tablets at the nearest equivalent total daily dose or lower end of recommended range; not to exceed 20 mg/day Hepatic impairment: 2.5 mg PO qDay initially (immediate release); extended release not studied Severe: Contraindicated.

Safety and efficacy not established

Renal impairment: Not studied; if GFR <50 mL/min, may decrease dose by 50% Severe: Contraindicated.

Immediate-release: Should be taken on an empty stomach. Take ½ hr before meals. Extended-release: Should be taken with food. Swallow whole, do not chew/crush/divide.

Hypersensitivity. Type 1 DM; ketoacidosis; severe renal or hepatic insufficiency. Pregnancy, lactation.

Hypoglycaemia, stress, elderly. Thyroid impairment; moderate hepatic or renal impairment. Monitor blood glucose concentration. Lactation: Not known if crosses into breast milk; not recommended

Pregnancy Available data from a small number of published studies and postmarketing experience with in pregnancy over decades have not identified any drug associated risks for major birth defects, miscarriage, or adverse maternal outcomes However, sulfonylureas (including glipizide) cross the placenta and have been associated with neonatal adverse reactions such as hypoglycemia; therefore, therapy should be discontinued at least two weeks before expected delivery; poorly-controlled diabetes in pregnancy increases maternal risk for diabetic ketoacidosis, pre-eclampsia, miscarriage, preterm delivery, stillbirth, and delivery complications; poorly controlled diabetes increases fetal risk for major birth defects, stillbirth, and macrosomia related morbidity Neonates of women with gestational diabetes who are treated with sulfonylureas during pregnancy may be at increased risk for neonatal intensive care admission and may develop respiratory distress, hypoglycemia, birth injury, and be large for gestational age; prolonged severe hypoglycemia, lasting 4-10 days, has been reported in neonates born to mothers receiving a sulfonylurea at the time of delivery and has been reported with the use of agents with a prolonged half-life; observe newborns for symptoms of hypoglycemia and respiratory distress and manage accordingly Due to reports of prolonged severe hypoglycemia in neonates born to mothers receiving a sulfonylurea at time of delivery, therapy should be discontinued at least two weeks before expected delivery Lactation Breastfed infants of lactating women on therapy should be monitored for symptoms of hypoglycemia; although glipizide was undetectable in human milk in one small clinical lactation study; this result is not conclusive because of limitations of assay used in the study; there are no data on effects of glipizide on milk production; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed child from therapy or from the underlying maternal condition Monitor breastfed infants for signs of hypoglycemia (e.g., jitters, cyanosis, apnea, hypothermia, excessive sleepiness, poor feeding, seizures)

Increased plasma concentration w/ certain antifungals (e.g. miconazole, fluconazole). Protein-bound drugs (e.g. NSAIDs, other sulfonamides, oral anticoagulants, hydantoins), probenecid, MAOIs, and chloramphenicol may potentiate hypoglycaemic action of glipizide. Diminished therapeutic effect w/ thiazides, other diuretics, phenothiazines, thyroid agents, oestrogens, OC, phenytoin, nicotinic acid, sympathomimetics, Ca channel blockers, rifampicin and isoniazid. Concomitant use w/ beta-blockers may impair glucose tolerance, increase frequency or severity of hypoglycaemia and block hypoglycaemia-induced tachycardia. Decreased serum concentration w/ colesevelam.

Side effects of Glipizide : GI upsets, diarrhoea, nausea; allergic skin reactions, leucopenia, thrombocytopenia, agranulocytosis, hyponatraemia; jaundice; haemolytic anaemia, pancytopenia. Potentially Fatal: Hypoglycaemia in presence of renal or hepatic damage and alcohol.

Glipizide stimulates insulin release from pancreatic ?-cells and reduces glucose output from the liver. It also increases insulin sensitivity at peripheral target sites.