Glipizide + Metformin Hydrochloride

Introduction: Glipizide + Metformin Hydrochloride is a combination medicine used to treat type 2 diabetes mellitus in adults. It helps control blood sugar levels and prevents serious complications of diabetes.

How it works: Glipizide is a sulfonylurea which works by increasing the amount of insulin released by the pancreas to lower blood glucose. Metformin is a biguanide which works by lowering glucose production in the liver, delaying glucose absorption from intestines and increasing the body's sensitivity to insulin.

Important Information: Take with food. Take it regularly at the same time each day. Do not stop without consulting your doctor. Regular blood sugar monitoring is recommended.

• Type 2 diabetes mellitus - as an adjunct to diet and exercise
• Initial therapy when hyperglycemia cannot be managed with diet and exercise alone
• Second-line therapy when sulfonylurea or metformin does not result in adequate control

Combination Oral hypoglycemic preparations

Sulfonylurea + Biguanide

Metformin is a biguanide antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Its pharmacological mechanisms of action are different from other classes of oral antihyperglycemic agents. Glipizide is a sulfonylurea which appears to lower blood glucose by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets.

Glipizide increases insulin secretion and Metformin reduces liver glucose production and improves insulin sensitivity to lower blood sugar levels.

Initial Therapy:

• Start: 2.5 mg/250 mg (glipizide/metformin) once daily with food
• If FPG 280-320 mg/dL: 2.5/500 mg twice daily
• Maximum: Glipizide 10 mg and metformin 2,000 mg daily

Second-Line Therapy:

• Start: 2.5/500 mg or 5/500 mg twice daily with food
• Maximum: Glipizide 20 mg and metformin 2,000 mg daily

* Use as directed by the registered physician

Oral tablet. Take with food (with morning and evening meals). Swallow whole, do not chew or crush.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and follow your regular schedule. Do not double the dose.

Common Side Effects:

• Hypoglycemia (low blood sugar)
• Taste change
• Nausea
• Stomach pain
• Diarrhea
• Headache
• Upper respiratory tract infection

Precautions:

• Hypoglycemia may occur when used with other antidiabetic medicines, alcohol or if you delay or miss a meal.
• Avoid alcohol (increases hypoglycemia risk).
• Inform doctor if you experience deep or rapid breathing, persistent nausea, vomiting, or stomach pain (signs of lactic acidosis).
• Regular kidney and liver function tests recommended.

Contraindications:

• Renal impairment (creatinine >1.5 mg/dL males, >1.4 mg/dL females)
• Diabetic ketoacidosis (with or without coma)
• Cardiac failure, recent MI, CHF
• Severe infection, stress, trauma
• Pregnancy and lactation

Drug Interactions:

• Glipizide: Decreased effect with beta-blockers, cholestyramine, hydantoins, thiazide diuretics
• Metformin: Additive effect with sulfonylureas; antagonistic effects with diuretics, corticosteroids

Food Interactions:

• Unsafe to consume alcohol with Glipizide + Metformin Hydrochloride.

Use in Pregnancy: May be unsafe during pregnancy. Animal studies have shown harmful effects.

Use in Lactation: Probably safe during breastfeeding. Limited data suggests the drug does not represent significant risk to the baby.

Pediatric Use: Safety and efficacy in children have not been established.

Geriatric Use: Elderly patients are more likely to have decreased renal function - caution required.

Renal Impairment: eGFR <30 mL/min/1.73m²: Contraindicated. eGFR 30-45: Do not initiate. eGFR <45: Evaluate risks and benefits of continuing.

Hepatic Impairment: Start with low dose in mild to moderate liver disease. Not recommended in severe liver disease.

Overdose: Hypoglycemia from glipizide. Lactic acidosis from metformin. Gastric lavage, activated charcoal and supportive care. Hemodialysis is effective.

Storage: Keep below 30°C, away from light and moisture. Keep out of reach of children.

Glipizide + Metformin Hydrochloride Tablet