Sign Out
As for any hypoglycemic agent, dosage must be adapted for each individual case. The GITS tablets should be swallowed whole with a sufficient amount of liquid. Patients should not chew, divide or crush the tablets. (See Precautions).
Initial Dose: The recommended starting dose of glipizide GITS is 5 mg/day, given with breakfast. For elderly patients and other patients at risk for hypoglycemia, see Elderly and High-Risk Patients.
Titration: Dosage adjustments may be in increments of 2.5 or 5 mg, as determined by blood glucose response. At least several days should elapse between titration steps. Steady-state plasma glipizide levels were achieved by the 5th day of dosing with glipizide GITS. Elderly patients may require 1-2 days longer.
Maintenance: Patients are effectively controlled on a once-a-day regimen. The maximum recommended dosage is 20 mg since the maximum blood glucose-lowering effect is observed at this level. Patients receiving immediate release glipizide between 5 and 20 mg daily may be switched safely to glipizide GITS once-a-day at the nearest equivalent or lower total daily dose.
Children: Safety and effectiveness in children have not been established.
Elderly and High-Risk Patients: To decrease the risk of hypoglycemia in patients at risk including elderly patients, debilitated, malnourished or patients with irregular caloric intake and patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions. Studies in approximately 200 patients ≥65 years indicate that glipizide GITS is as safe and effective in this age group as in those patients <65 years.
Patients Receiving Insulin: As with other sulfonylurea-class hypoglycemics, many stable non-insulin dependent diabetic patients receiving insulin may be transferred safely to treatment with Glucotrol XL extended-release tablets. When transferring patients from insulin to Glucotrol XL, the following general guidelines should be considered:
For patients whose daily insulin requirement is ≤20 units, insulin may be discontinued and Glucotrol XL therapy may begin at usual dosages. Several days should elapse between titration steps.
For patients whose daily insulin requirement is >20 units, the insulin dose should be reduced by 50% and Glucotrol XL therapy may begin at usual dosages. Subsequent reduction in insulin dosage should depend on individual patient response. Several days should elapse between titration steps.
During the insulin withdrawal period, the patient should self monitor glucose levels. Patients should be instructed to contact the prescriber immediately if these tests are abnormal. In some cases, especially when the patient has been receiving >40 units of insulin daily, it may be advisable to consider hospitalization during the transition period.
Patients Receiving Other Oral Hypoglycemic Agents: As with other sulfonylurea, when switching patients to Glucotrol XL GITS from another sulfonylurea they should be observed carefully for hypoglycemia (eg, by symptoms or by blood glucose monitoring) for at least 2 weeks. When switching patients to Glucotrol XL GITS a conservative dose is recommended. When adding other blood-glucose-lowering agents to Glucotrol XL GITS for combination therapy, the agent should be initiated at the lowest recommended dose, and patients should be observed carefully for hypoglycemia. Refer to the product information supplied with the oral agent for additional information.
When adding Glucotrol XL to other blood-glucose-lowering agents, it can be initiated at 5 mg. Those patients who may be more sensitive to hypoglycemic drugs may be started at a lower dose. Titration should be based on clinical judgement.
