Adult: As immediate-release: Initially, 2.5-5 mg daily as a single dose. Adjust dose at intervals of several days in increments of 2.5-5 mg daily according to response. Doses >15 mg may be given in 2 divided doses. Max: 20 mg daily. As extended-release: Initially, 2.5-5 mg once daily, adjust dose according to response in increments of 5-10 mg once weekly. Max: 20 mg Elderly: Initially, 2.5 mg once daily, titrate dose by 2.5-5 mg daily at 1-2 weeks intervals. Maintenance dosing should be conservative.
Renal Impairment
Mild to moderate: As immediate release: Initially, 2.5 mg once daily, then elective titration up to 20 mg daily. Maintenance dosing should be conservative. As extended-release: 2.5 mg once daily. Severe: Contraindicated.
Hepatic Impairment
Mild to moderate: Initially, 2.5 mg once daily. Maintenance dosing should be conservative. Severe: Contraindicated.
Administration
immediate-release: Should be taken on an empty stomach. Take 30 min before meals. extended-release: Should be taken with food. Swallow whole, do not chew/crush/divide.
Contraindications
Hypersensitivity to glipizide, other sulfonylureas or sulfonamides. Type 1 diabetes mellitus, diabetic ketoacidosis with or without coma or history of ketoacidotic coma, severe thyroid impairment. Severe renal or hepatic impairment. Pre-existing pathologic or iatrogenic severe gastrointestinal narrowing (extended-release). Concomitant use with miconazole.
Special Precautions
Patients with established atherosclerotic CV disease, prior allergic reactions to sulphonamides, G6PD deficiency, stress-related states. Mild to moderate renal and hepatic impairment. Elderly, debilitated and malnourished patients. Pregnancy and lactation.
This drug may cause dizziness, drowsiness, and visual disturbances, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood and urine glucose concentrations, glycosylated Hb, renal function, LFT, weight; signs and symptoms of hypoglycaemia.
Overdosage
Symptoms: Hypoglycaemia; faintness, confusion, sweating or shaking. Management: Mild hypoglycaemia may be treated with oral glucose or with any sugary food or drinks. For severe hypoglycaemia, administer glucagon or rapid IV inj of glucose 50% solution followed by continuous infusion of glucose 10% solution. Monitor patient for at least 48 hours.
Drug Interactions
Increased plasma concentration with fluconazole and voriconazole. Increased hypoglycaemic effect with NSAIDs (e.g. phenylbutazone), ACE inhibitors, MAOIs, cimetidine, chloramphenicol, probenecid, coumarins and fibrates. Potentially Fatal: Severe hypoglycaemia leading to coma with miconazole.
Food Interaction
Increased hypoglycaemic action with alcohol.
Action
Description: Glipizide stimulates insulin release from pancreatic ß-cells and reduces glucose output from the liver. It also increases insulin sensitivity at peripheral target sites. Duration: 12-24 hours. Pharmacokinetics: Absorption: Rapidly and completely absorbed from the gastrointestinal tract (immediate-release). Food delays absorption. Bioavailability: 90-100%. Time to peak plasma concentration: 1-3 hours; 6-12 hours (extended-release). Distribution: Plasma protein binding: 98-99%, primarily to albumin. Volume of distribution: 10-11 L. Metabolism: Metabolised in the liver by CYP2C19 to inactive metabolites. Excretion: Via urine (<10% as unchanged drug; 80% as metabolites); faeces (10%). Elimination half-life: 2-5 hours.
Chemical Structure
Glipizide Source: National Center for Biotechnology Information. PubChem Database. Glipizide, CID=3478, https://pubchem.ncbi.nlm.nih.gov/compound/Glipizide (accessed on Jan. 22, 2020)
Storage
Immediate-release: Store below 25°C. Protect from light. Extended-release: Store between 20-25°C. Protect from moisture and humidity.
A10BB07 - glipizide ; Belongs to the class of sulfonylureas. Used in the treatment of diabetes.
References
Anon. Glipizide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/05/2019.Buckingham R (ed). Glipizide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/05/2019.Glipizide Tablet (Sandoz Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/05/2019.Glipizide Tablet, Extended Release (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/05/2019.Glucotrol and Glucotrol XL Tablets. U.S. FDA. https://www.fda.gov/. Accessed 28/08/2014.Joint Formulary Committee. Glipizide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/05/2019.McEvoy GK, Snow EK, Miller J et al (eds). Glipizide. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 28/08/2014.Minidiab Tablet [Pfizer (Malaysia) Sdn. Bhd.]. National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my/. Accessed 15/05/2019.
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