Glipizide

FDA label

Read the full label on DailyMed ↗

Titration At least several days between titration steps (increments of 2.5–5 mg)

Renal Conservative initial and maintenance dosing to avoid hypoglycemia

Hepatic Start 2.5 mg QD; conservative initial/maintenance dosing (hypoglycemia may be prolonged)

No fixed regimen — dose to minimum effective by blood glucose monitoring; conservative dosing in elderly, debilitated/malnourished, renal or hepatic impairment

Instructions

• Take ~30 min before a meal for greatest postprandial glucose reduction
• Divide total daily doses >15 mg and give before meals of adequate caloric content
• Administer ≥4 h before colesevelam
• Transfer from insulin: ≤20 units/day — stop insulin, start usual glipizide dose; >20 units/day — cut insulin 50% and start usual dose, then taper by response
• Transfer from long half-life sulfonylureas (e.g., chlorpropamide): watch 1–2 wk for overlapping hypoglycemia

Available strengths

• tab 5, 10 mg

Contraindications

• Type 1 diabetes mellitus
• Diabetic ketoacidosis, with or without coma (treat with insulin)
• Hypersensitivity to sulfonamide derivatives (per ER label)

Cautions

• Severe hypoglycemia — highest risk: elderly, renal impairment, debilitated/malnourished, adrenal/pituitary/hepatic insufficiency, deficient caloric intake, prolonged exercise, alcohol, combination with other antidiabetics; sympatholytics (beta-blockers) can mask warning symptoms
• Hemolytic anemia in G6PD deficiency — avoid; consider non-sulfonylurea (also reported without known G6PD deficiency)
• Possible increased cardiovascular mortality with sulfonylureas (UGDP study, tolbutamide) — inform patient of risks/alternatives
• Cholestatic jaundice / liver injury — discontinue if occurs
• No conclusive evidence of macrovascular risk reduction

Adverse reactions

• GI most common: nausea, diarrhea (~1/70); constipation, gastralgia (~1/100) — dose-related
• Hypoglycemia
• Allergic skin reactions (erythema, urticaria, pruritus, eczema ~1/70); photosensitivity; porphyria cutanea tarda
• Dizziness, drowsiness, headache (~1/50)
• Rare: cholestatic/hepatocellular liver injury with jaundice; leukopenia, agranulocytosis, thrombocytopenia, hemolytic/aplastic anemia, pancytopenia; hyponatremia/SIADH; disulfiram-like reaction (very low incidence)

Pregnancy No drug-associated major-defect signal in decades of use, but sulfonylureas cross the placenta — neonatal hypoglycemia reported; discontinue ≥2 wk before expected delivery (from ER label)

Lactation Undetectable in human milk in one small assay-limited study; monitor breastfed infants for hypoglycemia (from ER label)