Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Glipizide is an oral drug that is used for
treating patients with type 2 diabetes. It belongs to the sulfonylurea class of
drugs that includes glimepiride (Amaryl), glyburide (Micronase, Diabeta),
tolbutamide (Orinase) and tolazamide (Tolinase).
Insulin is a hormone that is made in the pancreas that, when released into
the blood causes cells in the body to remove sugar (glucose) from the blood and
reduces the formation of glucose by the liver. Patients with type 2 diabetes
have high glucose (sugar) levels in their blood because the cells in their
bodies are resistant to the effect of the insulin, and the liver produces too
much glucose. In addition, in type 2 diabetes the pancreas is unable to produce
the increased amounts of insulin that are necessary to overcome the resistance.
Glipizide reduces blood glucose by stimulating the pancreas to produce more
insulin. Glipizide is not a cure for diabetes.
PRESCRIBED FOR: Glipizide is used together with diet and exercise to
reduce blood glucose in patients with type 2 diabetes.
DOSING: The usual starting dose when using immediate release tablets
is 5 mg administered 30 minutes before a meal. The maximum dose is 40 mg daily.
Doses higher than 15 mg per day should be divided.
The starting dose when using extended-release tablets is 5 mg daily up to a
maximum dose of 20 mg daily. Patients using immediate release tablets may be
converted to the nearest equivalent extended-release dose.
DRUG INTERACTIONS: Alcohol may prolong the action of glipizide by
delaying the absorption and elimination of glipizide. Patients taking glipizide
should keep alcohol consumption to a minimum. Cholestyramine may reduce the
absorption and consequently the effect of glipizide. Therefore, glipizide should
be administered 1-2 hours before cholestyramine is administered. Fluconazole
(Diflucan) may increase the absorption and therefore increase the effect of
glipizide.
Many drugs can potentially increase or decrease glucose levels thus
increasing or decreasing the effect of glipizide. Drug interactions which cause
low blood glucose (hypoglycemia) can occur with nonsteroidal anti-inflammatory
drugs (e.g., ibuprofen), sulfa drugs, warfarin, miconazole, and beta-blockers
(e.g., propranolol). Drug interactions which cause high blood glucose
(hyperglycemia) can occur with thiazide diuretics, corticosteroids, thyroid
medicines, estrogens, niacin, phenytoin, and calcium channel blocking drugs
(e.g., diltiazem). Patients should be monitored closely for loss of glucose
control when such drugs are administered.
PREGNANCY: Use of glipizide during pregnancy has not been adequately
studied.
NURSING MOTHERS: It is not known whether glipizide is excreted in
breast milk.
SIDE EFFECTS: Side effects include headache, dizziness, diarrhea, and
gas. Skin rashes can occur and cause itching, hives, or a diffuse measles-like
rash. Rare but serious side effects include hepatitis, jaundice, and a low
sodium concentration. Glipizide may also cause hypoglycemia. The risk of
hypoglycemia increases when glipizide is combined with other glucose reducing
agents.
References: Facts and Comparisons. Wolters Kluwer Health, Inc
2005, Prescribing Information for Glucotrol, Pfizer Inc. 2000
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
The major goal in treating diabetes is to minimize any elevation of blood
sugar (glucose) without causing abnormally low levels of blood sugar. Type 1
diabetes is treated with insulin, exercise, and a
diabetic diet. Type 2 diabetes
is treated first with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is
considered.
Adherence to a diabetic diet is an important aspect of controlling elevated
blood sugar in patients with diabetes. The American Diabetes Association (ADA)
has provided guidelines for a diabetic diet. The ADA diet is a balanced,
nutritious diet that is low in fat, cholesterol, and simple sugars. The total
daily calories are evenly divided into three meals. In the past two years, the
ADA has lifted the absolute ban on simple sugars. Small amounts of si...
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