glipizide and metformin (Metaglip has been discontinued in the US)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    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.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What is the dosage for glipizide/metformin hydrochloride?

  • For patients inadequately controlled on diet and exercise alone: Generally, the recommended starting dose of glipizide/metformin is 2.5/250 mg administered once or twice daily. A starting dose of 2.5/500 mg twice daily may be considered for patients with fasting plasma glucose (FPG) of 280-320 mg/dL. If necessary, dosage may be increased by 1 tablet daily every 2 weeks to achieve adequate blood glucose control. The maximum daily dose is 20/2000 mg. Avoid starting treatment with the 5/500 mg strength due to the risk of hypoglycemia (low blood glucose levels).
  • For patients inadequately controlled on glipizide or metformin monotherapy: Treatment may be started with either 2.5/500 mg or 5/500 mg administered by mouth twice daily with meals. To avoid hypoglycemia, the starting dose must not exceed the current dose of glipizide or metformin that the patient has been already taking.
  • For patients who are already taking a combination of sulfonylurea/metformin who desire to switch to a combination pill: To avoid hypoglycemia, avoid exceeding the current dose of sulfonylurea and metformin. If necessary, the dose may be increased gradually to the minimum dosage required to achieve adequate blood glucose control.
  • Patients with liver disease: Use of glipizide/metformin in patients with liver disease is generally not recommended. Liver disease increases the risk of metformin associated lactic acidosis, a rare but potentially fatal condition which causes an accumulation of acid in the body.
  • Patients with kidney disease: Metformin should not be used in females with serum creatinine concentration > 1.4 mg/dL or in males with serum creatinine concentration > 1.5 mg/dL.
  • Pediatrics: The safety and efficacy of glipizide/metformin has not been established in pediatric patients. Therefore, use of glipizide/metformin in this patient population is not recommended.

Which drugs or supplements interact with glipizide/metformin hydrochloride?

  • Drugs which cause blood glucose levels to increase may diminish the effectiveness of glipizide/metformin therapy. These drugs include:
  • Cimetidine (Tagamet), by decreasing the elimination of metformin from the body, can increase the amount of metformin in the blood by 40%. This may increase the frequency of side effects from metformin.
  • Alcohol consumption increases the effect of metformin on lactate production, increasing the risk of lactic acidosis.
  • Due to the risk of lactic acidosis, metformin containing products must be temporarily discontinued prior to the administration of radiopaque contrast dyes.
  • Metformin should be held for at least 48 hours after contrast dye administration and should not be restarted until patient's kidney function returns back to normal.
  • Beta blockers may increase the blood glucose lowering actions of sulfonylureas. Cardio-selective beta blockers such as acebutolol (Sectral), atenolol (Tenormin), metoprolol (Lopressor or Toprol XL), and penbutolol (Levatol) may be safer than their nonselective counterparts.
  • Colesevelam (Welchol) may reduce blood levels of glipizide. Patients are advised to take glipizide 1 hour before or 4 hours after colesevelam administration to minimize the risk of their interaction.
  • Concomitant use of systemic antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), miconazole, and voriconazole (VFEND) with glipizide may cause hypoglycemia.

Is glipizide/metformin hydrochloride safe to use during pregnancy or while breastfeeding?

  • Glipizide/metformin has not been adequately evaluated in pregnant women. Due to the lack of conclusive safety data, glipizide/metformin should be avoided during pregnancy if possible. Glipizide/metformin is classified as FDA pregnancy risk category C (animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks).
  • It is not known if glipizide/metformin is excreted in breast milk. Due to the lack of safety data and the potential risk for hypoglycemia in the nursing infant, use of glipizide/metformin during breastfeeding is not recommended.

What else should I know about glipizide/metformin hydrochloride?

What preparations of glipizide/metformin hydrochloride are available?
  • Oral tablets (glipizide/metformin): 2.5/250, 2.5/500 or 5/500 mg
How should I keep glipizide/metformin hydrochloride stored?
  • Tablets should be stored at room temperature between 15 C and 30 C (59 F and 86 F).

REFERENCES:

FDA Prescribing Information.

NIH. Disulfiram.

Medically Reviewed by a Doctor on 12/16/2016

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