Glipizide

A to Z Drug Facts

 Action Decreases blood glucose by stimulating insulin release from pancreas and by increasing tissue sensitivity to insulin.

 Indications Adjunct to diet to lower blood glucose in patients with non-insulin-dependent diabetes mellitus (type II) whose hyperglycemia cannot be controlled by diet alone.

 Contraindications Hypersensitivity to sulfonylureas; diabetes complicated by ketoacidosis, with or without coma; sole therapy of insulin-dependent (type I) diabetes mellitus; diabetes when complicated by pregnancy.

 Route/Dosage

ADULTS: PO 5 mg/day 30 min before breakfast. Dose should be adjusted in 2.5 to 5 mg/day increments based on blood glucose response. Divided doses may be given (maximum single daily dose 15 mg; maximum total daily dose 40 mg). ELDERLY OR PATIENTS WITH LIVER DISEASE: PO 2.5 mg/day initially.

 Interactions

Alcohol: Produces disulfiram-like reactions (facial flushing, headache, breathlessness). Androgens, chloramphenicol, clofibrate, fenfluramine, fluconazole, gemfibrozil, histamine H₂ antagonists, magnesium salts, methyldopa, monoamine oxidase, oral anticoagulants, phenylbutazone, probenecid, salicylates, sulfinpyrazone, sulfonamides, tricyclic antidepressants, urinary acidifiers: Hypoglycemic effects may be increased. Betablockers, cholestyramine, diazoxide, hydantoins, rifampin, thiazide diuretics, urinary alkalinizers: May decrease hypoglycemic effect. Food: Absorption is delayed when taken with food. Give drug » 30 min before meal.

 Lab Test Interferences Mild-to-moderate elevations in BUN and creatinine.

 Adverse Reactions

CV: May have increased risk of cardiovascular mortality when compared with patients treated with diet alone. CNS: Dizziness; vertigo. DERM: Allergic skin reactions; eczema; pruritus; erythema; urticaria; morbilliform or maculopapular eruptions; lichenoid reactions; photosensitivity. EENT: Tinnitus. GI: GI disturbances (eg, nausea, epigastric fullness, heartburn); diarrhea. GU: Mild diuresis; elevated BUN and creatinine. HEPA: Cholestatic jaundice; elevated liver function test results. HEMA: Leukopenia; thrombocytopenia; aplastic anemia; agranulocytosis; hemolytic anemia; pancytopenia; hepatic porphyria. META: Hypoglycemia. OTHER: Disulfiram-like reaction; weakness; paresthesia; fatigue; malaise.

 Precautions

Pregnancy: Category C. Insulin is recommended to maintain blood glucose levels during pregnancy. Prolonged severe neonatal hypoglycemia can occur if sulfonylureas are administered at time of delivery. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly and debilitated patients: Elderly and debilitated patients are particularly susceptible to hypoglycemic action. Hypoglycemia may be difficult to recognize in elderly. Hepatic and renal impairment: Use drug with caution and monitor liver and renal function frequently.

 Administration/Storage

• Dose can be divided if single dose is not effective. Also divide doses if patient is taking > 15 mg/day.
• Administer drug 30 min before meal; food delays absorption.
• If administering to pregnant patient, discontinue at least 1 mo before expected date of delivery.
• Store in tightly closed container at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note hepatic or renal impairment and nature of patient's diabetes (type I vs type II).
• Check blood sugars frequently and observe for symptoms of hypoglycemia or hyperglycemia and report to health care provider.
• Test urine for glucose and acetone at least three times daily during titration period; report results to health care provider.
• When patients with impaired liver or renal function are receiving this drug, check liver and renal function tests frequently.

 Patient/Family Education

• Remind patient to take medication on empty stomach 30 min before meals.
• Teach patient to self-monitor blood glucose.
• Emphasize importance of following diabetic diet.
• Inform patient that this drug is not substitute for exercise and diet control and that patient should follow prescribed regimens.
• Instruct patient to inform all health care providers involved in his/her care that they are taking this drug.
• Advise patient to carry identification stating that patient is diabetic.
• Inform patient to contact his/her health care provider if symptoms of hypoglycemia occur (fatigue, excessive hunger, profuse sweating, numbness of extremities).
• Tell patient to notify health care provider if symptoms of hyperglycemia occur (excessive thirst or urination, urinary glucose or ketones).
• Instruct patient to report these symptoms to health care provider: Nausea, vomiting, diarrhea, heartburn, sore throat, rash, unusual bruising or bleeding or other physical complaints.
• Advise patient not to take any medication (including otc) or alcohol without consulting health care provider.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts