Today's med: Glipizide (brand name: Glucotrol, Glucotro XL)
Drug Class: Antidiabetic agent, Sulfonylurea
Action: Stimulates insulin release from the pancreatic beta cells; reduces glucose output from the liver; insulin sensitivity is increased at peripheral target sites
Indications:
Contraindications: Hypersensitivity to glipizide or any component of the formulation; type 1 diabetes mellitus (insulin dependent, IDDM); diabetic ketoacidosis (with or without coma)
Adverse Effects:
Central nervous system: Dizziness (2% to 7%), nervousness (4%), anxiety (<3%), depression (<3%), hypoesthesia (<3%), insomnia (<3%), pain (<3%), drowsiness (2%), headache (2%)
Dermatologic: Pruritus (1% to <3%), eczema (1%), erythema (1%), maculopapular eruptions (1%), morbilliform eruptions (1%), rash (1%), urticaria (1%)
Endocrine & metabolic: Hypoglycemia (<3%)
Gastrointestinal: Diarrhea (1% to 5%), flatulence (3%), constipation (1% to <3%), nausea (1% to <3%), dyspepsia (<3%), vomiting (<3%), abdominal pain (1%)
Hepatic: Alkaline phosphatase increased, AST increased, LDH increased
Neuromuscular & skeletal: Tremor (4%), arthralgia (<3%), leg cramps (<3%), myalgia (<3%), paresthesia (<3%)
Ocular: Blurred vision (<3%)
Renal: Blood urea nitrogen increased, creatinine increased
Respiratory: Rhinitis (<3%)
Miscellaneous: Diaphoresis (<3%)
<1% (Limited to important or life-threatening): Agranulocytosis, anorexia, aplastic anemia, arrhythmia, blood in stool, cholestatic jaundice, conjunctivitis, disulfiram-like reaction, edema, gait instability, hemolytic anemia, hypertension, hypertonia, hyponatremia, jaundice, leukopenia, liver injury, migraine, pancytopenia, photosensitivity, porphyria, retinal hemorrhage, SIADH, thrombocytopenia, vertigo
Standard Dosing:
Extended release tablet (Glucotrol XL®): Initial: 5 mg once daily; usual dose: 5-10 mg once daily; maximum recommended dose: 20 mg/day; dosage adjustments based on blood glucose monitoring should be made no more frequently than every 7 days
When transferring from immediate release to extended release glipizide: May switch the total daily dose of immediate release to the nearest equivalent daily dose of the extended release tablet and administer once daily; alternatively, may initiate extended release at 5 mg once daily and titrate accordingly.
When transferring from insulin to glipizide immediate release or extended release tablet:
Current insulin requirement ≤20 units: Discontinue insulin and initiate glipizide at usual dose
Current insulin requirement >20 units: Decrease insulin by 50% and initiate glipizide at usual dose; gradually decrease insulin dose based on patient response
Conversion from therapy with long half-life agents: Observe patient carefully for 1-2 weeks when converting from a longer half-life agent (eg, chlorpropamide) to glipizide due to overlapping hypoglycemic effects.
Elderly:
Immediate release tablet: Initial: 2.5 mg once daily; consider titrating by 2.5-5 mg/day at 1- to 2-week intervals
Extended release tablet: Initial and maintenance dosing should be on the lower end of the recommended range.
Administer immediate release tablets 30 minutes before a meal (preferably before breakfast if once-daily dosing) to achieve greatest reduction in postprandial hyperglycemia. Extended release tablets should be given with breakfast. Patients that are NPO or require decreased caloric intake may need doses held to avoid hypoglycemia.
Take immediate release tablets 30 minutes before meals (preferably before breakfast if once-daily dosing); extended release tablets should be taken with breakfast. Individualized medical nutrition therapy (MNT) based on ADA recommendations is an integral part of therapy.
Concerns: • Cardiovascular mortality: Product labeling states oral hypoglycemic drugs may be associated with an increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. Data to support this association are limited, and several studies, including a large prospective trial (UKPDS) have not supported an association.
• Hypoglycemia: All sulfonylurea drugs are capable of producing severe hypoglycemia. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when ethanol is ingested, or when more than one glucose-lowering drug is used. It is also more likely in elderly patients, malnourished patients and in patients with impaired renal or hepatic function; use with caution. Autonomic neuropathy, advanced age, and concomitant use of beta-blockers or other sympatholytic agents may impair the patient’s ability to recognize the signs and symptoms of hypoglycemia; use with caution.
• Sulfonamide allergy: Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is not specifically contraindicated in product labeling; however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency: Patients with G6PD deficiency may be at an increased risk of sulfonylurea-induced hemolytic anemia; however, cases have also been described in patients without G6PD deficiency during postmarketing surveillance. Use with caution and consider a nonsulfonylurea alternative in patients with G6PD deficiency.
Drug
interactions: Link: http://www.drugs.com/drug-interactions/glipizide.html
A total of 857 drugs (5482 brand and generic names) are known to interact with glipizide.
- 1 major drug interactions (3 brand and generic names)
- 781 moderate drug interactions (5022 brand and generic names)
- 75 minor drug interactions (457 brand and generic names)
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