Glipizide Metformin Brand Name– Metaglip
What is Glipizide Metformin
Glipizide metformin is a combination of 2 oral antidiabetic agents. The combination is used as an adjunct to diet and exercise to lower blood glucose levels in patients with type 2 diabetes mellitus (DM).
Metformin is an oral biguanide antidiabetic agent. While metformin carries a low risk for lactic acidosis as outlined in the prescribing information and boxed warning of all metformin-containing products, care in prescribing and monitoring can reduce this risk.
Glipizide is a second-generation sulfonylurea that is often added to metformin with or without other antidiabetic agents in patients who need further medication to achieve A1C and blood glucose target goals; combined use of metformin with glipizide results in improvements in fasting glucose, postprandial glucose, and A1C versus the use of either agent alone.
Glipizide has a shorter duration of action than glyburide and is not metabolized to active metabolites.
Metformin is first-line in the treatment of type 2 DM. In patients with established cardiovascular (CV) disease, heart failure (HF), or chronic kidney disease (CKD), a sodium-glucose co-transporter 2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with proven CV benefit and reduction of CKD progression is recommended for add-on therapy, independent of baseline A1C or individualized A1C target.
In patients without indicators of high-risk or established CV disease, HF, or CKD, sulfonylureas are an option that as a class generally reduce hemoglobin A1C by 1% to 2%; however, the second-generation agents are preferred over first-generation agents due to a lower risk of hypoglycemia and favorable cost, efficacy, and safety profiles.
In the elderly patients and those with renal dysfunction, a shorter-duration sulfonylurea such as glipizide is preferred over glyburide.
Disadvantages of sulfonylurea therapy include hypoglycemia (especially in the elderly), weight gain, and frequent loss of efficacy over time; however, the weight gain is relatively modest in large cohort studies and the incidence of severe hypoglycemia is lower than with insulin.
In patients who are starting on insulin therapy and are taking a sulfonylurea, discontinue or reduce the dose of the sulfonylurea to reduce the risk of hypoglycemia.
Indications
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus not controlled by diet and exercise alone
for use as initial therapy in previously untreated patients
Side Effects
- abdominal pain
- agranulocytosis
- anemia
- angioedema
- anorexia
- aplastic anemia
- arthralgia
- atopic dermatitis
- cholestasis
- coma
- diarrhea
- dizziness
- dysgeusia
- elevated hepatic enzymes
- flatulence
- flushing
- folate deficiency
- headache
- hemolysis
- hepatitis
- hyperhidrosis
- hypertension
- hypoglycemia
- hyponatremia
- hypotension
- hypothermia
- infection
- jaundice
- lactic acidosis
- leukopenia
- maculopapular rash
- malaise
- metabolic acidosis
- metallic taste
- musculoskeletal pain
- myalgia
- nausea
- pancytopenia
- photosensitivity
- pruritus
- pyrosis (heartburn)
- rhabdomyolysis
- secondary failure
- seizures
- SIADH
- thrombocytopenia
- urticaria
- vasculitis
- vitamin B12 deficiency
- vomiting
- weight loss
Monitoring Parameters
- blood glucose
- CBC
- glucose-6-phosphate dehydrogenase (G6PD) activity
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- serum creatinine/BUN
Contraindications
- acidemia
- acute heart failure
- acute myocardial infarction
- adrenal insufficiency
- alcoholism
- breast-feeding
- burns
- cardiac disease
- cardiogenic shock
- children
- dehydration
- diabetic ketoacidosis
- diarrhea
- ethanol ingestion
- ethanol intoxication
- fever
- G6PD deficiency
- gastroparesis
- geriatric
- GI obstruction
- heart failure
- hemolytic anemia
- hepatic disease
- hypercortisolism
- hyperglycemia
- hyperthyroidism
- hypoglycemia
- hypothyroidism
- hypoxemia
- ileus
- infection
- lactic acidosis
- malnutrition
- metabolic acidosis
- neonates
- obstetric delivery
- pernicious anemia
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- radiographic contrast administration
- renal disease
- renal failure
- renal impairment
- sepsis
- sulfonamide hypersensitivity
- sulfonylurea hypersensitivity
- surgery
- trauma
- type 1 diabetes mellitus
- vomiting
Interactions
- Abacavir; Dolutegravir; Lamivudine
- Abacavir; Lamivudine, 3TC
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetazolamide
- Acetohexamide
- Acitretin
- Acrivastine; Pseudoephedrine
- Adefovir
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amiloride; Hydrochlorothiazide, HCTZ
- Aminolevulinic Acid
- Amiodarone
- Amlodipine; Benazepril
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
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- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
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- Aspirin, ASA; Pravastatin
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- Chlorpheniramine; Hydrocodone; Phenylephrine
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- Dexmethylphenidate
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- Diazoxide
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- Digoxin
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- Donepezil; Memantine
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- Dorzolamide; Timolol
- Doxycycline
- Drospirenone
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- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
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- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Elexacaftor; tezacaftor; ivacaftor
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir alafenamide
- Emtricitabine; Tenofovir disoproxil fumarate
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Entecavir
- Ephedrine
- Epinephrine
- Eprosartan
- Eprosartan; Hydrochlorothiazide, HCTZ
- Eravacycline
- Erdafitinib
- Erythromycin; Sulfisoxazole
- Esmolol
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estramustine
- Estrogens
- Estropipate
- Ethacrynic Acid
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethotoin
- Etonogestrel
- Exenatide
- Famotidine
- Famotidine; Ibuprofen
- Fenofibrate
- Fenofibric Acid
- Fexofenadine; Pseudoephedrine
- Fibric acid derivatives
- Fluconazole
- Fluocinolone; Hydroquinone; Tretinoin
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluoxymesterone
- Fosamprenavir
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Furosemide
- Gadoterate meglumine
- Garlic, Allium sativum
- Gemfibrozil
- Glecaprevir; Pibrentasvir
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glyburide
- Glyburide; Metformin
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Green Tea
- Griseofulvin
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Halobetasol; Tazarotene
- Hydantoins
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydroxychloroquine
- Hydroxyprogesterone
- Ibuprofen; Pseudoephedrine
- Iloperidone
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- Insulin Aspart
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- Iodipamide Meglumine
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- Lamotrigine
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- Lente Insulin
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- Linezolid
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- Nicotine
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