Glipizide Metformin

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

  1. abdominal pain
  2. agranulocytosis
  3. anemia
  4. angioedema
  5. anorexia
  6. aplastic anemia
  7. arthralgia
  8. atopic dermatitis
  9. cholestasis
  10. coma
  11. diarrhea
  12. dizziness
  13. dysgeusia
  14. elevated hepatic enzymes
  15. flatulence
  16. flushing
  17. folate deficiency
  18. headache
  19. hemolysis
  20. hepatitis
  21. hyperhidrosis
  22. hypertension
  23. hypoglycemia
  24. hyponatremia
  25. hypotension
  26. hypothermia
  27. infection
  28. jaundice
  29. lactic acidosis
  30. leukopenia
  31. maculopapular rash
  32. malaise
  33. metabolic acidosis
  34. metallic taste
  35. musculoskeletal pain
  36. myalgia
  37. nausea
  38. pancytopenia
  39. photosensitivity
  40. pruritus
  41. pyrosis (heartburn)
  42. rhabdomyolysis
  43. secondary failure
  44. seizures
  45. SIADH
  46. thrombocytopenia
  47. urticaria
  48. vasculitis
  49. vitamin B12 deficiency
  50. vomiting
  51. 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
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  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Aluminum Hydroxide; Magnesium Trisilicate
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  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
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  • Enalapril, Enalaprilat
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  • Ethotoin
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  • Green Tea
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