Glyburide Metformin

Glyburide Metformin Brand Name– Glucovance

What is Glyburide Metformin

Glyburide 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.

Glyburide is a second-generation oral sulfonylurea. Glyburide 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; the combination of metformin with glyburide results in significant improvements in fasting glucose, postprandial glucose, and A1C versus the use of either agent alone.

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.

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.

Glyburide, due to its prolonged duration of action, is not the preferred sulfonylurea in geriatric patients; glipizide is considered a better therapeutic choice for the elderly.

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. asthenia
  9. cholestasis
  10. Co-Enzyme Q-10 deficiency
  11. diarrhea
  12. dizziness
  13. dysgeusia
  14. dyspepsia
  15. elevated hepatic enzymes
  16. erythema
  17. flatulence
  18. flushing
  19. folate deficiency
  20. headache
  21. hemolysis
  22. hemolytic anemia
  23. hepatitis
  24. hypoglycemia
  25. hyponatremia
  26. hypotension
  27. jaundice
  28. lactic acidosis
  29. leukopenia
  30. maculopapular rash
  31. malaise
  32. metabolic acidosis
  33. metallic taste
  34. myalgia
  35. nausea
  36. pancytopenia
  37. photosensitivity
  38. pruritus
  39. pyrosis (heartburn)
  40. rhabdomyolysis
  41. secondary failure
  42. SIADH
  43. thrombocytopenia
  44. urticaria
  45. vasculitis
  46. vitamin B12 deficiency
  47. vomiting
  48. weight gain

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
  • 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
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  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
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