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glipizide
Glibenese§, Glucotrol,
Glucotrol XL, Minidiab‡

Pregnancy Risk Category C

How supplied
Tablets:
5 mg, 10 mg
Tablets (extended-release):
5 mg, 10 mg

Action
Unknown. A sulfonylurea that probably stimulates insulin release from the pancreatic beta cells and reduces glucose output by the liver. An extrapancreatic effect increases peripheral sensitivity to insulin.

Indications & dosage
Adjunct to diet to lower blood glucose level in patients with type 2 non-insulin-dependent diabetes mellitus--

Adults:
initially, 5 mg P.O. daily 30 minutes before breakfast. Maximum once-daily dose is 15 mg. Doses above 15 mg should be divided; maximum total daily dose is 40 mg for immediate-release tablets. Extended-release tablets: initially, 5 mg P.O. daily. Adjust in 5-mg increments q 3 months depending on level of glycemic control. Maximum daily dose is 20 mg.
Elderly:
for patients over age 65, initial dose is 2.5 mg P.O. daily.
Adjust-a-dose:
For patients with liver disease, initial dose is 2.5 mg P.O. daily.
To replace insulin therapy--

Adults:
if insulin dosage is more than 20 U daily, patient is started at usual dosage in addition to 50% of insulin. If insulin dosage is less than 20 U, insulin may be discontinued on initiation of glipizide.

Adverse reactions
CNS:
dizziness, drowsiness, headache.
GI:
nausea, constipation, diarrhea.
GU:
elevated BUN and creatinine levels.
Hematologic:
leukopenia, hemolytic anemia, agranulocytosis, thrombocytopenia, aplastic anemia.
Hepatic:
cholestatic jaundice, alterations in cholesterol, alkaline phosphatase, and AST levels.
Metabolic: hypoglycemia.
Skin:
rash, pruritus.

Interactions
Drug-drug.
Anabolic steroids, chloramphenicol, clofibrate, guanethidine, MAO inhibitors, probenecid, salicylates, sulfonamides: increased hypoglycemic activity. Monitor blood glucose levels.
Beta blockers:
prolonged hypoglycemic effect and masked symptoms of hypoglycemia. Use together cautiously.
Corticosteroids, glucagon, rifampin, thiazide diuretics:
decreased hypoglycemic response. Monitor blood glucose levels.
Hydantoins:
increased blood levels of hydantoins. Monitor blood glucose levels.
Oral anticoagulants:
increased hypoglycemic activity or enhanced anticoagulant effect. Monitor blood glucose levels, PT and INR.
Drug-lifestyle.
Alcohol use: altered glycemic control, most commonly hypoglycemia. May also cause disulfiram-like reaction. Discourage concomitant use.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with diabetic ketoacidosis with or without coma; also contraindicated in pregnant or breast-feeding women.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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