Glipizide-Metformin

Glipizide-Metformin is a combination medication used for the treatment of type 2 diabetes mellitus.

• Glipizide-Metformin is available under various brand names: Metaglip

Common side effects of Glipizide-Metformin include:

• nausea,
• diarrhea,
• stomach upset,
• muscle aches, and
• headache

Serious side effects of Glipizide-Metformin include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• easy bleeding or bruising,
• persistent sore throat,
• fever,
• persistent nausea,
• severe stomach pain,
• yellowing of the eyes or skin (jaundice),
• dark urine,
• cold sweat,
• blurred vision,
• dizziness,
• drowsiness,
• shaking,
• fast heartbeat,
• headache,
• fainting,
• tingling of the hands or feet,
• hunger,
• increased thirst,
• increased urination,
• confusion,
• drowsiness,
• flushing,
• rapid breathing, and
• fruity breath odor

Rare side effects of Glipizide-Metformin include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Tablet

• 2.5 mg/250 mg
• 2.5 mg/500 mg
• 5 mg/500 mg

Type 2 Diabetes Mellitus

Adult dosage

• Initial treatment: start at 2.5 mg/250 mg (Glipizide-Metformin) orally every day with food
• If fasting plasma glucose = 280-320 mg/dL: 2.5/500 mg orally every 12 hours
• Titrate every 2 weeks to no more than 10/2000 mg per day in divided doses
• Type 2 DM Inadequately Controlled on Sulfonylurea &/or Metformin

Adult dosage

• 2nd-line treatment: Start at 2.5/500 mg or 5/500 mg orally every 12 hours with food
• Titrate to no more than 20/2000 mg per day in divided doses

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Glipizide-Metformin has severe interactions with no other drugs.
• Glipizide-Metformin has serious interactions with the following drugs:
  • aminolevulinic acid oral
  • aminolevulinic acid topical
  • contrast media (iodinated)
  • ethanol
  • ioversol
  • ivosidenib
  • lumacaftor/ivacaftor
  • methyl aminolevulinate
  • methylene blue
• Glipizide-Metformin has moderate interactions with at least 302 other drugs.
• Glipizide-Metformin has minor interactions with at least 112 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Severe renal disease: eGFR below 30 ml/min/1.73 m²
• Documented hypersensitivity to drug or components
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
• Renal disease or renal dysfunction (eg, as suggested by serum creatinine levels above 1.5 mg/dL [males], above 1.4 mg/dL [females], or abnormal creatinine clearance) whichmay also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Glipizide-Metformin?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Glipizide-Metformin?”

Cautions

• Patients with glucose-6-phosphate dehydrogenase deficiency may be at risk of sulfonylurea-induced hemolytic anemia
• Administration of oral hypoglycemic drugs reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin; data in support of this association is limited and several studies, including a large prospective trial, have not supported this association; metformin does not appear to share this risk; in patients with established atherosclerotic cardiovascular disease, other agents are preferred
• Long-term metformin use is associated with vitamin B12 deficiency; measurement of hematologic parameters on an annual basis is advised in patients on metformin and any apparent abnormalities should be appropriately investigated and managed; certain individuals (those with inadequate vitamin B12 or calcium intake or absorption) appear to be predisposed to develop subnormal vitamin B 12 levels; in these patients, routine serum vitamin B12 measurements at 2- to 3-year intervals may be useful
• In patients with advanced age, the drug should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function; in elderly patients, particularly those above 80 years of age, renal function should be monitored regularly and, generally, the drug should not be titrated to the maximum dose
• Before initiation of therapy and at least annually thereafter, renal function should be assessed and verified as normal; in patients in whom development of renal dysfunction is anticipated, renal function should be assessed more frequently and therapy discontinued if evidence of renal impairment is present
• Cardiovascular collapse (shock) from whatever cause, acute congestive heart failure, acute myocardial infarction, and other conditions characterized by hypoxemia have been associated with lactic acidosis and may also cause prerenal azotemia; when such events occur in patients on this therapy, the drug should be promptly discontinued
• Therapy should be temporarily suspended for any surgical procedure (except minor procedures not associated with restricted intake of food and fluids) and should not be restarted until the patient’s oral intake has resumed and renal function has been evaluated as normal
• Alcohol is known to potentiate effect of metformin on lactate metabolism. Patients, therefore, should be warned against excessive alcohol intake, acute or chronic, while receiving; due to its effect on the gluconeogenic capacity of the liver, alcohol may also increase risk of hypoglycemia
• Since impaired hepatic function has been associated with some cases of lactic acidosis, this drug should generally be avoided in patients with clinical or laboratory evidence of hepatic disease
• A patient with type 2 diabetes previously well controlled on metformin who develops laboratory abnormalities or clinical illness (especially vague and poorly defined illness) should be evaluated promptly for evidence of ketoacidosis or lactic acidosis; evaluation should include serum electrolytes and ketones, blood glucose and, if indicated, blood pH, lactate, pyruvate, and metformin levels; if acidosis of either form occurs, this drug must be stopped immediately and other appropriate corrective measures initiated
• Hypoglycemia
  • This drug combination is capable of producing hypoglycemia; therefore, proper patient selection, dosing, and instructions are important to avoid potential hypoglycemic episodes
  • Risk of hypoglycemia is increased when caloric intake is deficient when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents or ethanol
  • Renal insufficiency may cause elevated drug levels of both glipizide and metformin hydrochloride; hepatic insufficiency may increase drug levels of glipizide and may also diminish gluconeogenic capacity, both of which increase the risk of hypoglycemic reactions
  • Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects; hypoglycemia may be difficult to recognize in the elderly and people who are taking beta-adrenergic blocking drugs
• Iodinated contrast imaging procedures
  • Discontinue metformin at the time of or before an iodinated contrast imaging procedure in patients with an eGFR between 30-60 mL/minute/1.73 m²; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinate contrast
  • Reevaluate eGFR 48 hr after the imaging procedure; restart metformin if renal function is stable
• See also individual drugs
  • glipizide
  • metformin

Pregnancy & Lactation

• Use with caution if benefits outweigh risks during pregnancy
• Lactation
  • Enters breast milk; not recommended