Glipizide

Registered South African indications:

• Type 2 diabetes mellitus

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Hypersensitivity to other sulfonylureas or sulfonamides
• Pregnancy
• Breastfeeding
• Severe renal impairment
• Severe hepatic impairment
• Severe thyroid impairment
• Insulin-dependent (juvenile onset type I) diabetes mellitus
• Diabetic ketoacidosis (with or without coma)
• History of ketoacidotic coma
• Coadministration with miconazole

Cautions

• Mild to moderate hepatic impairment
• Mild to moderate renal impairment
• Elderly
• Porphyria
• Debilitated or malnourished patients
• Adrenal insufficiency
• Pituitary insufficiency
• Deficient caloric intake
• Severe or prolonged exercise
• Alcohol consumption
• Use of more than one glucose-lowering agent
• Stress
  - Fever
  - Trauma
  - Infection
  - Surgery
• Glucose-6-phosphate dehydrogenase deficiency
• Galactose intolerance
• Lapp lactase deficiency
• Glucose galactose  malabsorption

Forms avail. in SA and covered in this monograph: tab

Non insulin-dependent diabetes mellitus
- When hyperglycaemia cannot be controlled by diet alone and advice has been given on weight reduction and exercise

• Oral (tab): Initial: 5mg, dly admin. before breakfast or lunch; Titrate by 2.5-5mg, if needed depending on blood glucose response; Max single dose: 15mg; Max: 20mg/24hrs  

Mild diabetics, elderly or those with liver disease may be started on 2.5mg

Allow several days between titrations 

Some patients may be effectively controlled on a once-a-day regimen. Total daily dosages above 15 mg should ordinarily be divided

Dosage must be adapted for each individual case

Short term administration of glipizide may be sufficient during periods of transient loss of control in patients usually controlled well on diet

Not established for use in children

Pregnancy

• Contraindicated
• Glipizide is contraindicated in pregnancy.  Glipizide was found to be mildly fetotoxic in rat reproductive studies. No teratogenic effects were found in rat or rabbit studies
• Prolonged severe hypoglycaemia (4-10 days) has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery
• Because recent information suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities, many experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible

Breastfeeding

• Contraindicated
• No data is available on secretion into breast milk. Therefore glipizide is contraindicated during breastfeeding

Renal Impairment

• Mild to moderate; Caution; dose adjustment recommended
  Oral (tab): Initial: 2.5mg, dly; Titrate gradually, as needed; Maintenance dosing should be conservative to avoid hypoglycaemic reactions
• Severe: Contraindicated

Hepatic Impairment

• Mild to moderate: Caution; dose adjustment recommended
  Oral (tab): Initial: 2.5mg, dly; Titrate gradually, as needed; Maintenance dosing should be conservative to avoid hypoglycaemic reactions
• Severe: Contraindicated

Elderly

• Caution; dose adjustment recommended
  Oral (tab): Initial: 2.5mg, dly; Consider titrating by 2.5-5mg at intervals of 1-2 weeks; Maintenance dosing should be conservative to avoid hypoglycaemic reactions

Porphyria Information

• Probably not porphyrinogenic (PNP)
  Common side effects that can be potentially porphyrinogenic through reduction in carbohydrate intake and that also can be confused with an acute porphyria attack are nausea, vomiting, diarrhoea, obstipation and abdominal pain. A less common side effect is hypoglycaemia, which also may be potentially porphyrinogenic

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Confusion
• Dizziness
• Somnolence
• Tremor
• Headache
• Malaise

Gastrointestinal Disorders

• Nausea and vomiting
• Diarrhoea
• Abdominal pain
• Constipation

Hepatobiliary Disorders

• Cholestatic jaundice
• Abnormal hepatic function
• Hepatitis
• Increased aspartate aminotransferase
• Increased lactose dehydrogenase
• Increased alkaline phosphatase
• Increased blood urea
• Increased creatinine

Endocrine and Metabolic Disorders

• Hypoglycaemia
• Hyponatremia
• Disulfiram-like reactions

Skin and Subcutaneous Tissue Disorders

• Eczema
• Allergic dermatitis
• Erythema
• Morbilliform rash
• Maculopapular rash
• Urticaria
• Pruritus
• Photosensitivity reaction

Immune, Blood and Lymphatic System Disorders

• Leukopenia
• Agranulocytosis
• Thrombocytopenia
• Haemolytic anaemia
• Pancytopenia
• Aplastic anaemia

Sensory Disorders

• Diplopia
• Blurred vision
• Visual impairment

Other

• Non-acute porphyria

• Miconazole
• Nonsteroidal anti-inflammatory drugs
• Phenylbutazone
• Fluconazole
• Voriconazole
• Salicylates
• Acetylsalicylic acid
• Beta-blockers
• Angiotensin-converting enzyme inhibitors
• Cimetidine
• Monoamine oxidase inhibitors
• Quinolones
• Highly protein bound agents
• Sulfonamides
• Chloramphenicol
• Probenecid
• Coumarins
• Fibrates
• Danazol
• Phenothiazines
• Chlorpromazine
• Corticosteroids
• Sympathomimetics
• Ritodrine
• Salbutamol
• Terbutaline
• Progestogens
• Neuroleptics
• Thiazides and other diuretics
• Thyroid products
• Oestrogens
• Oral contraceptives
• Phenytoin
• Nicotinic acid
• Calcium channel blockers
• Isoniazid
• Alcohol

• Blood glucose
• HbA1C

Specific cases may require:

• Renal function
• Hepatic function
• Weight  

Glipizide is an oral blood-glucose-lowering drug of the sulfonylurea class. The primary mode of action of glipizide is the stimulation of insulin secretion from the beta-cells of pancreatic islet tissue. There is also increasing evidence that extrapancreatic effects involving potentiation of insulin action form a significant component of the activity of glipizide.

Tablet 5mg

• Minidiab (Pfizer) originator