glipizide is a second-generation sulfonylurea oral hypoglycemic agent that works by stimulating the pancreas to secrete insulin, thereby reducing blood sugar levels. It is indicated for mild to moderate type 2 diabetes patients who have not achieved satisfactory results with diet control and physical exercise for 2 to 3 months.
Adverse Reactions(Glipizide side effects):
- Metabolic/Endocrine System: Hypoglycemia is relatively rare with this medication and may occur in the elderly, physically active individuals, those with irregular eating habits, individuals consuming alcohol or alcohol-containing beverages, and those with poor liver or kidney function.
- Gastrointestinal Reactions(Glipizide side effects): Common symptoms include nausea and upper abdominal fullness.
- Hematological System(Glipizide side effects): There have been reports of hematological abnormalities with this medication.
- Allergic Reactions(Glipizide side effects): Individual patients may experience skin allergic reactions.
- Other Glipizide side effects: Headaches are commonly reported.
Contraindications:
- Allergy to this medication or sulfa drugs.
- Patients with diagnosed type 1 diabetes.
- Type 2 diabetes patients with conditions such as ketoacidosis, coma, severe burns, infection, trauma, or major surgery.
- Impaired liver or kidney function.
- Leukopenia.
- Adrenal insufficiency.
- Pregnant women.
Adult Dosage and Administration:
(1) For patients who have failed to control blood sugar with diet therapy alone, the starting dose is 2.5–5 mg per day, adjusted based on blood sugar and urine sugar levels, with increments or decrements of 2.5–5 mg at a time. If the daily dose exceeds 15 mg, it should be divided into 2 to 3 doses and taken before meals.
(2) For patients already taking other oral sulfonylurea hypoglycemic agents, discontinue other sulfonylureas for 3 days, recheck blood sugar, and start this medication, gradually increasing the dose from 5 mg until satisfactory efficacy is achieved. The maximum daily dose should not exceed 30 mg.
(3) Swallow the tablet whole with water; do not chew, divide, or crush. Take with breakfast.
Use in Elderly:
In clinical studies, patients aged 65 and older accounted for 33% of the total patient population. Elderly patients took approximately 1-2 days longer to reach a steady state compared to younger patients. No overall differences in effectiveness or safety were observed between young and elderly patients, but some individuals may be more sensitive to the medication.
Therefore, special attention should be given to elderly, frail, or undernourished patients, as well as those with adrenal or pituitary insufficiency, who are particularly prone to hypoglycemia caused by hypoglycemic agents. Hypoglycemia may be difficult to recognize in the elderly. Additionally, caution should be exercised when determining the starting and maintenance doses for elderly, frail, or undernourished patients, as well as those with renal or hepatic impairment, to avoid hypoglycemic reactions.
Use in Pregnant and Nursing Women:
Reproductive studies in rats found that all dose levels (5-50 mg/kg) had a slight embryotoxic effect, similar to that observed with other sulfonylureas such as tolbutamide and Tolasulfonylurea. This effect occurred during the perinatal period and is believed to be directly related to the pharmacological action of glipizide (lowering blood sugar). No teratogenic effects were found in studies in rats and rabbits. There are no well-controlled studies in pregnant women. glipizide should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus.
Recent research suggests that abnormal blood sugar levels during pregnancy are associated with a higher incidence of congenital malformations, leading many experts to recommend the use of insulin during pregnancy to maintain blood sugar levels as close to normal as possible.
Non-teratogenic Effects: There have been reports of severe hypoglycemia in neonates for a prolonged period (4-10 days) when sulfonylureas were used at the time of delivery. These reports were more common with patients using long-acting drugs. If glipizide is used during pregnancy, it should be discontinued at least one month before the expected delivery date.
Precautions:
1.All sulfonylurea medications have the potential to cause severe hypoglycemia.
It is crucial to appropriately select patients, determine dosages, and provide correct guidance on medication usage to avoid hypoglycemic episodes. Impaired renal or liver function can affect the excretion of glipizide, and hepatic insufficiency can weaken the body’s ability to produce glucose, both of which increase the risk of severe hypoglycemic reactions.
Elderly, frail, and undernourished patients, as well as those with adrenal or pituitary insufficiency, are at greater risk for hypoglycemia from antidiabetic medications. Hypoglycemia can be difficult to recognize in the elderly and in patients using beta-blockers. Insufficient calorie intake, intense or prolonged exercise, alcohol consumption, or the use of multiple hypoglycemic agents can increase the likelihood of hypoglycemia. The combined use of antidiabetic drugs can also increase the potential for hypoglycemia.
2.Loss of Blood Sugar Control:
Patients who have achieved stable blood sugar control with a particular diabetes treatment regimen may experience a loss of control in stressful situations such as fever, trauma, infection, or surgery. In these cases, the medication must be discontinued and insulin therapy initiated. Any oral hypoglycemic agent, including glipizide, may become less effective in lowering blood sugar to desired levels over time in many patients, possibly due to the advancement of diabetes or a reduced response to the medication. This phenomenon is known as secondary failure, distinct from primary failure, which refers to the medication’s ineffectiveness when first administered. Before determining a patient has experienced secondary failure, sufficient dosage adjustments and continued adherence to dietary therapy should be implemented.
3.Hemolytic Anemia:
Patients with G6PD deficiency may develop hemolytic anemia when taking sulfonylurea drugs. As glipizide is a sulfonylurea, caution should be exercised in patients with G6PD deficiency, and non-sulfonylurea alternatives should be considered for these individuals. Post-marketing reports have also described hemolytic anemia in patients without G6PD deficiency.
Glipizide brand name
Glipizide is produced and sold by different pharmaceutical companies in the United States, with some of the main manufacturers including:
- Pfizer Inc.
- Sandoz Inc.
- Teva Pharmaceuticals