Usual Adult Dose for Diabetes Type 2

Immediate release:
Initial dose: 2.5 to 5 mg orally once a day 30 minutes before breakfast

• Dose titration: Adjust in increments of 2.5 to 5 mg every few days based on blood glucose response; if response to a single dose is not satisfactory, dividing the dose and administering twice a day before meals of adequate caloric content may prove effective

Maintenance dose: 2.5 to 40 mg per day; total daily doses above 15 mg/day should be divided and administered twice a day
Maximum daily dose: 40 mg/day

Extended Release:
Initial dose: 2.5 to 5 mg orally once a day before first main meal of the day
Maintenance dose: 5 to 10 mg orally once a day
Maximum daily dose: 20 mg

SWITCH from Immediate-Release to Extended-Release:

• Patients may be switched from immediate-release to extended-release at the nearest equivalent total daily dose.

Comments:

• Patients at higher risk of hypoglycemia, e.g., elderly, debilitated, or malnourished patients should generally start therapy at lowest dose possible to avoid hypoglycemic reactions.
• As with any other hypoglycemic agent, there is no fixed dosage regimen for the management of diabetes; patients should be monitored to determine the minimum effective dose.
• When adding to or removing other blood-glucose-lowering agents, close monitoring is necessary to avoid hypoglycemia.

Use: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Usual Geriatric Dose for Diabetes Type 2

Immediate-release:
Initial dose: 2.5 mg orally once a day 30 minutes before breakfast

Extended-release:
Initial dose: 2.5 mg orally once a day with breakfast or before the first main meal of the day

Maintenance dose: See Adult Dosing

Renal Dose Adjustments

Use caution; initial doses and dose titration should be conservative to avoid hypoglycemia

• Immediate-release: Initial dose: 2.5 mg orally once a day 30 minutes prior to breakfast
• Extended-release: Initial dose: 2.5 mg orally once a day with breakfast or first main meal of the day

Liver Dose Adjustments

Use caution; initial doses and dose titration should be conservative to avoid hypoglycemia

• Immediate-release: Initial dose: 2.5 mg orally once a day 30 minutes prior to breakfast
• Extended-release: Initial dose: 2.5 mg orally once a day with breakfast or first main meal of the day

Dose Adjustments

Transfer From Insulin:

• For patients with daily insulin doses of 20 units or less: Discontinue insulin and begin glipizide at usual dosages.
• For patients with daily insulin doses greater than 20 units: Reduce insulin dose by 50% and begin glipizide at usual dosages.
• Allow several days between glipizide titration steps; subsequent reductions in insulin dosage should depend on individual patient response.
• During the insulin withdrawal period, test urine samples for sugar and ketone bodies at least three times daily.
• Some patients receiving greater than 40 units of insulin daily may need to consider hospitalization during the transition period.

Patients Receiving Other Oral Hypoglycemic Agents:

• When transferring from longer half-life sulfonylureas: Observe for 1 to 2 weeks for hypoglycemia

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the drug or any of its ingredients
• Hypersensitivity to sulfonamide derivatives
• Type 1 diabetes mellitus
• Diabetic ketoacidosis, with or without coma

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
Immediate-release:

• Take orally 30 minutes before a meal
• For doses greater than 15 mg/day: Take orally in divided doses twice a day with meals of adequate caloric intake

Extended-release:

• Take orally once a day with breakfast or the first main meal of the day
• Swallow tablets whole; do not break, crush, dissolve, chew, or cut
• The non-dissolvable shell of the extended-release product may appear in the stool

Concomitant use with Colesevelam: Administer glipizide 4 hours prior to colesevelam

General:

• This drug is not indicated for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis

Monitoring:

• Monitor blood and urine glucose periodically
• Measure glycosylated hemoglobin levels (A1C) at 3-month intervals

Patient advice:
Read the US FDA-approved patient labeling (Patient Information).

• Patients should be informed of potential risks and advantages of sulfonylurea therapy and of alternatives modes of therapy.
• Patients should be informed of the risks of hypoglycemia, symptoms, treatment, and predisposing conditions, patients should understand the risks of driving and performing hazardous tasks when blood sugars are low.
• Inform patients about the importance of adhering to dietary instructions and regular exercise program.