Monograph Details
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Endocrine System
> Diabetes
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GLUCOVANCE 5mg/500mg |
| Manufacturer |
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Bristol-Myers Squibb |
| Legal Classification |
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Rx
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| Pharmacological Class |
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Sulfonylurea + biguanide. |
| Generic Name |
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Glyburide 5mg, metformin HCl 500mg; tabs. |
| Also |
• GLUCOVANCE 1.25mg/250mg
• GLUCOVANCE 2.5mg/500mg
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| Indications |
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Adjunct to diet and exercise in type 2 diabetes, as initial therapy or as second-line therapy when response to a sulfonylurea or metformin is inadequate; may add a thiazolidinedione. |
| Children |
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Not recommended. |
| Adults |
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Take with meals. First-line: initially 1.25mg/250mg once daily; or, 1.25mg/250mg twice daily (AM & PM) if HbA1c >9% or FPG >200mg/dL. May increase by 1.25mg/250mg per day every 2 weeks. Second-line (previously treated with sulfonylurea and/or metformin): 2.5mg/500mg or 5mg/500mg twice daily (AM & PM); may increase by up to 5mg/500mg every 2 weeks (initial dose should not exceed previous daily doses of individual components). Max 20mg/2000mg per day. May add a thiazolidinedione; see literature. Elderly: avoid max doses. |
| Contraindications |
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Renal disease or dysfunction. CHF requiring drug treatment. Metabolic acidosis, diabetic ketoacidosis. Concomitant intravascular iodinated contrast agents (suspend during and for 48 hours after use). |
| Precautions |
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Confirm normal renal function before starting therapy (esp. in patients ≥80yrs); monitor renal and hepatic function. Discontinue if lactic acidosis, sepsis, hypoxemia or dehydration occurs. Avoid in hepatic disease. Suspend before surgery that requires fasting. Monitor blood (esp. Vit. B12 in susceptible patients). Elderly, debilitated, uncompensated strenuous exercise, malnourished or deficient caloric intake, adrenal or pituitary insufficiency, alcohol intoxication: increased risk of hypoglycemia. Pregnancy (Cat.B), nursing mothers: not recommended, consider using insulin instead. |
| Interactions |
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Cationic drugs eliminated by renal tubular secretion (eg, amiloride, cimetidine, digoxin, procainamide, quinidine, trimethoprim, ranitidine), furosemide, nifedipine: may increase metformin levels. Glyburide potentiated by NSAIDs, highly protein-bound drugs, salicylates, sulfonamides, probenecid, coumarins, MAOIs, β-blockers. Disulfiram-like reaction with alcohol (rare). Excessive alcohol potentiates metformin's effect on lactate. Diuretics, steroids, phenothiazines, phenytoin, sympathomimetics, calcium channel blockers, isoniazid, niacin, others may cause hyperglycemia. β-blockers may mask hypoglycemia. |
| Adverse Reactions |
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Lactic acidosis (rare, 1/2 the cases are fatal), GI upset (abdominal pain, diarrhea, nausea), headache, dizziness, hypoglycemia. Oral hypoglycemic agents may increase risk of cardiovascular mortality. With rosiglitazone: edema, weight gain. |
| How Supplied |
Tabs 1.25/250, 2.5/500—100, 500
Tabs 5/500—100 |
| Additional Resources |
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• Related Prescribing Note |
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