Monograph Details
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Endocrine System
> Diabetes
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METAGLIP 2.5mg/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 (2nd generation) + biguanide. |
| Generic Name |
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Glipizide 2.5mg, metformin HCl 500mg; tabs. |
| Also |
• METAGLIP 2.5mg/250mg
• METAGLIP 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. |
| Children |
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Not recommended. |
| Adults |
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Take with meals. First-line: initially 2.5mg/250mg once daily; or, if fasting plasma glucose is 280–320mg/dL, may start at 2.5mg/500mg twice daily. May increase by 1 tab/day every 2 weeks; max 10mg/1000mg or 10mg/2000mg per day in divided doses. Second-line: (previously treated with sulfonylurea or metformin only): 2.5mg/500mg or 5mg/500mg twice daily (initial dose should not exceed previous daily doses of individual components); may increase by ≤ 5mg/500mg up to minimum effective dose or max 20mg/2000mg per day. Previously treated with combination therapy (sulfonylurea plus metformin): may be switched to 2.5mg/500mg or 5mg/500mg (initial dose should not exceed previous daily doses of individual components). Elderly: avoid max doses. |
| Contraindications |
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Renal disease or dysfunction. Metabolic acidosis, diabetic ketoacidosis. Concomitant intravascular iodinated contrast agents (suspend during and for 48 hours). |
| Precautions |
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Confirm normal renal function before starting therapy (esp. in patients ≥80 years); 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). Stress. Elderly, debilitated, uncompensated strenuous exercise, malnourished or deficient caloric intake, adrenal or pituitary insufficiency, alcohol intoxication increases hypoglycemia risk. Pregnancy (Cat.C), 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. Glipizide potentiated by NSAIDs, highly protein-bound drugs, salicylates, sulfonamides, probenecid, coumarins, MAOIs, β-blockers, azole antifungals. Disulfiram-like reaction with alcohol (rare). Excess alcohol potentiates metformin's effect on lactate. Diuretics, steroids, phenytoin, phenothiazines, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid, 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, upper respiratory infection, headache, dizziness, hypertension, musculoskeletal pain, hypoglycemia. Sulfonylureas may increase cardiovascular mortality risk. |
| How Supplied |
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Tabs—100 |
| Additional Resources |
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• Related Prescribing Note |
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