glipizide

(glip' i zide)
Glucotrol, Glucotrol XL

Pregnancy Category C

Drug classes
Antidiabetic
Sulfonylurea (second generation)

Therapeutic actions
Stimulates insulin release from functioning beta cells in the pancreas; may improve
binding between insulin and insulin receptors or increase the number of insulin receptors;
more potent in effect than first-generation sulfonylureas.

Indications
• Adjunct to diet and exercise to lower blood glucose with type 2 (non–insulin-
dependent) diabetes mellitus
• Adjunct to insulin therapy in the stabilization of certain cases of type 1 (insulin-
dependent) diabetes, reducing the insulin requirement and decreasing the chance
of hypoglycemic reactions

Contraindications and cautions

• Contraindicated with allergy to sulfonylureas; diabetes with ketoacidosis, sole
therapy of type 1 diabetes or diabetes complicated by pregnancy, diabetes
complicated by fever, severe infections, severe trauma, major surgery, ketosis,
acidosis, coma (insulin is indicated); type 1 diabetes, serious hepatic impairment,
serious renal impairment.
• Use cautiously with uremia, thyroid or endocrine impairment, glycosuria,
hyperglycemia associated with primary renal disease; labor and delivery (if
glipizide is used during pregnancy, discontinue drug at least 1 mo before
delivery); lactation; pregnancy.

Available forms
Tablets—5, 10 mg; ER tablets—2.5, 5, 10 mg

Dosages
Give approximately 30 min before breakfast to achieve greatest reduction in postprandial
hyperglycemia.
ADULTS
• Initial therapy: 5 mg PO before breakfast. Adjust dosage in increments of 2.5–
5 mg as determined by blood glucose response. At least several days should
elapse between adjustments. Maximum once-daily dose should not exceed 15 mg;
above 15 mg, divide dose, and administer before meals. Do not exceed
40 mg/day. ER tablets: 5 mg/day. Adjust dosage in 5-mg increments every 3 mo;
maximum dose—20 mg/day.
 • Maintenance therapy: Total daily doses above 15 mg PO should be divided; total
daily doses above 30 mg are given in divided doses bid.
• Extended release: 5 mg/day with breakfast, may be increased to 10 mg/day after 3
mo if indicated.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS AND PATIENTS WITH HEPATIC IMPAIRMENT
Geriatric patients tend to be more sensitive to the drug. Start with initial dose of
2.5 mg/day PO. Monitor for 24 hr and gradually increase dose after several days as
needed.

Pharmacokinetics
Route Onset Peak Duration
Oral 1–1.5 hr 1–3 hr 10–24 hr

Metabolism: Hepatic; T1/2: 2–4 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Bile and urine

Adverse effects
• CNS: Drowsiness, asthenia, nervousness, tremor, insomnia, tinnitus, fatigue
• CV: Increased risk of CV mortality
• Endocrine: Hypoglycemia, SIADH
• GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea
• Hematologic: Leukopenia, thrombocytopenia, anemia
• Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria,
photosensitivity, fever, eosinophilia, jaundice

Interactions
Drug-drug
• Increased risk of hypoglycemia with sulfonamides, chloramphenicol,
oxyphenbutazone, phenylbutazone, salicylates, clofibrate
• Decreased effectiveness of glipizide and diazoxide if taken concurrently
• Increased risk of hyperglycemia with rifampin, thiazides
• Risk of hypoglycemia and hyperglycemia with ethanol; "disulfiram reaction" also
has been reported
Drug-alternative therapy
• Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery

Nursing considerations
Assessment
• History: Allergy to sulfonylureas; diabetes with complications; type 1 diabetes,
serious hepatic or renal impairment, uremia, thyroid or endocrine impairment,
glycosuria, hyperglycemia associated with primary renal disease; pregnancy
 • Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R,
adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum
creatinine, liver function tests, blood glucose, CBC

Interventions
• Give drug 30 min before breakfast; if severe GI upset occurs or more than
15 mg/day is required, dose may be divided and given before meals.
• Monitor urine or serum glucose levels frequently to determine drug effectiveness
and dosage.
• Transfer to insulin therapy during periods of high stress (eg, infections, surgery,
trauma).
• Use IV glucose if severe hypoglycemia occurs as a result of overdose.

Teaching points
• Take this drug 30 min before breakfast for best results.
• Do not discontinue this medication without consulting your health care provider.
• Monitor urine or blood for glucose and ketones.
• Do not use this drug during pregnancy; consult health care provider.
• Avoid alcohol while using this drug.
• Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-
colored stools, hypoglycemic or hyperglycemic reactions.

Adverse effects in Italic are most common; those in Bold are life-threatening.