Names and pronunciation
(glip-i′zide) Glucotrol, Glucotrol XL
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Individual generic drug information
Extracted information for glipiZIDE only.
(glip-i′zide) Glucotrol, Glucotrol XL
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Func. class.: Antidiabetic
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Chem. class.: Sulfonylurea (2nd generation)
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Do not confuse: glipiZIDE/Glucotrol/glyBURIDE
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ACTION: Causes functioning β cells in pancreas to release insulin, leading to drop in blood glucose levels; may improve insulin binding to insulin recep- tors or increase the number of insulin receptors with prolonged administration; may also reduce basal hepatic glucose secretion; not effective if patient lacks functioning β cells
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USES: Type 2 diabetes mellitus
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Extracted information for glipiZIDE only.
CONTRAINDICATIONS: Hyper- sensitivity to sulfonylureas/sulfonamides, type 1 diabetes, diabetic ketoacidosis Precautions: Pregnancy, geriatric patients, cardiac disease, severe renal/ hepatic disease, G6PD deficiency
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SIDE EFFECTS CNS: Headache, weakness, dizziness, drowsiness, tinnitus, fatigue, vertigo ENDO: Hypoglycemia GI: Hepatotoxicity, cholestatic jaun- dice, nausea, vomiting, diarrhea, heart- burn, weight gain HEMA: Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia; increased AST, ALT, alk phos; pancytopenia, hemolytic anemia INTEG: Rash, allergic reactions, pruritus, urticaria, eczema, photosensitivity, ery- thema, allergic vasculitis SYST: Serious hypersensitivity
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INTERACTIONS • May mask symptoms of hypoglycemia: β-blockers Increase: action of digoxin, glycosides, cyclosporine Increase: hypoglycemic effects—insulin, MAOIs, cimetidine, chloramphenicol, gua- nethidine, methyldopa, NSAIDs, salicylates, probenecid, androgens, anticoagulants, clofibrate, fenfluramine, fluconazole, gem- fibrozil, histamine H2 antagonists, magne- sium salts, phenylbutazone, sulfinpyrazone, sulfonamides, tricyclics, urinary acidifiers, clarithromycin, fibric acid derivatives, vori- conazole; monitor blood glucose Decrease: hypoglycemic effect—thiazide diuretics, rifampin, isoniazid, cholestyr- amine, diazoxide, hydantoins, urinary alkalinizers, charcoal, corticosteroids, colesevelam; monitor blood glucose Drug/Herb Increase: antidiabetic effect—garlic, horse chestnut Decrease: hypoglycemic effect—green tea Drug/Lab Test Increase: AST, ALT, LDH, BUN, creatinine Decrease: platelets, WBC, sodium
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TREATMENT OF OVERDOSE: Use one of the following: Glucose 25 g IV via dextrose 50% sol, 50 mL, 1 mg glucagon, oral carbohydrate depending on severity
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Extracted information for glipiZIDE only.
DOSAGE AND ROUTES Glimepiride • Adult: PO 1-2 mg/day with breakfast, then increase by ≤2 mg/day q1-2wk, max 8 mg/day • Geriatric: PO 1 mg/day; may increase if needed Renal/hepatic dose • Adult: PO 1 mg/day with breakfast; may titrate upward as needed GlipiZIDE • Adult: PO 5 mg initially before break- fast, then increase by 2.5-5 mg after sev- eral days to desired response; max 40 mg/day in divided doses; PO (XL) 5 mg/ day with breakfast, may increase to 10 mg/day, max 20 mg/day • Geriatric: PO 2.5 mg/day; may increase if needed Hepatic disease • Adult: PO 2.5 mg initially, then increase to desired response; max 40 mg/day in divided doses or 15 mg/dose
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Available forms: Glimepiride: tabs 1, 2, 4 mg; glipiZIDE: tabs, scored 5, 10 mg; ext rel tabs (XL) 2.5, 5, 10 mg
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Administer: • Do not break, crush, or chew ext rel tabs; may crush tabs and mix with fluids if unable to swallow whole • GlipiZIDE: give product 30 min before meals (regular release); with breakfast (ext rel); Glimepiride: with breakfast; if patient is NPO, may need to hold dose to prevent hypoglycemia • Gradual conversion from other oral hypoglycemics to these products is not needed; insulin ≥20 units/day, convert using 25% reduction in insulin dose ev- ery day or every other day • Store in tight, light-resistant container at room temperature
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Extracted information for glipiZIDE only.
Assess: • Hypo/hyperglycemic reaction that can occur soon after meals; for severe hypo- glycemia, give IV D50W, then IV dextrose solution • Blood glucose, A1c levels during treat- ment to determine diabetes control • Blood dyscrasias: CBC at baseline and throughout treatment; report decreased blood count • For allergy to sulfonamides, potential for cross-reactivity • For renal, hepatic dysfunction: use dose reductions, or avoidance of use may be required; increased risk of hypoglyce- mia in hepatic failure • Pregnancy/breastfeeding: identify whether pregnancy is planned or sus- pected; breastfed infant may be hypoglyce- mic; use only if benefits outweigh fetal risk
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Evaluate: • Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; improved serum glucose, A1c
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to drink alcohol; about disulfiram reaction (nausea, headache, cramps, flushing, hypoglycemia) • To report bleeding, bruising, weight gain, edema, SOB, weakness, sore throat, swelling in ankles, rash • To check for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera; prescriber should be notified • About symptoms of hypo/hyperglyce- mia, what to do about each; to have glu- cagon emergency kit available; to carry sugar packets • That product must be continued on daily basis; about consequences of dis- continuing product abruptly; to take product in morning to prevent hypogly- cemic reactions at night • To use sunscreen or stay out of the sun, wear protective clothing (photosensitivity) • To avoid OTC medications unless or- dered by prescriber • That diabetes is a lifelong illness; prod- uct will not cure disease G • That all food in diet plan must be eaten to prevent hypoglycemia; to continue weight control, dietary restrictions, exer- cise, hygiene • To carry emergency ID with prescriber and medication information • To test using blood glucose meter while taking this product • That ext rel tab may appear in stool • To notify prescribers of use prior to surgery • Not to drive or engage in hazardous tasks until response is known, dizziness may occur • That continuing follow-up exams and lab work will be needed
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Extracted information for glipiZIDE only.
PHARMACOKINETICS PO: Completely absorbed by GI route; glipiZIDE: onset 1-1½ hr, peak 2-3 hr, duration 12-24 hr, half-life 2-4 hr; glimepiride: peak 2-3 hr, half-life 5 hr; metabolized in liver, excreted in urine, 90%-95% plasma-protein bound
Source page 630
Filter the extracted dose blocks for this individual drug.
Glimepiride
• Adult: PO 1-2 mg/day with breakfast, then increase by ≤2 mg/day q1-2wk, max 8 mg/day
Candidate age grouping · source page 630
Glimepiride
• Adult: PO 1 mg/day with breakfast; may titrate upward as needed GlipiZIDE
Candidate age grouping · source page 630
Glimepiride
• Adult: PO 5 mg initially before break- fast, then increase by 2.5-5 mg after sev- eral days to desired response; max 40 mg/day in divided doses; PO (XL) 5 mg/ day with breakfast, may increase to 10 mg/day, max 20 mg/day
Candidate age grouping · source page 630
Glimepiride
• Adult: PO 2.5 mg initially, then increase to desired response; max 40 mg/day in divided doses or 15 mg/dose
Candidate age grouping · source page 630