Drug Name
Generic Name : glipizide
Brand Name: Glucotrol, Glucotrol XL
Classification: Antidiabetic, Sulfonylurea (second generation)
Pregnancy Category C
Dosage & Route
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
- 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.
Therapeutic actions
- Glipizide stimulates insulin release from pancreatic β-cells and reduces gluconeogenesis in liver cells. It also increases insulin sensitivity at target sites.
Indications
- Adjunct to diet and exercise to lower blood glucose with type 2 diabetes mellitus
- Adjunct to insulin therapy in the stabilization of certain cases of type 1 diabetes, reducing the insulin requirement and decreasing the chance of hypoglycemic reactions
Adverse effects
- GI upsets, diarrhoea, nausea; allergic skin reactions, leucopenia, thrombocytopenia, agranulocytosis, hyponatraemia; jaundice; haemolytic anaemia, pancytopenia.
- Potentially Fatal: Hypoglycaemia in presence of renal or hepatic damage and alcohol.
Contraindications
- Hypersensitivity. Type 1 DM; ketoacidosis; severe renal or hepatic insufficiency. Pregnancy, lactation.
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, LFTs, 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.
- WARNING: Transfer to insulin therapy during periods of high stress (eg, infections, surgery, trauma).
- WARNING: Use IV glucose if severe hypoglycemia occurs as a result of overdose.
Teaching points
- Take this drug 30 minutes before breakfast for best results.
- Do not discontinue this drug without consulting your health care provider.
- Monitor urine or blood for glucose and ketones.
- If taking ER tablets, swallow them whole; do not crush, chew, or divide tablets. The empty tablet may appear in your stool.
- 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.