Dosing and uses of Metaglip (glipizide-metformin)
Adult dosage forms and strengths
glipizide/metformin
tablet
- 2.5mg/250mg
- 2.5mg/500mg
- 5mg/500mg
Type 2 Diabetes Mellitus
Initial treatment: start at 2.5 mg/250 mg (glipizide/metformin) PO qDay with food
If fasting plasma glucose = 280-320 mg/dL: 2.5/500 mg PO q12hr
Titrate q2week to no more than 10/2000 mg per day in divided doses
Type 2 DM Inadequately Controlled on Sulfonylurea &/or Metformin
2nd-line treatment: Start at 2.5/500 mg or 5/500 mg PO q12hr with food
Titrate to no more than 20/2000 mg per day in divided doses
Dosage modifications
Hepatic impairment: Avoid use
Renal impairment
- Obtain eGFR before starting metformin
- eGFR <30 mL/min/1.73 m²: Contraindicated
- eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate treatment
- Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly)
- If eGFR falls below 45mL/min/1.73 m² while taking metformin, risks and benefits of continuing therapy should be evaluated
- If eGFR falls below 30 mL/min/1.73 m²: while taking metformin, discontinue the drug
Pediatric dosage forms and strengths
Not recommended
Geriatric dosage forms and strengths
Conservative doses reommended; do not titrate to maximum dose
Warnings
Black box warnings
Discontinue metformin at the time of or before an iodinated contrast imaging procedure in patients with an eGFR between 30-60 mL/minute/1.73 m²; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinate contrast
Lactic acidosis
- Characterized by elevated blood lactate levels (>5 mmol/L)
- Rare but serious complication that can occur because of metformin accumulation; increased risk with sepsis, dehydration, excess alcohol intake, hepatic insufficiency, renal impairment, and acute congestive heart failure
- Subtle onset with nonspecific symptoms (eg, malaise, myalgias, respiratory distress, somnolence, nonspecific abdominal distress)
- Monitor lab for decreased serum pH, increased anion gap, and elevated blood lactate If suspected, discontinue drug and hospitalize patient immediately
- Metformin is highly dialyzable (clearance up to 170 mL/min under good hemodynamic conditions); prompt hemodialysis is recommended to correct the acidosis and to remove accumulated metformin
Contraindications
Severe renal disease: eGFR <30 ml/min/1.73 m²
Metabolic acidosis, diabetic ketoacidosis
Cautions
Rare but serious lactic acidosis can occur due to accumulation of metformin
Patients with glucose-6-phosphate dihydrogenase deficiency may be at risk of sulfonylurea induced hemolytic anemia
Iodinated contrast imaging procedures
- Discontinue metformin at the time of or before an iodinated contrast imaging procedure in patients with an eGFR between 30-60 mL/minute/1.73 m²; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinate contrast
- Reevaluate eGFR 48 hr after the imaging procedure; restart metformin if renal function is stable
See also individual drugs
- glipizide
- metformin
Pregnancy and lactation
Pregnancy category: C
Lactation: enters breast milk; not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
