Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/1988
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Glipizide (Tablet)
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There is no fixed dosage regimen for the management of diabetes
mellitus with glipizide or any other hypoglycemic agent. In addition to
the usual monitoring of urinary glucose, the patient's blood
glucose must also be monitored periodically to determine the minimum
effective dose for the patient; to detect primary failure, i.e.,
inadequate lowering of blood glucose at the maximum recommended dose of
medication; and to detect secondary failure, i.e., loss of an adequate
blood-glucose-lowering response after an initial period of
effectiveness. Glycosylated hemoglobin levels may also be of value in
monitoring the patient's response to therapy. Short-term administration of glipizide may be sufficient during
periods of transient loss of control in patients usually controlled well
on diet. In general, glipizide should be given approximately 30 minutes
before a meal to achieve the greatest reduction in postprandial
hyperglycemia.<br/>Initial Dose: The recommended starting dose is 5 mg, given before
breakfast. Geriatric patients or those with liver disease may be
started on 2.5 mg.<br/>Titration: Dosage adjustments should ordinarily be in increments of
2.5 to 5 mg, as determined by blood glucose response. At least
several days should elapse between titration steps. If response
to a single dose is not satisfactory, dividing that dose may
prove effective. The maximum recommended once daily dose is 15
mg. Doses above 15 mg should ordinarily be divided and given
before meals of adequate caloric content. The maximum
recommended total daily dose is 40 mg.<br/>Maintenance: Some patients may be effectively controlled on a
once-a-day regimen, while others should better response with
divided dosing. Total daily doses above 15 mg should ordinarily
be divided. Total daily doses above 30 mg have been safely given on a b.i.d. basis to long-term patients. In elderly patients, debilitated or malnourished
patients, and patients with impaired renal or hepatic function,
the initial and maintenance dosing should be conservative to
avoid hypoglycemic reactions .<br/>Patients Receiving Insulin: As with other sulfonylurea-class hypoglycemics, many
stable non-insulin-dependent diabetic patients receiving insulin
may be safely placed on glipizide. When transferring patients
from insulin to glipizide, the following general guidelines
should be considered: For patients whose daily insulin requirement is 20 units
or less, insulin may be discontinued and glipizide therapy may
begin at usual dosages. Several days should elapse between
glipizide titration steps. For patients whose daily insulin requirement is greater
than 20 units, the insulin dose should be reduced by 50% and
glipizide therapy may begin at usual dosages. Subsequent
reductions in insulin dosage should depend on individual patient response. Several days should elapse between glipizide titration
steps. During the insulin withdrawal period, the patient should
test urine samples for sugar and ketone bodies at least three
times daily. Patients should be instructed to contact the
prescriber immediately if these tests are abnormal. In some
cases, especially when patient has been receiving greater than
40 units of insulin daily, it may be advisable to consider
hospitalization during the transition period.<br/>Patients Receiving Other Oral Hypoglycemic Agents: As with other sulfonylurea-class hypoglycemics, no
transition period is necessary when transferring patients to
glipizide. Patients should be observed carefully (1-2 weeks) for
hypoglycemia when being transferred from longer half-life
sulfonylureas (e.g., chlorpropamide) to glipizide due to
potential overlapping of drug effect.
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Glipizide
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Glipizide (Tablet)
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Glipizide tablets are indicated as an adjunct to diet for the
control of hyperglycemia and its associated symptomatology in patients
with non-insulin-dependent diabetes mellitus (NIDDM; type II), formerly
known as maturity-onset diabetes, after an adequate trial of dietary
therapy has proved unsatisfactory. In initiating treatment for non-insulin-dependent diabetes, diet
should be emphasized as the primary form of treatment. Caloric
restriction and weight loss are essential in the obese diabetic patient.
Proper dietary management alone may be effective in controlling the
blood glucose and symptoms of hyperglycemia. The importance of regular
physical activity should also be stressed, and cardiovascular risk
factors should be identified, and corrective measures taken where
possible. If this treatment program fails to reduce symptoms and/or blood
glucose, the use of an oral sulfonylurea or insulin should be
considered. Use of glipizide must be viewed by both the physician and
patient as a treatment in addition to diet, and not as a substitute for
diet or as a convenient mechanism for avoiding dietary restraint.
Furthermore, loss of blood glucose control on diet alone also may be
transient, thus requiring only short-term administration of glipizide. During maintenance programs, glipizide should be discontinued if
satisfactory lowering of blood glucose is no longer achieved. Judgments
should be based on regular clinical and laboratory evaluations. In considering the use of glipizide in asymptomatic patients, it
should be recognized that controlling blood glucose in
non-insulin-dependent diabetes has not been definitely established to be
effective in preventing the long-term cardiovascular or neural
complications of diabetes.
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Glipizide
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