S-9.6 Sulfonylureus-Formualtion_Glipizide

• As an adjunct to healthy eating and physical activity in the treatment of type 2 diabetes.

For the latest PBS indications for glimepiride please see

https://www.pbs.gov.au/medicine/item/2440K

• Glipizide is often recommended 30 minutes before food to allow its peak action to begin at approximately the same time as the absorption of food. This is not always practical or safe in those that have memory loss. Initial dose is usually 2.5-5mg. Increases in dose should be individualised depending on glucose levels (person centred care) and adjusted with several days in between for stabilisation. Maximum dose of glipizide is 40mg in divided doses with the maximum single dose of 15mg (30mg in two divided doses is often safely given long term). Renal and hepatic dysfunction should have a dose reduction consideration due to the increase risk of hypoglycaemia.
• Use in Renal Impairment – The metabolism and excretion of glipizide may be slowed in those with impaired renal function. If hypoglycaemia should occur in such individuals, it may be prolonged and appropriate management should be instituted.
• Use in Hepatic Impairment – The metabolism and excretion of glipizide may be slowed in those with impaired hepatic function. If hypoglycaemia should occur in such individuals, it may be prolonged and appropriate management should be instituted.

• Glipizide (duration of action 6-8 hours) may be a reasonable choice for the elderly. However, hypoglycaemia is still a risk in this population and must still be taken into consideration.

• • Any blood glucose level under 4mmol/ L is known as a hypoglycaemic episode when being treated with a sulfonylurea. Counselling how to recognise and treat a hypoglycaemic episode is recommended when starting an individual on a sulfonylurea for the first time. Consideration should also be given to blood glucose monitoring for those who wish to participate.
  • Treatment with azole antifungals. (Azole antifungals inhibit the metabolism of sulfonylureas resulting in increased systemic exposure and consequent toxicity). This may increase the risk of hypoglycaemia and must be considered.
  • Glucose-6-phosphate Dehydrogenase Deficiency (G6PD)

• Hypoglycaemia
• Gastrointestinal reactions- Occasional (0.1 to 1%) -nausea, diarrhoea, abdominal pain and vomiting.
• Dermatologic reactions- Allergic skin reactions (e.g., pruritus, or urticaria). If the reaction continues, the medicine should be stopped. In the event of urticaria, a physician should be consulted.

• Hypersensitivity to glipizide and other ingredients.
• Severe renal dysfunction
• Individuals on dialysis
• Severe hepatic dysfunction.
• Pregnancy or lactation
• Type 1 diabetes, history of ketoacidosis.
• Haemolytic anaemia- Treatment of individuals with glucose-6-phospate dehydrogenase (G6PD) deficiency with a sulfonylurea agent can lead to haemolytic anaemia. An alternative class of medicine should be considered.
• Severe thyroid dysfunction
• Infections or trauma