Glipizide and Metformin (Oral)

Glipizide and Metformin are two oral medicines combined to form a single treatment for high blood sugar (glucose) in patients with type 2 diabetes or a certain type of diabetes mellitus.

Overview

People with type 2 diabetes tend to have excess sugar in their bloodstream because the body cannot efficiently use insulin to store sugar.

Controlling blood sugar levels in these patients helps to prevent serious medical problems such as blindness or liver damage.

Together, Glipizide and Metformin help to regulate blood sugar levels in such patients. Glipizide helps the pancreas to release insulin and the body to store blood sugar.

Metformin is a first-line treatment for diabetes. It helps the body to better use insulin that is naturally produced in the pancreas. It also reduces the amount of sugar the liver makes and the amount the intestine absorbs.

Although the medicine is for controlling high blood glucose levels, patients are still required to monitor their blood glucose regularly. This helps them keep track of their blood sugar levels, ensuring they are not too low or too high.

Glipizide and Metformin are the generic names of the US brand name Metaglip. Metaglip has since been discontinued by the US Food and Drug Administration (FDA). The medicines are supplied as a tablet by prescription only and are taken by mouth.

These two medicines cannot treat type 1 diabetes, but may also be used for purposes not listed in this medication guide.

Conditions Treated

Type Of Medicine

  • Sulfonylureas + Biguanide Antihyperglycemic

Side Effects

Most, if not all, prescription medicines cause side effects. Glipizide and Metformin may cause side effects which are expected and required as the medicine works in the body.

Other side effects are unwanted and may or may not require medical attention.

Serious side effects

Patients have developed a life-threatening condition known as lactic acidosis while taking this medicine. Early symptoms of this condition may be mild but may become worse and possibly fatal if not treated immediately.

Seek emergency medical attention right away if you experience any of the following mild (but serious) symptoms:

  • Trouble breathing
  • Uneven heart rate
  • Muscle pain or weakness
  • Stomach pain
  • Nausea with vomiting
  • Numbness or cold feeling in the arms and legs
  • Feeling extremely weak or tired
  • Dizziness

Also call your doctor right away if you notice any of the following side effects:

More commonly occur

  • Seizures
  • Fever
  • Anxiety
  • Depression
  • Chills
  • Feeling unusually tired or weak
  • Nervousness
  • Cough
  • Dizziness
  • Fast heartbeat
  • Sore throat
  • Blurred vision
  • Cool, pale skin
  • Shakiness
  • Fever
  • Nausea
  • Confusion
  • Slurred speech
  • Headache
  • Coma
  • Sneezing
  • Excessive hunger
  • Nightmares
  • Cold sweats

Less commonly occur

  • Pounding sensation in the ears
  • Urine that appears cloudy or bloody
  • Pain or difficulty urinating
  • Frequent urge to urinate
  • Burning sensation while urinating
  • Pain in the side or lower back
  • Bladder pain
  • Slow heartbeat

Rarely occur

  • Sleepiness
  • General feeling of discomfort
  • Discomfort in the abdomen
  • Lack of desire to eat
  • Fainting episodes
  • Troubled breathing (such as fast or shallow)
  • Cramps or pain in the muscles
  • Shortness of breath
  • Diarrhea

The following side effects may occur, but do not usually require medical attention. They tend to go away on their own as the body gets used to the medicine. If any of them occurs and gets worse, bothers you or does not go away, tell your doctor.

More commonly occur

  • Stomach pain
  • Pain in the muscle or bone
  • Vomiting

One or more, but not all, side effects listed here may be experienced by a patient. Some patients may also have other side effects not listed here.

You can ask your doctor or health care professional about ways to prevent or reduce side effects.

You may also call the FDA at 1-800-FDA-1088 to report side effects.

Dosage

Glipizide and Metformin are supplied as a tablet to be taken by mouth only. Dosage usually varies from one patient to the other.

Your doctor will decide your dose based on the condition you are being treated for, your age, and the presence of other medical conditions if any. Your dose may also depend on whether the medicine is being used as a first-line or second-line treatment.

Take your dose exactly as directed and follow all other directions given to you by your doctor and pharmacist.

Dosage and other directions can be found on the prescription label. They usually include the strength of your dose, time between each dose, and the duration of treatment. Also, read the patient information leaflet for more helpful information.

The following is only a recommended dosage guide. You should stick to the dosage directions given to you by your doctor.

Treating type 2 diabetes

First-time treatment:

Adults: Start by taking 2.5 milligrams (mg) of Glipizide and 250 milligrams (mg) of Metformin. Take them once a day with a meal. Your doctor may increase your dose over the next few weeks until your blood sugar is under control.

Children: Treatment with this medicine must be determined by a doctor.

Patients with type 2 diabetes may be directed by their doctor to use the medicine along with a special diet and exercise. This helps to further control blood sugar.

As second-line therapy:

Adults: Take 2.5 milligrams (mg) of Glipizide and 500 milligrams (mg) of Metformin two times daily, with a meal. Or, you can take 5 milligrams (mg) of Glipizide and 500 milligrams (mg) of Metformin two times a day. Take with your meal.

Your doctor may gradually increase your dose until your blood glucose is under control. The starting dose should be less than the daily dose of Glipizide or Metformin you are already taking.

Children: Treatment must be determined by a doctor.

Prior treatment with a sulfonylurea antidiabetic agent and/or metformin:

Adults: Patients being switched from a sulfonylurea plus Metformin to a Glipizide and Metformin combination should be given an initial dose. This dose should not exceed the daily dose of Glipizide (or equivalent dose of another sulfonylurea) and Metformin that was being taken.

Children: Treatment must be determined by a doctor.

Missed dose

If you missed a dose of the medicine, take it as soon as possible. However, if it is time to take the next dose, skip the missed dose and take the next dose on time. An extra dose should not be taken to make up for the missed dose.

Overdose

Call the local poison control center at 1-800-222-1222 or seek urgent medical care if you overdose on this drug. If the patient collapses or is not breathing, call 911.

Symptoms of overdose include:

  • Nausea
  • Excessive hunger
  • Anxiety
  • Cold sweat
  • Shakiness
  • Confusion
  • Diarrhea
  • Difficulty concentrating
  • Behavior that makes you appear drunk
  • Drowsiness
  • Abdominal discomfort
  • Fast heartbeat
  • Blurred vision
  • Unusual sleepiness
  • Breathing that is shallow or fast
  • General feeling of discomfort
  • Unusual tiredness or weakness
  • Headache
  • Muscle pain or cramping
  • Seizures
  • Cool, pale skin
  • Slurred speech
  • Nervousness
  • Coma
  • Nightmares
  • Trouble sleeping (restlessness)
  • Decreased appetite

Interactions

Using other medicines with Glipizide and Metformin may cause adverse interaction. Let your doctor know about all prescription and non-prescription medicines and health supplements you take.

Sometimes it may be best for the patient's health that other medicines are used.

To avoid a significant interaction, Glipizide and Metformin should not be used with the following medicines. If treatment is necessary, your doctor may change your dose or how often you take any of your medicines.

  • Diatrizoate
  • Ethiodized Oil
  • Iotrolan
  • Ioxitalamic Acid
  • Iocetamic Acid
  • Iodipamide
  • Acetrizoic Acid
  • Iodixanol
  • Ioseric Acid
  • Iodopyracet
  • Ioglicic Acid
  • Iodoxamic Acid
  • Iobitridol
  • Iohexol
  • Ioxaglate
  • Iocarmic Acid
  • Iomeprol
  • Iobenzamic Acid
  • Iopentol
  • Iopamidol
  • Iophendylate
  • Iopronic Acid
  • Iopromide
  • Iosimide
  • Ioglycamic Acid
  • Iotasul
  • Iopanoic Acid
  • Iothalamate
  • Iotroxic Acid
  • Ipodate
  • Metrizamide
  • Ioversol
  • Metrizoic Acid
  • Iodohippuric Acid
  • Tyropanoate Sodium
  • Iodamide

Although using any of the following medicines is not usually recommended during treatment, it may be required in some cases. To reduce the risk of significant interaction, your doctor may change the dose or how often you use any of your medicines.

  • Gatifloxacin
  • Dulaglutide
  • Enoxacin
  • Ritonavir
  • Flumequine
  • Dofetilide
  • Gemifloxacin
  • Lanreotide
  • Acarbose
  • Dolutegravir
  • Fleroxacin
  • Aspirin
  • Entacapone
  • Balofloxacin
  • Pefloxacin
  • Besifloxacin
  • Levofloxacin
  • Dasabuvir
  • Lomefloxacin
  • Bupropion
  • Moxifloxacin
  • Lixisenatide
  • Prulifloxacin
  • Norfloxacin
  • Octreotide
  • Nadifloxacin
  • Ofloxacin
  • Ceritinib
  • Pasireotide
  • Tosufloxacin
  • Ciprofloxacin
  • Pazufloxacin
  • Ombitasvir
  • Sparfloxacin
  • Thioctic Acid
  • Vandetanib
  • Metreleptin
  • Paritaprevir
  • Disopyramide
  • Rufloxacin

The risk of certain side effects may increase if this medicine is used with any of the following other medicines. If using any of them together with Glipizide and Metformin is best for you, your doctor may change the dose or how often you use any of your medicines.

  • Cimetidine
  • Acebutolol
  • Procarbazine
  • Colesevelam
  • Ranolazine
  • Atenolol
  • Rasagiline
  • Nialamide
  • Safinamide
  • Practolol
  • Sotalol
  • Timolol
  • Carteolol
  • Pindolol
  • Tranylcypromine
  • Celiprolol
  • Voriconazole
  • Cyclosporine
  • Esmolol
  • Fenugreek
  • Bisoprolol
  • Clarithromycin
  • Furazolidone
  • Iproniazid
  • Rifampin
  • Isocarboxazid
  • Labetalol
  • Propranolol
  • Linezolid
  • Metipranolol
  • Selegiline
  • Bitter Melon
  • Levobunolol
  • Nadolol
  • Guar Gum
  • Nebivolol
  • Oxprenolol
  • Patiromer
  • Metoprolol
  • Penbutolol
  • Methylene Blue
  • Phenelzine
  • Glucomannan
  • Psyllium
  • Carvedilol
  • Ranitidine
  • Moclobemide
  • Betaxolol

Other medicines not listed here may also interact with this medicine. You may ask your doctor for more information about other drugs that may cause interaction.

Other Interactions

Food, alcohol, tobacco, and other medical problems may interact with this medicine.

Food, alcohol, and tobacco

Your doctor may advise you to have a meal when taking the medicine. You may also be cautioned on the use of alcohol, tobacco or other substances while taking this drug.

It is not recommended that you use this medicine with the following substance. If its use cannot be avoided, your doctor may change your dose or the time between each dose.

  • Ethanol

Other medical problems

The presence of other medical problems may affect or be affected by the medicine. Tell your doctor of all medical problems you may have.

This medicine should not be used in patients with the following condition:

The medication may worsen the following condition:

  • Vitamin B12 deficiency

Using insulin is recommended to help control diabetes in patients with the following conditions:

  • Surgery (major)
  • Acid in the blood (acidosis or ketoacidosis)

Using Metformin in patients with the following conditions may increase the risk of lactic acidosis:

Patients with the following condition should stop taking this medicine before having any medical exams or diagnostic tests that might cause less urine output than usual.

If the test shows your kidney function as normal, your doctor may tell you to start taking the medicine again 48 hours after the test.

  • Heart, kidney or other problems that require you to take lab tests or examinations that use certain medicines known as contrast agents, with x-ray exams.

Patients with the following conditions may be more likely to develop low blood sugar while taking this combination medicine:

  • Undernourished condition
  • Alcohol intoxication
  • Weakened physical condition
  • Underactive pituitary gland (uncontrolled)
  • Strenuous or prolonged exercise done without adequate food intake
  • Underactive adrenal gland (uncontrolled)
  • Other conditions that cause low blood sugar

Warnings

  • Do not use Glipizide and Metformin unless it was prescribed for you. Your doctor will consider your medical history and the potential risks and benefits involved before deciding whether to treat you.
  • You should not use this medicine if you have congestive heart failure, liver or kidney disease, or if you are experiencing diabetic ketoacidosis. Tell your doctor if you have these conditions.
  • This medicine is not safe for use in children.
  • Do not use the medicine if you are allergic to it. Tell your doctor if you have had an allergic reaction to Glipizide and Metformin, any of its inactive ingredients, or other medicines.
  • Let your doctor know if you have any allergy to foods, preservatives, dyes or animals.
  • Do not use other medicines with Glipizide and Metformin unless your doctor approves.
  • Give your doctor a list of all medications prescription and over-the-counter medicines (OTCs), vitamins, nutritional supplements, and herbal products you take or plan to take.
  • Except their kidney function is not reduced, patients over 80 years of age should not be treated with this medicine. The risk of low blood sugar may be greater because they may not easily spot the signs of high or low blood sugar.
  • A serious, possibly life-threatening condition called lactic acidosis may occur while using this medicine. Get emergency help right away if you develop this condition. Symptoms may be mild at the beginning but may become severe and cause death.
  • Avoid drinking alcohol when using the medicine. Your doctor may also warn you about using alcohol. Alcohol lowers blood sugar level and may increase the risk of lactic acidosis.
  • Tell your doctor if you are pregnant or may become pregnant. Your doctor may need to take precautions in treating you since adequate studies have not been done to determine if using the medicine may harm an unborn baby.
  • Let your doctor know if you are breastfeeding. It is not known whether this medicine may pass through breast milk and harm a breastfeeding infant. Your doctor may need to take precautions when treating you with it.
  • Check your blood sugar regularly to make sure it is not too low or high. Symptoms of low blood sugar may be different for each patient.

You should pay attention to your symptoms, so you know how low blood sugar affects you. This will help you to quickly treat it and avoid emergency medical care.

  • Call your doctor right away if symptoms of high or low blood sugar occur and are severe.
  • Avoid allowing your blood sugar to drop too low. Hypoglycemia (low blood glucose) may occur if you are under stress, miss a meal, drink alcohol, or exercise for long periods.

Headache, irritability, hunger, sweating, tremor, trouble concentrating, nausea, weakness, blurred vision, tiredness, restlessness, nervousness, drowsiness, and slurred speech are common symptoms of Hypoglycemia.

It may help to carry glucose tablets, candy, milk or orange juice to use in case your blood sugar goes low.

  • Keep a glucagon kit and a syringe and needle at all times. Ensure you know how to use it properly. You may need to use it if you develop severe symptoms of low blood sugar.

Severe symptoms include convulsions (seizures) and loss of consciousness.

  • Do not let your blood glucose level become too high (Hyperglycemia). To avoid this, ensure you take your diabetes medicine regularly and on time. Also, stick to your diet and avoid overeating. Lack of exercise, fever or an infection may also cause high blood sugar.
  • Talk to your doctor if your sugar test is high and you have symptoms such as dry mouth, nausea, vomiting, blurred vision, ketones in urine, drowsiness, increased urge to urinate, sleepiness, loss of appetite, tiredness, or excess thirst.
  • You should teach other family members how to prevent side effects or help with side effects if they should occur. Also, teach them to help you if you experience symptoms of low or high blood sugar, and when to call for emergency medical care.
  • You may need special counseling about lifestyle changes, such as changes in your diet or exercise. These changes may require your doctor to adjust the dose of your diabetes medicine.
  • You should get counseling on contraception and pregnancy, so you are aware of problems that may occur during pregnancy in patients with diabetes.
  • You should always be prepared in case you need emergency medical care. It may help to wear a neck chain, bracelet, or carry an identification card that says you have diabetes. It should also include the medicines you use.
  • Whenever you travel, always keep a document that includes your medical history along with a recent prescription. If you travel to destinations with a different time zone, remember there may be changes in time and you should adjust your meal time to suit the new time zone.
  • Do not share this medicine with anyone else even if they have diabetes or similar symptoms.
  • Keep all follow-up appointments so your doctor can check your progress during treatment.

Storage

Glipizide and Metformin should be stored in a closed container and kept away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Responsibly throw away medicine that is expired or no longer needed, ideally through a drug take-back program.

You may ask your healthcare professional or local waste disposal agency how to safely dispose of unwanted medicine, needles, and syringes.

Summary

Glipizide and Metformin are two oral medicines that are effective in treating high blood sugar in patients with type 2 diabetes and a certain type of diabetes mellitus. They are used together as a single form of treatment.

Glipizide helps the pancreas to release insulin and the body to store blood sugar. Metformin helps the body to better use natural insulin that is produced in the pancreas. It also controls the amount of sugar the intestine absorbs.

The ability to use this combination medicine to control blood glucose levels help prevent serious medical problems, such as liver blindness or liver damage.

It is safe to use the medicine to treat young and older adults. Extra precautions need to be taken, however, in patients over 80 years of age, especially if they have other medical problems. The risk of side effects may increase due to age.

This combination medicine is not safe for patients with congestive heart failure, liver or kidney disease, or who are experiencing diabetic ketoacidosis. Precautions must be taken by a doctor when treating patients with certain other medical conditions.

This combination drug may cause a serious and possibly life-threatening condition called lactic acidosis. As such, patients need to monitor their diabetes condition closely and be aware of the symptoms of lactic acidosis.

This is especially important since it can start as mild symptoms and develop into a condition that can be fatal if not treated urgently.

Patients who consume alcohol may place themselves at a greater risk of developing lactic acidosis since alcohol lowers the blood sugar level.

Even though the medicine helps control high blood sugar, patients still need to regularly monitor their blood sugar. This helps prevent medical conditions that may result from blood sugar being too high (Hyperglycemia) or too low (Hypoglycemia).

Because of the nature of type 2 diabetes and the possible health risks, patients and their household members need to be taught how to recognize side effects and when to call for emergency medical attention.