Glyburide and Metformin are often combined to help combat high blood sugar levels caused by type 2 diabetes. Typically, the body releases insulin after eating. This insulin helps the body to retain excess sugar for use later on, and the process occurs during normal, healthy digestion of food.
In patients with type 2 diabetes, the body does not function properly when it comes to storing excess sugar, and these sugars instead remain in the bloodstream. Chronic levels of high blood sugar can result in serious health conditions in the future if not treated.
The first step in the management of type 2 diabetes is typically diet management, but, in many cases, medicines are required to help the body to regulate blood sugar levels. The combination of Glyburide and Metformin helps the body to achieve this.
Glyburide, which belongs to a family of medicines known as sulfonylureas, causes the pancreas to release more insulin into the bloodstream. It works by binding to the ATP-sensitive potassium channels and the inhibitory regulatory subunit sulfonylurea receptors, and subsequently inhibiting them. As a result, intracellular calcium levels are increased, and this stimulates the release of insulin. Glyburide is available under a number of different brand names including Daonil, Diabeta, Gilemal, Euglucon, Glybovin, Micronase and more.
Metformin has a three-pronged mechanism of action. It reduces the level of sugar stored in the liver, reduces the level of sugar absorbed in the body and helps the cells of the body to use sugar in a more effective manner. Since its discovery in 1922, Metformin has been widely used in the treatment of diabetes, and it is currently listed as an Essential Medicine by the World Health Organization, on account of its efficacy and relatively low wholesale cost. In addition to treating diabetes, Metformin is also regularly prescribed to treat polycystic ovary syndrome, cardiovascular disease and certain diabetes-related cancers. It may also be prescribed off-label at the discretion of a doctor to treat other conditions not listed by the manufacturer.
Along with the desired effects, the Gylburide and Metformin combination can cause unwanted side effects. The most frequently reported side effects by patients undergoing treatment with this medication include the following:
As the patient continues to take Glyburide and Metformin as prescribed by a physician, most (if not all) of the previously mentioned side effects should begin to lessen. If side effects persist over a prolonged period or appear to worsen, the patient should inform their doctor as soon as is practical. Many of these symptoms can be alleviated using over the counter remedies or prescription drugs. A doctor or pharmacist may be able to offer advice on how to alleviate symptoms of mild discomfort. A dry mouth, for example, can be treated by sucking on sugar-free candy and drinking regular glasses of icy water.
Other side effects that are experienced less frequently, albeit often enough to warrant mentioning, include the following:
One rare side effect of taking a combination of Glyburide and Metformin concerns the manner in which these drugs can affect the psychology of the patient. It is possible that some patients may experience confusion, hallucinations, mood swings and symptoms associated with depression. Patients with a history of mental health conditions are, therefore, advised to use this combination medicine with caution.
Not all side effects may be listed. Although it has been documented that Glyburide and Metformin can cause metabolic, gastrointestinal, hematologic, respiratory, nervous system, dermatologic, hypersensitive, hepatic, renal, ocular, endocrine, musculoskeletal and psychiatric side effects, patient may also experience other symptoms. In the event of experiencing an unlisted side effect, the patient is advised to contact their doctor and to report their findings to the FDA if they wish.
As with all medicines, it is important for patients to only take a combination of Glyburide and Metformin as prescribed by a qualified doctor. This means that patients should avoid taking any more of these medicines than advised, either in terms of dose size or frequency of dose. Additionally, patients should be prepared to cease taking these medicines if advised to do so by their physician, even if they still have a supply of the drugs remaining.
Glyburide and Metformin should be taken orally with food. When prescribing this combination medication, a doctor is likely to recommend a dietary and fitness regimen to be adhered to in conjunction with Glyburide and Metformin use. The dosage of this medicine will vary depending on the requirements of the patient. It is, therefore, important for the patient to listen carefully to all instructions imparted by their doctor at the time this medicine is prescribed. The patient may also follow the instructions printed on the side of the packaging the drug was shipped in, as these should be similar to what the prescribing physician recommends.
As a standard initial therapy in patients with inadequate glycemic control, patients can expect to receive a dose anywhere between 1.25mg and 250mg, taken orally, once every day.
Patients with fasting blood glucose registering greater than 200mg/dL, or with HbA1c larger than 9% may be prescribed a starting dose of 1.25mg to 250mg twice every day. Maintenance doses can be increased on a fortnightly basis in increments of 1.25mg to 250mg, taken once per day. The minimum effective possible dose to achieve glycemic control should be used once this has been ascertained after the initial period of therapy.
Patients who are already using one of the listed medications (Glyburide or Metformin) who are switching to a combination of the two should begin with an initial dose of 2.5mg Glyburide/500mg Metformin, taken orally, once every day.
This dose should be increased in increments between 5mg to 500mg until the minimum effective dose required to achieve adequate blood glucose control has been observed. The maximum dose should not exceed 20mg Glyburide/2000mg Metformin per day. The 5mg/500mg combined dose should not be used as an initial therapy, as this can increase the risk of hypoglycemia. Doctors recommend that initial doses should be on the conservative side to avoid hypoglycemia and various gastrointestinal side effects.
Patients switching to a combined therapy of Glyburide and Metformin should take an initial dose which does not exceed their current daily dose of Glyburide (or equivalent medication). The decision to switch to the closest equivalent dose should be based on clinical judgement and may need to be monitored to ensure the safety of the patient and the efficacy of the medication. Patients who experience hypoglycemia may require a reduced Glyburide component.
Patients who are not adequately controlled by a combination of Glyburide and Metformin may require the addition of another medicine called Thiazolidinedione.
Renal dose adjustments:
Patients with kidney problems may require dose adjustments in order to prevent them being put at any further risk of kidney damage. This combination medicine may not be suitable for those with serum creatinine level readings of 1.5mg/dL or higher, or with abnormal creatinine clearance.
This medication is contraindicated in patients with certain conditions known to cause renal dysfunction or disease, such as acute myocardial infarction, septicemia and cardiovascular collapse.
Glyburide and Metformin is not recommended for patients with serum creatinine levels above the upper limits for their age bracket. Treatment with this combined medication should not be initiated in patients above the age of 80 unless CrCl measurements demonstrate that renal function is not reduced in any way. If renal dysfunction develops, treatment with Glyburide and Metformin should be discontinued immediately.
Other dose adjustments:
Debilitated, malnourished and geriatric patients should, as a general rule, not be titrated to the maximum documented dose in order to avoid any risk of hypoglycemia.
While the manufacturers of Glyburide and Metformin provide general dose instructions, it should be reiterated that these recommendations can be altered at the discretion of the patient's doctor. Doctors will take into account the height, weight, age and condition of the patient, among other factors, when determining the optimal initiation and maintenance dosages.
All drugs have the potential to interact with other medicines or chemicals within the human body, and these interactions can change the effects of one or more of the medicines involved. In some cases, an interaction can stop a medicine from being effective in treating the condition it was designed to alleviate. In other instances, interactions can cause dangerous and even fatal side effects.
Because these risks exist, it is vital for the patient to keep a full, detailed list of all medicines they are currently undergoing treatment with. This includes over the counter remedies, complimentary medicines, vitamin supplements and herbal treatments, as well as prescribed drugs.
Below is a truncated list of medications known to interact negatively with Glyburide and Metformin. Patients who are currently undergoing treatment with any of these medicines should inform their doctor or healthcare provider prior to starting a course of Glyburide and Metformin therapy:
Food and drink interactions:
Patients undergoing treatment with this combination medication are advised to speak to their physician before consuming alcohol at the same time as Glyburide and Metformin. This is because alcohol has the potential to affect blood glucose levels in diabetic patients. Therefore, the propensity for both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) is increased, depending on how much and how often the patient drinks. Patients should avoid using alcohol altogether if they do not control their diabetes or diet very well, or if they already have any of the following conditions:
It should be reiterated that moderate, healthy levels of alcohol consumption generally do not affect blood glucose levels, provided that the condition is kept sufficiently under control. Doctors agree that alcoholic beverage intake is limited to one drink per day for women and two drinks per day for men, maximum, in conjunction with a normal healthy meal plan. Diabetic patients should also avoid drinking alcohol on an empty stomach or immediately after exercising, as this can increase the risk of hypoglycemia.
This combination can potentially (albeit rarely) cause a serious, potentially life-threatening condition known as lactic acidosis. This is more likely to occur in patients who have a history of one or more of the following conditions:
Patients who are over 65, have recently had surgery or are often dehydrated may also be at an increased risk of developing lactic acidosis. These patients are advised to consult their doctor or healthcare professional regarding these risks prior to undergoing treatment with Glyburide and Metformin.
In the event of requiring a CT scan that requires dye to be injected directly into the veins, the patient will be required to temporarily stop taking this medication. Patients who undergo an x-ray may also need to temporarily cease taking Glyburide and Metformin.
The blood sugar of patients with diabetes should be checked often. Blood sugar, along with other tests, should be regularly conducted at the office of the patient's doctor in order to ensure that they are receiving the best possible treatment, and that the condition is being kept sufficiently under control. Patients are advised to stick to these regular appointments and reschedule any missed arrangements.
Although diet plays a large part in how blood sugar levels are regulated, other factors 'such as medications, stress, exercise, skipped meals, surgery, illness or alcohol use - can all have an adverse effect on how diabetes is controlled, with or without the use of medicines like Glyburide and Metformin.
Some doctors may prescribe additional vitamin B12 in conjunction with Glyburide and Metformin. This is because B12 levels can potentially become depleted as a result of regular Glyburide and Metformin use.
Patients are advised to avoid driving or operating heavy machinery when their blood sugar is low, or has recently been low. This can increase the chances of having an accident.
Anemia may occur in patients who have a G6PD deficiency. Patients with this condition should consult with their healthcare provider.
Blood sugar should be checked at home regularly to combat the potential for a hypoglycemic attack. The patient's doctor should explain how and when blood sugar should be checked.
Patients who have also been prescribed Colesevelam should take it at least four hours after taking Glyburide and Metformin. Other medications may also need to be tiered in order to preserve their efficacy, and patients are advised to discuss this with their doctor.
Controlling blood sugar can become more difficult when the patient is under duress, such as during an instance of fever, injury, infection or surgery. Changes in physical activity or exercise levels may also affect blood sugar levels. Patients are, therefore, advised to stick to the diet and workout plan devised by their doctor or healthcare provider.
When taking this medicine, patients may find that their skin is more sensitive to UV light, causing them to get sunburned more easily. Patients should avoid direct exposure to the sun, sunlamps or tanning beds. Patients are advised to wear sunscreen and eyewear that protects them from the harmful effects of the sun when outdoors.
Abnormal glucose levels are associated with greater incidences of congenital abnormalities in the womb. Women who are pregnant or planning on becoming pregnant in the near future should discuss the benefits and risks of this medication with their doctor.
Both Glyburide and Metformin are excreted in low doses into human breast milk, so use of this medication is not recommended for breastfeeding mothers. Women in this situation should make a decision to either discontinue breastfeeding or discontinue the use of this medication.
This medication should be kept in a closed container (preferably the one it was shipped in) at room temperature. The manufacturer also insists that it should be kept away from sources of light, heat and moisture, making it unsuitable for storage in a bathroom cabinet. Instead, it should be kept out of the reach of children in a dedicated medicine cabinet if possible.
Patients who need to dispose of unwanted, unused or expired Glyburide and Metformin should do so in a safe and hygenic manner, in accordance with FDA guidelines and state law. Many pharmacies offer medicine take back programs, where they will recycle or dispose of unwanted medicines, and many patients find this the easiest method of safely disposing of medications that are no longer required.
While the combination of Glyburide and Metformin can be greatly beneficial, it may also pose a risk to patients who do not communicate properly with their doctors. As a treatment designed to regulate blood sugar in those with type 2 diabetes, Glyburide and Metformin work to increase the level of insulin in the blood and the level of sugar in the liver respectively.
However, these medicines can also cause co-ordination problems, hypoglycemia (low blood sugar), drowsiness, dizziness and anxiety. These side effects can potentially impair the day to day functioning of the patient and even put them in perilous situations if the right precautions are not taken. Because of this risk, it is important for the patient to tell their doctor as much as they can about their own medical history, as well as explaining any hereditary or family medical issues.
When taken correctly and used in conjunction with a diet and exercise regimen devised by a qualified healthcare professional, this medication can help the patient to control their blood sugar and regain a much greater quality of life, with the potential for their condition to secede completely. To achieve this, the patient must be willing to put the work in to stick to their diet plan, and to work alongside their doctor to develop the minimum effective dosage regimen. Professionals agree this is the most practical way of reducing and reversing the effects of diabetes.