Glipizide and metformin

Glipizide and metformin is a combination of two oral diabetes medicines that help control blood sugar levels.

Glipizide and metformin is used along with diet and exercise to improve blood sugar control in adults with type 2 diabetes. Glipizide and metformin is not for treating type 1 diabetes.

Glipizide and metformin may also be used for purposes not listed in this medication guide.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

Take glipizide and metformin with meals.

Call your doctor if you are sick with vomiting, diarrhea, or a fever. These conditions can lead to severe dehydration, which could be dangerous while you are taking glipizide and metformin.

Drink plenty of liquids while you are taking glipizide and metformin.

You may have low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar (fruit juice, hard candy, crackers, raisins, or non-diet soda).

Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Glipizide and metformin is only part of a complete treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Store at room temperature away from moisture and heat.

Your doctor may have you take extra vitamin B12 while you are taking glipizide and metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

You should not take glipizide and metformin if you have severe kidney disease or diabetic ketoacidosis (call your doctor for treatment).

If you need to have any type of x-ray or CT scan that uses a dye injected into your veins, you may need to temporarily stop taking glipizide and metformin.

You may develop lactic acidosis, which is a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired.

You should not use glipizide and metformin if you are allergic to glipizide or metformin, or if you have:

• severe kidney disease; or
• metabolic acidosis or diabetic ketoacidosis (call your doctor for treatment).

If you need to have any type of x-ray or CT scan that uses a dye injected into your veins, you may need to stop taking glipizide and metformin for a short time.

Tell your doctor if you have ever had:

• kidney disease;
• congestive heart failure, especially if you take digoxin (Lanoxin) or furosemide (Lasix);
• a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency;
• liver disease;
• heart disease; or
• if you are over 80 years old and have not recently had your kidney function checked.

You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk.

Follow your doctor's instructions about using this medicine if you are pregnant or become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications for both the mother and the baby. However, you may need to stop taking glipizide and metformin for a short time just before your due date.

Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk.

You should not breastfeed while you are taking this medicine.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

This medicine may cause serious side effects. Stop using this medicine and call your doctor immediately if you have:

• heart problems-- swelling, rapid weight gain, feeling short of breath;
• severe hypoglycemia-- extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, seizure; or
• lactic acidosis-- unusual muscle pain, trouble breathing, stomach pain, vomiting, irregular heart rate, dizziness, feeling cold, or feeling very weak or tired.

Common side effects of glipizide and metformin may include:

• upset stomach, nausea, diarrhea;
• headache; or
• cold symptoms such as stuffy nose, sneezing, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Usual Adult Dose for Diabetes Type 2:

Doses provided as glipizide-metforminPatients with Inadequate Glycemic Control on Diet and Exercise Alone: -Initial dose: 2.5 mg-250 mg orally once a dayPatients with Fasting Blood Glucose (FBG) between 280 and 320 mg/dL:-Initial dose: 2.5 mg-500 mg orally twice a day Maintenance Dose: Increase in increments of 2.5 mg-500 mg per day every 2 weeks to the minimum effective dose to achieve adequate blood glucose control Maximum Initial Dose: 10 mg-1000 mg or 10 mg-2000 mg per day in divided dosesPatients with Inadequate Glycemic Control on Glipizide (or another Sulfonylurea) and /or Metformin:Initial dose: 2.5 mg-500 mg or 5 mg-500 mg orally twice a dayMaintenance Dose: Increase in increments of no more than 5 mg-500 mg to the minimum effective dose to achieve adequate blood glucose control Maximum Dose: 20 mg-2000 mg per day Comments:-Give with meals; initial doses should be conservative to avoid hypoglycemia largely due to glipizide and gastrointestinal side effects largely due to metformin.-For patients who are switching to combination therapy, initial doses should not exceed the daily dose of glipizide (or equivalent sulfonylurea) and metformin already being taken; the decision to switch to the nearest equivalent dose should be based on clinical judgement. -Monitor patients closely for signs and symptoms of hypoglycemia. Use: As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.

Take your dose as soon as you can, but only if you are about to eat a meal. If you miss a meal, skip the missed dose and wait until your next meal.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can cause severe low blood sugar or lactic acidosis.

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis.

If you also take colesevelam, avoid taking it within 4 hours after you take glipizide and metformin.

Many medications can impact glipizide and metformin, which may make glipizide and metformin less effective or raise your risk of lactic acidosis. This includes both prescription and over-the-counter medications, vitamins, and herbal products. Not all possible interactions are mentioned here. Inform your doctor about all your current medications and any medicine you begin or discontinue.