Home Drug Guide Metformin Hydrochloride and Glipizide

Drug Guide

Generic Name

Metformin Hydrochloride and Glipizide

Brand Names Metaglip, Glipizide and Metformin Hydrochloride

Classification

Therapeutic: Antidiabetic agent (for type 2 diabetes)

Pharmacological: Combination sulfonylurea and biguanide

FDA Approved Indications

  • Management of type 2 diabetes mellitus to improve glycemic control.

Mechanism of Action

Metformin decreases hepatic glucose production and increases insulin sensitivity; Glipizide stimulates insulin secretion from pancreatic beta cells.

Dosage and Administration

Adult: Dosage varies based on patient response; initial doses typically are 2.5 mg glipizide with 500 mg metformin once daily, titrated as needed.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution, monitor renal function closely.

Renal Impairment: Adjust dose based on renal function; contraindicated in severe renal impairment.

Hepatic Impairment: Use with caution; monitor hepatic function.

Pharmacokinetics

Absorption: Metformin is well absorbed; Glipizide is rapidly absorbed.

Distribution: Metformin is minimally bound to plasma proteins; Glipizide is highly protein-bound.

Metabolism: Metformin is not metabolized; Glipizide undergoes hepatic metabolism.

Excretion: Metformin is excreted unchanged in urine; Glipizide metabolites are excreted renally.

Half Life: Metformin: approximately 17.6 hours; Glipizide: about 2-4 hours.

Contraindications

  • Severe renal impairment (eGFR <30 mL/min).
  • Acute or chronic metabolic acidosis, including diabetic ketoacidosis.

Precautions

  • Use cautiously in hepatic impairment, heart failure, and elderly; monitor renal function regularly.

Adverse Reactions - Common

  • Nausea (Common)
  • Diarrhea (Common)
  • Hypoglycemia (Less common when used alone; more with combination therapy.)

Adverse Reactions - Serious

  • Lactic acidosis (Rare but serious; risk increased in renal impairment)

Drug-Drug Interactions

  • Cimetidine, drugs that impair renal function, corticosteroids, certain diuretics, other hypoglycemics.

Drug-Food Interactions

N/A

Drug-Herb Interactions

  • Potential interactions with herbal products that affect blood glucose (e.g., ginseng).

Nursing Implications

Assessment: Monitor blood glucose levels, renal function, liver function, and signs of hypoglycemia or lactic acidosis.

Diagnoses:

  • Risk for unstable blood glucose levels
  • Risk for hypoglycemia
  • Risk for lactic acidosis.

Implementation: Administer with meals to reduce gastrointestinal side effects; monitor blood glucose regularly; adjust dose based on response and lab results.

Evaluation: Assess glycemic control and adverse effects; adjust therapy accordingly.

Patient/Family Teaching

  • Take medication as prescribed, with meals to minimize gastrointestinal effects.
  • Recognize signs of hypoglycemia (sweating, dizziness) and hyperglycemia.
  • Maintain regular blood glucose monitoring.
  • Report symptoms of lactic acidosis (muscle pain, abnormal fatigue).

Special Considerations

Black Box Warnings:

  • Lactic acidosis - increased risk in patients with renal impairment.
  • Renal function should be monitored regularly.

Genetic Factors: Consider genetic variability in drug response.

Lab Test Interference: May interfere with certain urine glucose tests.

Overdose Management

Signs/Symptoms: Severe hypoglycemia, lactic acidosis (e.g., hyperventilation, confusion).

Treatment: Immediate administration of glucose; hold the medication; supportive care; dialysis in severe cases.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for standard shelf life as per manufacturer instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.