Drugs List

Therapeutic Indications

Uses

Non insulin dependent diabetes mellitus when diet has failed

Administration

Glipizide should be taken orally approximately 30 minutes before a meal to achieve the greatest reduction in post-prandial hyperglycaemia.

Contraindications

Children under 18 years
Breastfeeding
Diabetic coma
Diabetic ketoacidosis
Pregnancy
Renal impairment - glomerular filtration rate below 10ml/minute
Renal impairment- GFR 10-50ml/minute with co-existing hepatic impairment
Severe hepatic impairment

Precautions and Warnings

Debilitation
Elderly
High alcohol intake
Adrenal insufficiency
G6PD deficiency
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Lactose intolerance
Malnutrition
Pituitary insufficiency
Porphyria
Renal impairment - glomerular filtration rate 10 - 50ml/minute

Advise patient ability to drive or operate machinery may be impaired
Advise patient to take precautions to avoid hypoglycaemia whilst driving
Some formulations contain lactose
Monitor blood or urinary glucose
Monitoring of glycosylated haemoglobin is recommended
Hypoglycaemic symptoms may be masked/altered with beta blockers
Risk of hypoglycaemia may be increased by exercise or ingestion of alcohol
Discontinue at first signs of jaundice
Discontinue if skin reactions persist
Temporary discontinuation & use of insulin may be needed at times of stress
Advise patient they have to inform the DVLA of antidiabetic medication
Advise patients on adequate dietary control
Advise regular and timely carbohydrates to avoid hypoglycaemia

Pregnancy and Lactation

Pregnancy

Glipizide is contraindicated in pregnancy.

Animal studies have shown milk fetotoxicity in rats, which was thought to be caused by hypoglycaemia. No teratogenic effects were observed in rats and rabbits.

Detailed guidance on the treatment of diabetes during pregnancy is available from the National Institute for Health and Clinical Excellence (NICE) at https://www.nice.org.uk/guidance/CG63

Insulin is the treatment of choice for both Type 1 and Type 2 diabetes during pregnancy as it provides better control of maternal blood glucose compared to oral hypoglycaemics. It is believed that human insulin and insulin analogues do not cross the placenta, however there may be endogenous carrier proteins allowing passage of insulin to the embryo during early gestation; animal insulin is believed to cross the human placenta. The foetus produces its own insulin once insulin-secreting cells in the foetal pancreas become differentiated at the end of the first trimester.

Human insulin is considered safe to use during pregnancy and extensive experience with human insulin during pregnancy does not indicate any embryotoxic potential. Human insulin is often the first line treatment for diabetes and the benchmark used when comparing the safety of other insulins during pregnancy.

Infants of diabetic mothers are at an increased risk of congenital abnormalities, the rate of which appears to be related to maternal glycaemic control during the first trimester. Careful control of maternal blood glucose is required throughout pregnancy. Good maternal glycaemic control during labour and birth is important in preventing adverse neonatal outcomes including neonatal hypoglycaemia and respiratory stress.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Glipizide is contraindicated in breastfeeding.

There are no large studies on the excretion of glipizide in human milk. Trough levels of glipizide were not detectable (less than 80 micrograms/L) in 2 mothers receiving 5 mg/day post-caesarean section and the infant blood glucose levels were normal.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Agranulocytosis
Aplastic anaemia
Blurred vision
Cholestatic jaundice
Confusion
Constipation
Diarrhoea
Diplopia
Disulfiram-like reactions
Dizziness
Drowsiness
Eczema
Erythema
Gastralgia
Haemolytic anaemia
Headache
Hepatic impairment
Hepatic porphyria
Hepatitis
Hypersensitivity reactions
Hypoglycaemia
Hyponatraemia
Increase in alkaline phosphatase
Increase in creatinine
Increase in lactate dehydrogenase
Increase in serum transaminases
Leucopenia
Maculopapular rash
Malaise
Morbilliform eruption
Nausea
Pancytopenia
Photosensitivity
Porphyria cutanea tarda
Pruritus
Thrombocytopenia
Tremor
Urticaria
Visual disturbances
Vomiting

Presentation

Oral formulations of glipizide

Drugs List

Therapeutic Indications

Uses

Non insulin dependent diabetes mellitus when diet has failed

Dosage

Short term use may be sufficient during periods of transient loss of control in patients normally well controlled on diet alone.

Adults

Elderly

Patients with Renal Impairment

Patients with Hepatic Impairment

Additional Dosage Information

Administration

Glipizide should be taken orally approximately 30 minutes before a meal to achieve the greatest reduction in post-prandial hyperglycaemia.

Contraindications

Children under 18 years
Breastfeeding
Diabetic coma
Diabetic ketoacidosis
Pregnancy
Renal impairment - glomerular filtration rate below 10ml/minute
Renal impairment- GFR 10-50ml/minute with co-existing hepatic impairment
Severe hepatic impairment

Precautions and Warnings

Debilitation
Elderly
High alcohol intake
Adrenal insufficiency
G6PD deficiency
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Lactose intolerance
Malnutrition
Pituitary insufficiency
Porphyria
Renal impairment - glomerular filtration rate 10 - 50ml/minute

Advise patient ability to drive or operate machinery may be impaired
Advise patient to take precautions to avoid hypoglycaemia whilst driving
Some formulations contain lactose
Monitor blood or urinary glucose
Monitoring of glycosylated haemoglobin is recommended
Hypoglycaemic symptoms may be masked/altered with beta blockers
Risk of hypoglycaemia may be increased by exercise or ingestion of alcohol
Discontinue at first signs of jaundice
Discontinue if skin reactions persist
Temporary discontinuation & use of insulin may be needed at times of stress
Advise patient they have to inform the DVLA of antidiabetic medication
Advise patients on adequate dietary control
Advise regular and timely carbohydrates to avoid hypoglycaemia

Pregnancy and Lactation

Pregnancy

Glipizide is contraindicated in pregnancy.

Animal studies have shown milk fetotoxicity in rats, which was thought to be caused by hypoglycaemia. No teratogenic effects were observed in rats and rabbits.

Detailed guidance on the treatment of diabetes during pregnancy is available from the National Institute for Health and Clinical Excellence (NICE) at https://www.nice.org.uk/guidance/CG63

Insulin is the treatment of choice for both Type 1 and Type 2 diabetes during pregnancy as it provides better control of maternal blood glucose compared to oral hypoglycaemics. It is believed that human insulin and insulin analogues do not cross the placenta, however there may be endogenous carrier proteins allowing passage of insulin to the embryo during early gestation; animal insulin is believed to cross the human placenta. The foetus produces its own insulin once insulin-secreting cells in the foetal pancreas become differentiated at the end of the first trimester.

Human insulin is considered safe to use during pregnancy and extensive experience with human insulin during pregnancy does not indicate any embryotoxic potential. Human insulin is often the first line treatment for diabetes and the benchmark used when comparing the safety of other insulins during pregnancy.

Infants of diabetic mothers are at an increased risk of congenital abnormalities, the rate of which appears to be related to maternal glycaemic control during the first trimester. Careful control of maternal blood glucose is required throughout pregnancy. Good maternal glycaemic control during labour and birth is important in preventing adverse neonatal outcomes including neonatal hypoglycaemia and respiratory stress.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Glipizide is contraindicated in breastfeeding.

There are no large studies on the excretion of glipizide in human milk. Trough levels of glipizide were not detectable (less than 80 micrograms/L) in 2 mothers receiving 5 mg/day post-caesarean section and the infant blood glucose levels were normal.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

Patients and family members should be advised on the signs and symptoms of hypoglycaemia, as well as the conditions that predispose to its development.

Patient should be informed of the importance of following dietary advice, taking regular exercise and of regular monitoring of blood glucose levels.

Patients should be advised to discuss their blood sugar control in the event of intercurrent illness.

Advise patients that their ability to drive or operate machinery may be impaired.

Inform the patient that he/she needs to inform the Driving and Vehicle Licensing Agency (DVLA) about the medication they are receiving. The Drivers Medical Group at the DVLA will be able to advise the patient on the legal issues surrounding the treatment of diabetes mellitus and driving.

The DVLA can be contacted by post at the following address:

Drivers' medical enquiries, DVLA, Swansea, SA99 1TU

By phone on 0300 790 6806; or by fax on 0845 850 0095

Detailed guidance on eligibility to drive, and precautions required, is available from the DVLA.

https://www.gov.uk/government/publications/at-a-glance

Further information concerning diabetes and driving may be obtained from the DVLA website at:

https://www.gov.uk/government/organisations/driver-and-vehicle-licensing-agency

Side Effects

Abdominal pain
Agranulocytosis
Aplastic anaemia
Blurred vision
Cholestatic jaundice
Confusion
Constipation
Diarrhoea
Diplopia
Disulfiram-like reactions
Dizziness
Drowsiness
Eczema
Erythema
Gastralgia
Haemolytic anaemia
Headache
Hepatic impairment
Hepatic porphyria
Hepatitis
Hypersensitivity reactions
Hypoglycaemia
Hyponatraemia
Increase in alkaline phosphatase
Increase in creatinine
Increase in lactate dehydrogenase
Increase in serum transaminases
Leucopenia
Maculopapular rash
Malaise
Morbilliform eruption
Nausea
Pancytopenia
Photosensitivity
Porphyria cutanea tarda
Pruritus
Thrombocytopenia
Tremor
Urticaria
Visual disturbances
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: August 2015

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Minodiab 2.5, Minodiab 5. Pharmacia Ltd. Revised June 2008.

The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

The Welsh Medicines Information Centre (WMIC) - Porphyria Information Service.
Available at: https://www.wmic.wales.nhs.uk/porphyria_info.php
Last revised: May 2015
Last accessed: 19 August 2015

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Glipizide. Last revised: 07 September 2013
Last accessed: 19 August 2015