This preparation is indicated as initial therapy, as an adjunct to diet and exercise, to improve glycemic control in patients with type 2 diabetes whose hyperglycemia cannot be satisfactorily managed with diet and exercise alone, and as second-line therapy when diet, exercise, and initial treatment with a sulfonylurea or metformin do not result in adequate glycemic control in patients with type 2 diabetes.

Metformin is a biguanide antihyperglycemic agent, which improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Its pharmacological mechanisms of action are different from other classes of oral antihyperglycemic agents. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Unlike sulfonylureas, metformin does not produce hypoglycemia in either patients with type 2 diabetes or normal subjects and does not cause hyperinsulinemia.

Glipizide is a sulfonylurea which appears to lower blood glucose by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. Extrapancreatic effects may play a part in the mechanism of action of oral sulfonylurea hypoglycemic drugs.

Glipizide & Metformin should be given once or twice daily with meals and should be initiated at a low dose, with gradual dose escalation.

Glipizide & Metformin as Initial Therapy: The recommended starting dose is 250 mg/2.5 mg once a day with a meal.

Glipizide & Metformin as Second-Line Therapy: The recommended starting dose is 500 mg/2.5 mg or 500 mg/5 mg twice daily with the morning and evening meals. The maximum recommended daily dose is 2000 mg metformin / 20 mg glipizide.

Cimetidine reduces the renal clearance of metformin. Alcohol potentiates the antihyperglycemic and hyperlactataemic effect of metformin. It may enhance the effects of anticoagulants. Such patients receiving the two drugs may need adjustment of the anticoagulant dosage. Nifedipine appears to enhance the absorption of metformin, but metformin has minimal effects on nifedipine. The hypoglycemic action of sulfonylureas may be potentiated by certain drugs including nonsteroidal anti-inflammatory agents, some azoles, and other drugs that are highly protein bound, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, monoamine oxidase inhibitors, and beta-adrenergic blocking agents.

Hypersensitivity to the drug, renal impairment, diabetic coma and ketoacidosis, chronic renal diseases, congestive heart failure, trauma, dehydration, alcohol dependence, pregnancy, breastfeeding, etc.

The most common side effects of Glipizide & Metformin are hypoglycemia, diarrhea, nausea/vomiting, abdominal pain, headache, musculoskeletal pain, etc.

Contraindicated during pregnancy and lactation.

Metformin is known to be substantially excreted by the kidney, and the risk of metformin accumulation and lactic acidosis is increased with the degree of impairment of renal function. Thus, patients with serum creatinine levels above the upper limit of normal should not receive metformin. In patients of advanced age, metformin should be carefully titrated to establish the minimum dose for adequate glycemic control, because aging is associated with reduced renal function. Metformin therapy should be temporarily suspended for any surgical procedure and should not be restarted until the patient's oral intake has resumed and renal function has been evaluated as normal. During concomitant therapy with sulfonylurea, blood glucose should be monitored. Metformin and insulin therapy should be carried out in hospital until the correct ratio of the two drugs has been established. The metabolism and excretion of glipizide may be slowed in patients with impaired renal and/or hepatic function. If hypoglycaemia should occur in such patients, it may be prolonged, and appropriate management should be instituted.

Combination Oral hypoglycemic preparations

Keep below 30°C temperature, away from light and moisture. Keep out of the reach of children.