What is the treatment for a glipizide (an oral hypoglycemic agent) overdose?

From the Guidelines

Treatment for glipizide overdose requires immediate medical attention and focuses on stabilizing blood glucose levels, with the primary intervention being administration of oral or intravenous glucose to counteract hypoglycemia, as recommended by the most recent guidelines 1. The main life-threatening complication of glipizide overdose is hypoglycemia, which can be prolonged due to the drug's long duration of action.

• Patients should receive continuous glucose monitoring with frequent blood glucose checks.
• 50% dextrose (D50) boluses should be administered for severe hypoglycemia, followed by maintenance with D10 or D5 infusions.
• Octreotide, typically given at 50-100 mcg subcutaneously or intravenously every 6-12 hours, is highly effective in preventing recurrent hypoglycemia by suppressing insulin release, as supported by previous studies 1. Key aspects of treatment include:
• Administration of glucose (approximately 15–20 g) as the preferred treatment for conscious individuals with hypoglycemia, with repetition of treatment if blood glucose monitoring shows continued hypoglycemia after 15 minutes 1.
• Consumption of a meal or snack to prevent recurrence of hypoglycemia once blood glucose levels return to normal.
• Consideration of glucagon administration for individuals at significant risk of severe hypoglycemia, with instruction of caregivers or family members on its administration 1. Treatment should continue for 12-24 hours after the last hypoglycemic episode, though monitoring may be needed for up to 24-48 hours since glipizide has a long duration of action.
• Activated charcoal may be administered if the patient presents within 1-2 hours of ingestion.
• Supportive care includes cardiac monitoring, maintaining airway patency, and addressing any electrolyte imbalances. Glipizide stimulates insulin release from pancreatic beta cells, which explains why hypoglycemia can be prolonged and why blocking insulin secretion with octreotide is effective in management.

From the FDA Drug Label

OVERDOSAGE There is no well documented experience with glipizide overdosage. The acute oral toxicity was extremely low in all species tested (LD 50greater than 4 g/kg). Overdosage of sulfonylureas, including glipizide, can produce hypoglycemia Mild hypoglycemic symptoms without loss of consciousness or neurologic findings should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns. Close monitoring should continue until the physician is assured that the patient is out of danger Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution This should be followed by a continuous infusion of a more dilute (10%) glucose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients should be closely monitored for a minimum of 24 to 48 hours since hypoglycemia may recur after apparent clinical recovery. The treatment for glipizide overdose includes:

• Mild hypoglycemic symptoms: treatment with oral glucose and adjustments in drug dosage and/or meal patterns
• Severe hypoglycemic reactions: immediate hospitalization and treatment with a rapid intravenous injection of concentrated (50%) glucose solution, followed by a continuous infusion of a more dilute (10%) glucose solution to maintain blood glucose above 100 mg/dL Close monitoring for at least 24 to 48 hours is recommended, as hypoglycemia may recur after apparent clinical recovery 2

From the Research

Treatment for Glipizide Overdose

• The treatment for glipizide overdose typically involves the administration of glucose to counteract hypoglycemia, but this approach can be unsatisfactory as glucose stimulates insulin release, leading to a need for escalating quantities of hypertonic glucose to maintain normoglycemia 3.
• Octreotide, a somatostatin analog, has been shown to be effective in reversing hyperinsulinemia and preventing hypoglycemia induced by sulfonylurea overdoses, including glipizide 3, 4, 5.
• The use of octreotide can reduce the need for exogenous glucose and decrease the risk of recurrent hypoglycemia 3, 5.
• In cases of severe hypoglycemia, octreotide can be administered intravenously or subcutaneously, with dosing regimens varying depending on the patient's age and weight 5.
• Other treatments, such as diazoxide, may also be used, but octreotide has been shown to be more effective in preventing recurrent hypoglycemia and reducing the need for supplemental dextrose 3, 5.

Key Considerations

• Glipizide overdose can result in profound and prolonged hypoglycemia, particularly in children and the elderly 6, 4.
• The use of octreotide in the treatment of sulfonylurea poisoning, including glipizide overdose, is supported by clinical and pharmacokinetic data 5.
• Maintenance doses of octreotide may be required to prevent recurrent hypoglycemia 5.
• Close monitoring of blood glucose levels and adjustment of treatment as needed is crucial in managing glipizide overdose 3, 5.