Immediate Release Glipizide Dosing for Type 2 Diabetes
The recommended starting dose of immediate release (IR) glipizide for type 2 diabetes is 5 mg once daily given approximately 30 minutes before breakfast, with dose adjustments made in increments of 2.5-5 mg based on blood glucose response. 1
Initial Dosing
- Standard starting dose: 5 mg once daily, taken 30 minutes before breakfast 1
- For elderly, debilitated, malnourished patients or those with hepatic/renal impairment: Start with 2.5 mg once daily 1
- Administer approximately 30 minutes before breakfast to achieve the greatest reduction in postprandial hyperglycemia 1
Dose Titration
- Allow at least several days between dose adjustments to properly assess glycemic response 1
- Make dose adjustments in increments of 2.5-5 mg based on blood glucose response 1
- If response to a single dose is not satisfactory, dividing the same total daily dose may prove more effective 1
- Maximum recommended once-daily dose: 15 mg 1
- Maximum recommended total daily dose: 40 mg 1
Maintenance Dosing
- Some patients may be effectively controlled on a once-daily regimen 1
- Others show better response with divided dosing 1
- Total daily doses above 15 mg should ordinarily be divided 1
- Total daily doses above 30 mg have been safely given on a twice-daily basis to long-term patients 1
Special Populations
Elderly/Hepatic/Renal Impairment
- Use conservative initial and maintenance dosing to avoid hypoglycemic reactions 1
- Start with 2.5 mg once daily 1
Patients Transitioning from Insulin
For patients whose daily insulin requirement is:
- ≤20 units: Insulin may be discontinued and glipizide therapy may begin at usual dosages 1
20 units: Reduce insulin dose by 50% and begin glipizide at usual dosages 1
- Monitor urine for sugar and ketone bodies at least three times daily during insulin withdrawal 1
- Consider hospitalization during transition for patients receiving >40 units of insulin daily 1
Patients Transitioning from Other Oral Hypoglycemic Agents
- No transition period necessary when transferring patients to glipizide 1
- When transferring from longer half-life sulfonylureas (e.g., chlorpropamide), observe carefully for 1-2 weeks for hypoglycemia due to potential overlapping effects 1
Monitoring
- Monitor both urinary glucose and blood glucose periodically 1
- Use glycosylated hemoglobin levels to monitor patient's response to therapy 1
- Monitor for:
- Primary failure (inadequate glucose lowering at maximum dose)
- Secondary failure (loss of adequate response after initial effectiveness) 1
Important Considerations
- When coadministered with colesevelam, administer glipizide tablets at least 4 hours prior to colesevelam 1
- Hypoglycemia is the most common adverse effect, particularly in elderly, debilitated, or malnourished patients 2
- For patients with chronic kidney disease, especially with eGFR <30 mL/min/1.73m², use with caution due to increased risk of hypoglycemia 3
Combination Therapy
- When metformin alone is insufficient, glipizide can be added as a second-line agent 2
- Consider SGLT2 inhibitors or GLP-1 receptor agonists as preferred add-on therapy for patients with cardiovascular or renal disease 3
By following these dosing guidelines and monitoring protocols, glipizide IR can be effectively and safely used to manage type 2 diabetes while minimizing the risk of hypoglycemia.