Is Glipizide (a sulfonylurea) on the Beers criteria?

Glipizide and the Beers Criteria

Glipizide is not specifically listed on the American Geriatrics Society (AGS) Beers Criteria as a medication to avoid in older adults. While some sulfonylureas are included in the Beers Criteria, glipizide is notably absent from the list of medications that should be avoided in older adults 1.

Understanding Sulfonylureas and the Beers Criteria

The AGS Beers Criteria is an explicit list of potentially inappropriate medications (PIMs) that should typically be avoided in older adults due to their unfavorable balance of benefits and harms compared to alternative treatment options 1. The criteria are regularly updated, with the most recent updates in 2019 and 2023 2.

Sulfonylureas on the Beers Criteria:

• Some long-acting sulfonylureas (such as chlorpropamide and glyburide) are included on the Beers list due to their higher risk of prolonged hypoglycemia in older adults
• Glipizide, being a shorter-acting sulfonylurea, is not specifically listed as a medication to avoid

Clinical Considerations for Glipizide in Older Adults

Despite not being on the Beers list, glipizide still requires careful consideration in older adults:

• Hypoglycemia Risk: Episodic hypoglycemia remains a leading cause of emergency department visits in older patients 1
• Deintensification Needs: Guidelines suggest relaxing glycemic goals in older adults, particularly those with frailty or multiple comorbidities 1
• Monitoring Requirements: Careful monitoring is needed when using any sulfonylurea in older adults

Practical Recommendations for Glipizide Use in Older Adults

When considering glipizide in older adults:

1. Assess hypoglycemia risk factors:

   • Advanced age
   • Renal impairment
   • Cognitive dysfunction
   • Poor nutritional status
   • Polypharmacy

2. Start with lower doses and titrate slowly in older adults 3

3. Consider alternatives if the patient has:

   • History of hypoglycemic episodes
   • Irregular eating patterns
   • Advanced age (>80 years)
   • Significant renal impairment

4. Monitor regularly for signs of hypoglycemia and adjust dosing accordingly

Important Clinical Pitfalls to Avoid

• Don't assume safety: While not on the Beers list, glipizide still carries risks in older adults
• Don't overlook drug interactions: Review for potential interactions with other medications that may increase hypoglycemia risk
• Don't maintain strict glycemic targets: Relaxed targets (HbA1c 7.5-8.5%) are often more appropriate for older adults 1
• Don't forget to review the medication list annually: Regular medication reviews are recommended for all older adults with diabetes 1

While glipizide itself is not on the Beers Criteria, clinicians should still exercise caution when prescribing it to older adults, particularly those with risk factors for hypoglycemia or who are taking multiple medications.