What is the recommended dosing for Glipizide (Glipizide) ER 10mg?

Glipizide ER 10mg Dosing

For glipizide ER 10mg, the standard dosing is once daily with breakfast, with a maximum dose of 20 mg/day for the extended-release formulation, though doses above 10-15 mg rarely provide additional glycemic benefit and increase hypoglycemia risk. 1, 2

Standard Dosing Protocol

• Glipizide ER should be administered once daily with breakfast to achieve optimal glycemic control 2
• The maximum approved daily dose for extended-release (ER/XL) formulation is 20 mg, which is lower than the 40 mg maximum for immediate-release formulations 1
• Doses above 15 mg should be carefully considered, as research demonstrates little additional benefit - increasing from 10 mg to 40 mg daily produced minimal improvement in blood glucose (9.6 vs 8.9 mmol/L) and may actually reduce beta-cell function 3

Dose Titration Strategy

• Start at 5 mg before breakfast for most patients, or 2.5 mg for elderly patients or those with liver disease 2
• Titrate in increments of 2.5-5 mg based on blood glucose response, with at least several days between adjustments 2
• If glycemic targets are not met at 15-20 mg daily, consider switching to insulin therapy rather than continuing to escalate glipizide, as further dose increases rarely provide meaningful benefit and increase hypoglycemia risk 4

Critical Renal Function Considerations

Before any dose adjustment, assess kidney function immediately, as this fundamentally changes the dosing approach: 4

• eGFR >50 mL/min/1.73 m²: No dose adjustment needed 4, 1
• eGFR 30-50 mL/min/1.73 m²: Start conservatively at 2.5 mg once daily and titrate slowly; exercise extreme caution with dose increases 4, 1
• eGFR <30 mL/min/1.73 m²: Consider switching to alternative agents rather than using glipizide 4

Important Safety Considerations

• Extended-release formulations carry higher hypoglycemia risk in renal impairment compared to immediate-release formulations 4
• Hypoglycemia is the most common adverse effect, particularly in elderly patients or those with renal impairment 1
• When co-administered with colesevelam, glipizide should be given at least 4 hours prior to avoid reduced absorption 2

Modern Treatment Context

• Glipizide is not a preferred agent in contemporary diabetes management - SGLT2 inhibitors and GLP-1 receptor agonists should be prioritized in patients with established cardiovascular disease, heart failure, or chronic kidney disease due to superior cardiovascular and renal protection 4
• If the patient has these comorbidities, consider adding or switching to these newer agents rather than escalating glipizide doses 4