Glipizide Once Daily Dosing
Starting Dose
The recommended starting dose of glipizide is 5 mg once daily, given approximately 30 minutes before breakfast. 1
For geriatric patients, debilitated or malnourished patients, and those with impaired renal or hepatic function, the initial dose should be 2.5 mg once daily to avoid hypoglycemic reactions 1
Patients with renal impairment (CrCl 30-50 mL/min/1.73 m²) should initiate glipizide conservatively at 2.5 mg once daily and titrate slowly to avoid hypoglycemia 2
Dose Titration
Dosage adjustments should ordinarily be in increments of 2.5–5 mg, as determined by blood glucose response, with at least several days elapsing between titration steps. 1
- If response to a single dose is not satisfactory, dividing that dose may prove effective 1
Maximum Dosing
The maximum recommended once daily dose is 15 mg. 1
Doses above 15 mg should ordinarily be divided and given before meals of adequate caloric content 1
The maximum recommended total daily dose is 40 mg 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
Maintenance Dosing
Some patients may be effectively controlled on a once-a-day regimen, while others show better response with divided dosing 1
Clinical Context and Positioning
Sulfonylureas like glipizide are positioned as second-line agents after metformin, typically used in combination therapy when metformin monotherapy fails to achieve glycemic targets 2
- GLP-1 receptor agonists and SGLT2 inhibitors are generally preferred over sulfonylureas for patients with diabetic kidney disease due to superior cardiovascular and renal outcomes 2
Common Pitfalls to Avoid
Do not start with higher doses in elderly or renally impaired patients – this substantially increases hypoglycemia risk 1
Do not advance doses more frequently than every several days – allow adequate time to assess glycemic response 1
Do not exceed 15 mg as a single daily dose – doses above this threshold should be divided 1
When combining glipizide with insulin therapy, reduce insulin doses by approximately 20% to minimize hypoglycemia risk, as the combination significantly increases this risk 3