From the Guidelines
Glipizide is contraindicated in patients with type 1 diabetes mellitus, diabetic ketoacidosis, or severe hepatic or renal impairment, and its use should be cautious in elderly patients, those with adrenal or pituitary insufficiency, and patients with severe cardiovascular disease. According to the most recent evidence from 1, glipizide should be initiated conservatively to avoid hypoglycemia, especially in patients with chronic kidney disease (CKD). The medication works by stimulating insulin release from pancreatic beta cells, so it requires functioning beta cells to be effective.
Key Considerations
- Patients with known hypersensitivity to glipizide or other sulfonylureas should avoid this medication.
- Glipizide should be avoided in patients with G6PD deficiency as it may cause hemolytic anemia.
- When starting glipizide, monitor blood glucose levels closely, especially if the patient is taking medications that may interact with it, such as beta-blockers, NSAIDs, or fluconazole, which can potentiate its hypoglycemic effects.
- The risk of hypoglycemia is increased in patients with substantial decreases in eGFR (CKD stages 4 and 5), as noted in 1 and 1.
Special Populations
- Elderly patients: use with caution due to increased risk of hypoglycemia.
- Patients with adrenal or pituitary insufficiency: use with caution due to increased risk of hypoglycemia.
- Patients with severe cardiovascular disease: use cautiously as hypoglycemic episodes can exacerbate cardiac conditions.
- Patients with CKD: initiate conservatively and titrate slowly to avoid hypoglycemia, as recommended in 1.
Monitoring and Interactions
- Monitor blood glucose levels closely when starting glipizide, especially in patients taking medications that may interact with it.
- Be aware of potential interactions with other medications, such as beta-blockers, NSAIDs, or fluconazole, which can potentiate hypoglycemic effects.
From the FDA Drug Label
CONTRAINDICATIONS Glipizide tablets are contraindicated in patients with: Known hypersensitivity to the drug. Type 1 diabetes mellitus, diabetic ketoacidosis, with or without coma. This condition should be treated with insulin. The contraindications for glipizide are:
- Known hypersensitivity to the drug
- Type 1 diabetes mellitus
- Diabetic ketoacidosis, with or without coma 2
From the Research
Contraindications for Glipizide
- Renal impairment is a recognized risk factor for prolonged hypoglycemia, as seen in patients with end-stage renal disease (ESRD) 3
- Patients with a history of hypoglycemic episodes, longer duration of diabetes, and a history of cerebrovascular disease are at greater risk of prolonged hypoglycemia when treated with sulfonylureas like glipizide 3
- There is no direct evidence of contraindications specific to glipizide in the provided studies, but sulfonylureas in general may be associated with a higher risk of hypoglycemia in certain patient populations 3, 4
- Glimepiride, another sulfonylurea, has been shown to have a reduced likelihood of hypoglycemia compared to glyburide, but its comparison to glipizide is limited to efficacy in lowering glucose levels 4
- One study on experimental endocarditis in rabbits is not relevant to the contraindications of glipizide 5