Glipizide and Metformin: Uses, Dosage and Side effects in humans

Metformin and Glipizide are prescription medications for managing type 2 diabetes. The article will highlight their indications, mechanisms of action, dosages, and potential toxicity in the management care of patients with diabetes.  

About Metformin

Metformin is an antidiabetic medication that has received FDA approval to treat patients with Type 2 diabetes mellitus. This medicine is often available in both immediate-release and extended-release forms and is typically administered in combination with other antidiabetic medications. Metformin is currently the only diabetes medicine applicable for prediabetics, as suggested by the American Diabetes Association.

When diagnosing type 2 diabetes, doctors primarily recommend lifestyle modifications such as following a more balanced diet and increasing physical activity. Metformin is commonly used alone or in combination with other diabetes medicines when the above-mentioned lifestyle interventions have proven ineffective in lowering blood sugar. The American Diabetes Association recommend Metformin as a recommended approach for treating Type 2 diabetes in both adults and children ten years or older. According to the standards of medical care for diabetes, if a patient’s haemoglobin A1c (HbA1c) level is less than 9% at diagnosis, monotherapy with Metformin is the recommended first-line treatment. However, if the level is greater than 9%, Metformin is suggested in combination with other diabetes medicines.

Furthermore, it is to be noted that Metformin is not meant to be used in patients with type 1 diabetes. Off-label use of Metformin manages gestational diabetes, prevents type 2 diabetes, and treats polycystic ovary syndrome.

Mechanism of action

Metformin is a biguanide class of medicine that effectively lowers glucose levels in the bloodstream by causing a significant reduction in the glucose production in the liver, diminishing intestinal absorption and improving sensitivity. The antidiabetic agent plays a key role in women with polycystic ovary syndrome (PCOS) by causing a significant reduction in insulin levels, causing decreased luteinising hormone and androgen levels. Reaching normal hormone levels helps regulate the menstrual cycle in females. This is the reason why healthcare providers advise premenopausal females to avoid pregnancy while taking this antidiabetes medicine.

The medicine typically takes around three hours to take effect after administration and is primarily eliminated unchanged through the kidneys. Hence, it is important to monitor kidney function when receiving this diabetes medicine to ensure safety and effectiveness.

Usage and dosage

The oral medication is typically prescribed at daily doses ranging from 500 mg to 2550 mg, depending on the patient’s condition. To avoid the risk associated with gastrointestinal issues, it is often prescribed to take it with a meal. The medicine is generally available in two formulations: immediate-release, which includes twice-daily dosing, and extended-release, which requires once-daily dosing. Moreover, the daily dose of Metformin is generally adjusted weekly from 500 to 850 mg to reduce the risk of adverse reactions in patients using this medicine. Healthcare specialists recommend using this medicine consistently every day. Extended-release tablets are typically taken once daily with a glass of water. This antidiabetic medicine is safe, effective, and affordable, and it may also help reduce the risk of heart disease and its associated complications.  

About Glipizide

Glipizide is a sulfonylurea medicine which got FDA approval for the treatment of adults with Type 2 diabetes mellitus. Doctors often prescribe it as an adjunct to a diet and exercise regimen. It can be prescribed in combination with Metformin to achieve control over HbA1c in patients with inadequate metabolic control, despite incorporating diet, exercise, and medication in the treatment regimen, within three months. Specifically, it can be used as a solo treatment in cases of intolerance or contraindication to using this antidiabetic agent. Considering its availability, cost, and effectiveness in controlling Type 2 diabetes, Glipizide and other sulfonylurea medications are commonly selected treatment options for healthcare specialists. This medicine has the potential to induce powerful antidiabetic effects.

Dosing forms

Glipizide is supplied in the form of immediate-release pills (5 mg and 10 mg) and extended-release tablets (2.5 mg, 5 mg, and 10 mg). It is intended only for patients with Type 2 diabetes. 

Immediate-release form: The treatment typically begins with a 5 mg daily dose. The dosage may be increased from 2.5 mg to 5 mg based on the patient’s blood sugar tolerance response. The expected maintenance dose is 2.5 mg to 20 mg daily, administered every 12 hours. The maximum daily dose should not exceed 40 mg.

Extended-release pills: The initial recommended dose is 5 mg once daily, usually consumed with breakfast. Furthermore, this dose may be adjusted according to patient tolerance, response and blood sugar levels.  

For patients with low levels of the insulin hormone, the recommendation usually includes discontinuation of insulin and initiation of Glipizide treatment at an appropriate dosage.

Liver failure: For patients with liver failure, treatment typically begins with a dose of 2.5 mg once daily, using immediate-release tablets. 

The primary side effects include hypoglycaemia (low blood sugar and weight gain. The commonly reported ones include gastrointestinal issues, including nausea and diarrhoea. Rarely, jaundice may result from Glipizide treatment, which requires treatment discontinuation.

The use of  Metformin and Glipizide requires a healthcare expert’s approach to achieve optimal patient results.