Glipizide

About Glipizide

Glipizide is a sulfonylurea, like glimepiride and glyburide: it lowers blood sugar mainly by stimulating the pancreas to release insulin. Both forms are labeled, with diet and exercise, for blood sugar control in adults with type 2 diabetes; neither is for type 1 diabetes or diabetic ketoacidosis, and safety and effectiveness in children have not been established. Immediate-release tablets usually start at 5 mg, or 2.5 mg in older adults and people with liver disease, taken about 30 minutes before breakfast; the dose rises by 2.5 to 5 mg with several days between steps, doses above 15 mg are divided before meals, and the most is 40 mg a day. Extended-release tablets start at 5 mg once a day with breakfast or the first main meal, or 2.5 mg if low blood sugar is more likely, up to 20 mg; someone switching from immediate-release tablets takes the nearest equivalent total daily dose once a day.

There is no boxed warning, but both labels carry a special warning that oral diabetes drugs of this kind have been linked to increased cardiovascular deaths, based on an older study of tolbutamide. All sulfonylureas can cause severe low blood sugar: eating too little, hard or long exercise, alcohol, other diabetes medicines, older age, frailty or poor nutrition, and kidney or liver problems raise the risk, and beta blockers can hide its signs. Sulfonylureas can cause hemolytic anemia in people with G6PD deficiency, and cases have been reported without a known deficiency. Glipizide must not be taken by anyone allergic to it, and the Glucotrol XL label also rules it out after an allergy to sulfonamide derivatives. Stomach upset is the most common side effect of the immediate-release tablets; dizziness, diarrhea, nervousness, tremor and gas were reported with the extended-release tablets.

Extended-release tablets are swallowed whole, never chewed, split or crushed; something that looks like a tablet may appear in the stool, and they are avoided with severe narrowing of the gut. The two forms are not swapped for each other at the counter. Sulfonylureas cross the placenta and newborns have had prolonged low blood sugar, so glipizide is stopped before the expected delivery date: at least two weeks before under the Glucotrol XL label, and a month before under the immediate-release label. It can make skin more sensitive to sunlight. The FDA lists every Glucotrol strength as discontinued, not for safety or effectiveness reasons, and Glucotrol XL 2.5 mg as discontinued, while Glucotrol XL 5 and 10 mg are still sold. Glipizide with metformin is a separate generic product.

Taking Glipizide

How to take it

Immediate-release tablets about 30 minutes before a meal, usually breakfast, with larger doses divided before meals; extended-release tablets once a day with breakfast or the first main meal. If you also take colesevelam, take glipizide at least 4 hours before it.

If you miss a dose

Ask the prescriber in advance what to do. As a general rule, take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Fluconazole raises glipizide levels and oral miconazole has been reported to cause severe low blood sugar; aspirin and other NSAIDs, sulfonamides and other diabetes medicines can add to its effect, and beta blockers can hide the signs of low blood sugar. Thiazides, steroids, estrogens and birth control pills can raise blood sugar, and alcohol can rarely cause a flushing reaction.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Glipizide differs from pharmacy to pharmacy

Generic glipizide in both forms has several makers and costs pharmacies little, so the dispensing fee can be a large part of a quote, and fees differ between pharmacies. A prescription that names Glucotrol XL and blocks substitution is priced as a brand. The two forms are not interchangeable, so the pharmacy fills the form named on the prescription.

Ways to pay less for Glipizide without insurance

• Ask whether glipizide is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If Glucotrol XL is prescribed, ask for a generic extended-release tablet rated equivalent to it, and make sure the prescription does not block substitution.
• Once your dose is settled, ask the prescriber for a ninety-day supply.
• If you also take metformin, ask the prescriber whether the combined glipizide and metformin tablet or two separate tablets would suit you, and ask for quotes on each.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Glipizide

1. 1.Is this the immediate-release or the extended-release tablet, and when should I take it?
2. 2.What should I do about my dose if I skip a meal or I am sick?
3. 3.How do I recognize and treat low blood sugar, and should my family know the signs?
4. 4.Do any of my medicines, such as fluconazole, a beta blocker or colesevelam, interact with it?

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