The metabolic and excretory patterns are similar with the two routes of administration, indicating that first-pass metabolism is not significant. The maximum once-daily dose as conventional tablets recommended by the manufacturer is 15 mg. Musculoskeletal pain has been reported in 8 or 6.7% of patients receiving the fixed combination of glipizide and metformin or metformin monotherapy, respectively, as second-line therapy for type 2 diabetes mellitus. The drug and its metabolites are also excreted in feces, apparently almost completely via biliary elimination; only small amounts may be excreted in feces as unabsorbed drug following oral administration. Furthermore, loss of blood glucose control on diet alone may be transient, thus requiring only short-term administration of glipizide or other antidiabetic medications. Initial glipizide dosage should be conservative in debilitated, malnourished, or geriatric patients, patients with impaired renal or hepatic function, or those who may otherwise be more sensitive to oral hypoglycemic agents because of an increased risk of hypoglycemia in these patients.Based on results of a randomized crossover study, patients receiving conventional glipizide tablets may be switched safely to extended-release glipizide tablets by giving the nearest equivalent total daily dose once daily. Follow all directions on your prescription label. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution. Such patients should be monitored for signs and symptoms of hypoglycemia following the switch. Alternatively, glipizide may be effective in some patients who have not responded or have ceased to respond to other sulfonylureas.It has been shown that glipizide therapy was effective in controlling blood sugar without deleterious changes in the plasma lipoprotein profiles of patients treated for NIDDM.In a placebo-controlled, crossover study in normal volunteers, glipizide had no antidiuretic activity and, in fact, led to a slight increase in free water clearance.Gastrointestinal absorption of glipizide in man is uniform, rapid, and essentially complete. In another substudy (UKPD 49), progressive deterioration in diabetes control was such that monotherapy was effective in only about 50% of patients after 3 years and in only about 25% of patients after 9 years; thus, most patients require multiple-drug antidiabetic therapy over time to maintain such target levels of disease control. A total daily dosage exceeding 10 mg of glipizide and 2 g of metformin hydrochloride has not been evaluated in clinical trials in patients receiving the fixed-combination preparation as initial therapy. Dosage may be increased in increments of one tablet (using the tablet strength at which therapy was initiated, either 2.5 mg glipizide/250 mg metformin hydrochloride or 2.5 mg glipizide/500 mg metformin hydrochloride) daily every 2 weeks until the minimum effective dosage required to achieve adequate glycemic control or a maximum daily dosage of 10 mg of glipizide and 2 g of metformin hydrochloride given in divided doses is reached. The primary mode of action of glipizide in experimental animals appears to be the stimulation of insulin secretion from the beta cells of pancreatic islet tissue and is thus dependent on functioning beta cells in the pancreatic islets. glipizide 5 mg tablet. Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. Geriatric patients or those with liver disease may be started on 2.5 mg.Dosage adjustments should ordinarily be in increments of 2.5 to 5 mg, as determined by blood glucose response. The extended-release tablets should be swallowed whole and should Extended-release tablets of glipizide are administered once daily, generally with breakfast. Patients should be observed carefully (1 to 2 weeks) for hypoglycemia when being transferred from longer half-life sulfonylureas (e.g., chlorpropamide) to glipizide due to potential overlapping of drug effect.When colesevelam is coadministered with glipizide ER, maximum plasma concentration and total exposure to glipizide is reduced. The effect is perinatal and believed to be directly related to the pharmacologic (hypoglycemic) action of glipizide. The area under the serum concentration-time curve (AUC) for glipizide increases in proportion to increasing doses. 16729-140-16, Patients should be instructed to contact the prescriber immediately if these tests are abnormal. Because of the prolonged elimination half-life of chlorpropamide, an exaggerated hypoglycemic response may occur in some patients during the transition from chlorpropamide to glipizide, and patients being transferred from chlorpropamide should be closely monitored for the occurrence of hypoglycemia during the initial 2 weeks of the transition period with conventional glipizide tablets or 1-2 weeks with extended-release glipizide tablets.