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1 High Alert thyroid, pituitary, or adrenal function; Malnutrition, high fever, prolonged nausea, or
vomiting; OB, Lactation: Safety not established; insulin recommended during preg-
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glipiZIDE (glip-i-zide) nancy.
Glucotrol, Glucotrol XL Adverse Reactions/Side Effects
Classification CNS: dizziness, drowsiness, headache, weakness. GI: constipation, cramps, diar-
Therapeutic: antidiabetics rhea, drug-induced hepatitis, dyspepsia,qappetite, nausea, vomiting. Derm: pho-
Pharmacologic: sulfonylureas tosensitivity, rashes. Endo: hypoglycemia. F and E: hyponatremia. Hemat: APLAS-
Pregnancy Category C TIC ANEMIA, agranulocytosis, hemolytic anemia, leukopenia, pancytopenia,
thrombocytopenia.
Indications Interactions
PO: Controls of blood sugar in type 2 diabetes mellitus when diet therapy fails. Re- Drug-Drug: Ingestion of alcohol may result in disulfiram-like reaction. Effective-
quires some pancreatic function. ness may bepby concurrent use of diuretics, corticosteroids, phenothiazines,
oral contraceptives, estrogens, thyroid preparations, phenytoin, nicotinic
Action acid, sympathomimetics, and isoniazid. Alcohol, androgens (testosterone),
Lowers blood sugar by stimulating the release of insulin from the pancreas and in- chloramphenicol, clofibrate, clarithromycin, fluoroquinolones, MAO in-
creasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose hibitors, NSAIDs (except diclofenac), salicylates, fluconazole sulfonamides,
production. Therapeutic Effects: Lowering of blood sugar in diabetic patients. and warfarin mayqrisk of hypoglycemia. Concurrent use with warfarin may alter
Pharmacokinetics the response to both agents (qeffects of both initially, thenpactivity); close monitor-
Absorption: Well absorbed following oral administration. ing recommended during any changes in dose. Beta-adrenergic blockers may
Distribution: Unknown. mask the signs and symptoms of hypoglycemia. Mayqcyclosporine levels. Colesev-
Protein Binding: 99%. elam maypeffects; administer glipizide ⱖ4 hr before colesevelam.
Metabolism and Excretion: Mostly metabolized by the liver. Route/Dosage
Half-life: 2.1– 2.6 hr. PO (Adults): 5 mg/day initially,qas needed (range 2.5– 40 mg/day); XL dose form
TIME/ACTION PROFILE (hypoglycemic activity) is given once daily. Doses ⬎15 m g/day may be given as 2 divided doses of regular-
ROUTE ONSET PEAK DURATION release product (not XL).
PO (Geriatric Patients): 2.5 mg/day initially.
PO 15–30 min 1–2 hr up to 24 hr
NURSING IMPLICATIONS
Contraindications/Precautions Assessment
Contraindicated in: Hypersensitivity; Hypersensitivity to sulfonamides (cross- ● Observe for signs and symptoms of hypoglycemic reactions (sweating, hunger,
sensitivity may occur); Insulin-dependent diabetics; Diabetic coma or ketoacidosis. weakness, dizziness, tremor, tachycardia, anxiety). Patients on concurrent beta-
Use Cautiously in: Severe cardiovascular or hepatic disease; Glucose 6-phos- blocker therapy may have very subtle signs and symptoms of hypoglycemia.
phate dehydrogenase deficiency (qrisk of hemolytic anemia); Geri:qsensitivity; ● Assess patient for allergy to sulfonamides.
dosagepmay be required; Severe renal disease (qrisk of hypoglycemia); Infection, ● Lab Test Considerations: Monitor serum glucose and glycosylated hemoglo-
stress, or changes in diet may alter requirements for control of blood sugar; Impaired bin periodically during therapy to evaluate effectiveness of treatment.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 ● Encourage patient to follow prescribed diet, medication, and exercise regimen to
prevent hypoglycemic or hyperglycemic episodes.
● Monitor CBC periodically during therapy. Report p in blood counts ● Concurrent use of alcohol may cause a disulfiram-like reaction (abdominal PDF Page #2
promptly. cramps, nausea, flushing, headaches, and hypoglycemia).
● May cause anqin AST, LDH, BUN, and serum creatinine. ● Instruct patient in proper testing of serum glucose and ketones. These tests should
● Toxicity and Overdose: Overdose is manifested by symptoms of hypoglycemia. be closely monitored during periods of stress or illness and health care profes-
Mild hypoglycemia may be treated with administration of oral glucose. Treat se- sional notified if significant changes occur.
vere hypoglycemia with IV D50W followed by continuous IV infusion of more di- ● May occasionally cause dizziness or drowsiness. Caution patient to avoid driving
lute dextrose solution at a rate sufficient to keep serum glucose at approximately or other activities requiring alertness until response to medication is known.
100 mg/dL. ● Caution patient to avoid other medications, especially aspirin and alcohol, while
Potential Nursing Diagnoses on this therapy without consulting health care professional.
Imbalanced nutrition: more than body requirements (Indications) ● Caution patient to use sunscreen and protective clothing to prevent photosensitiv-
Noncompliance (Patient/Family Teaching) ity reactions.
● Advise patient to inform health care professional of medication regimen prior to
Implementation treatment or surgery.
● High Alert: Accidental administration of oral hypoglycemic agents to non-dia- ● Advise patient to notify health care professional promptly if unusual weight gain,
betic adults and children has resulted in serious harm or death. Before adminis- swelling of ankles, drowsiness, shortness of breath, muscle cramps, weakness,
tering, confirm that patient has Type 2 diabetes. sore throat, rash, or unusual bleeding or bruising occurs.
● Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, ● Insulin is the recommended method of controlling blood sugar during pregnancy.
infection, or surgery may require administration of insulin. Counsel female patients to use a form of contraception other than oral contracep-
● To convert from other oral hypoglycemic agents, gradual conversion is not re-
tives and to notify health care professional promptly if pregnancy is planned or
quired. For insulin dose of less than 20 units/day, change to glipizide can be made
suspected.
without gradual dose adjustment. Patients taking 20 or more units/day should
● Advise patient to carry a form of sugar (sugar packets, candy) and identification
convert gradually by receiving glipizide and a 25– 30% reduction in insulin dose
every day or every 2nd day with gradual insulin dose reduction as tolerated. Moni- describing disease process and medication regimen at all times.
tor serum or glucose and ketones at least 3 times/day during conversion. ● Emphasize the importance of routine follow-up exams.
● PO: Administer 30 min before a meal. Swallow extended-release tablets whole; do Evaluation/Desired Outcomes
not crush, break or chew.
● Control of blood glucose levels without the appearance of hypoglycemic or hyper-
Patient/Family Teaching glycemic episodes.
● Instruct patient to take medication at same time each day. Take missed doses as
soon as remembered unless almost time for next dose. Do not take if unable to eat. Why was this drug prescribed for your patient?
● Explain to patient that this medication controls hyperglycemia but does not cure
diabetes. Therapy is long term.
● Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia oc-
curs, advise patient to drink a glass of orange juice or ingest 2– 3 tsp of sugar,
honey, or corn syrup dissolved in water or an appropriate number of glucose tab-
lets and notify health care professional.
䉷 2015 F.A. Davis Company
