Follow carefully the special meal plan your doctor gave you. This is the most important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

Glipizide and metformin combination should be taken with meals to help reduce the gastrointestinal side effects that may occur during treatment.

Dosing

The dose of glipizide and metformin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of glipizide and metformin. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking glipizide and metformin.

• For oral dosage form (tablets):
  • For type 2 diabetes:
    • For first-time treatment:
      • Adults: At first, 2.5 milligrams (mg) of glipizide and 250 milligrams (mg) of metformin once a day with a meal. Then, your doctor may increase your dose a little at a time every two weeks until your blood sugar is controlled.
      • Children: Use and dose must be determined by your doctor.
    • As second-line therapy:
      • Oral, 2.5 milligrams (mg) of glipizide and 500 milligrams (mg) of metformin or 5 milligrams (mg) of glipizide and 500 milligrams (mg) of metformin two times a day, with the morning and evening meals. Then, your doctor may increase your dose a little at a time until your blood sugar is controlled. The starting dose should not exceed the daily dose of glipizide or metformin already being taken.
      • Children: Use and dose must be determined by your doctor.
    • For patients previously treated with a sulfonylurea antidiabetic agent and/or metformin:
      • Adults: When switching patients from a sulfonylurea plus metformin to the glipizide and metformin combination, the initial dose should not exceed the daily dose of glipizide (or equivalent dose of another sulfonylurea) and metformin that was being taken.
      • Children: Use and dose must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Ask your health care professional how you should dispose of any medicine you do not use. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For glipizide and metformin the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to glipizide or metformin. Also tell your doctor and pharmacist if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Glipizide and metformin combination has not been studied in pregnant women or animals. However, independent studies with glipizide and also with metformin have not shown that either medicine causes birth defects or other problems in animal studies. It is easier during pregnancy to control your blood sugar by using injections of insulin rather than by taking oral diabetes medicines. Close control of your blood sugar can reduce the chance of your baby gaining too much weight, having birth defects, or having high blood sugar before birth. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding It is not known whether glipizide or metformin passes into human breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of glipizide and metformin in children with use in other age groups.

Older adults Some older adults may be more sensitive than younger adults to the effects of these medicines. The first signs of low or high blood sugar are not easily seen or do not occur at all in older adults. This may increase the chance of low blood sugar developing during treatment. Older adults are more likely to have age-related problems and glipizide and metformin should be used carefully as age increases. This medicine should not be started in adults over 80 years of age unless kidney function is not reduced.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking glipizide and metformin, it is especially important that your doctor and pharmacist know if you are taking any of the following:

• Alcohol Drinking alcohol may increase the risk of developing lactic acidosis and/or very low blood sugar.

• Beta-adrenergic blocking agents (acebutolol [e.g., Sectral], atenolol [e.g., Tenoretic, Tenormin], betaxolol [e.g., Kerlone], Bisoprolol [e.g., Zebeta, Ziac], carteolol [e.g., Cartrol], carvedilol [e.g., Coreg], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor, Toprol], nadolol [e.g., Corgard, Corzide], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal, Inderide], sotalol [e.g., Betapace, Sorine], timolol [e.g., Blocadren, Timolide]) Beta-adrenergic blocking agents can hide the symptoms of low blood sugar (hypoglycemia). Because of this, a person with diabetes might not recognize that he or she has low blood sugar and might not take immediate steps to treat it.

• Cimetidine (e.g., Tagamet) or
• Amiloride (e.g., Midamor) or
• Digoxin (e.g., Lanoxin) or
• Furosemide (e.g., Lasix) or
• Morphine (e.g., MS Contin) or
• Procainamide (e.g., Procanbid, Pronestyl) or
• Quinidine (e.g., Quinaglute, Quinidex) or
• Quinine (malaria medicine) or
• Ranitidine (e.g., Zantac) or
• Triamterene (e.g., Dyrenium) or
• Trimethoprim (e.g., Proloprim) or
• Vancomycin (e.g., Vancocin) Use with glipizide and metformin may cause high blood levels of glipizide and metformin, which may increase the chance of low blood sugar or other side effects.

• Fluconazole (e.g., Diflucan) Using this medicine at the same time as glipizide and metformin may cause severe low blood sugar (hypoglycemia).

• Acid in the blood (acidosis or ketoacidosis) or
• Surgery (major) Use of insulin is best to help control diabetes in patients with these conditions.

• Blood poisoning or
• Dehydration (severe) or
• Heart or blood vessel disorders or
• Kidney disease or
• Liver disease Lactic acidosis can occur in these conditions and chances of it occurring are even greater with a medicine that contains metformin.

• Congestive Heart Failure Glipizide and metformin should not be used in patients who have this medical condition.

• Kidney, heart, or other problems that require medical tests or examinations that use certain medicines called contrast agents, with x-ray exams Because this medicine contains metformin, your doctor should advise you to stop taking it before you have any medical exams or diagnostic tests that might cause less urine output than usual; you may be advised to start taking the medicine again 48 hours after the exams or tests if your kidney function is tested and found to be normal.

• Alcohol intoxication or
• Strenuous exercise not accompanied by adequate intake of food or
• Underactive adrenal gland, not properly controlled or
• Underactive pituitary gland, not properly controlled or
• Undernourished condition or
• Weakened physical condition or
• Any other condition that causes low blood sugar Patients with these conditions may be more likely to develop low blood sugar while taking a medication that contains glipizide and metformin.

• Vitamin B₁₂ deficiency This condition may be made worse by this medication.