Hypoglycemic effect of certain drugs including Glypizide is potentiated by drugs including NSAIDs, some azole and other drugs that are protein bound, Salicylates and Chloramphenicol, Probenecid, Coumarin, MAO inhibitors and beta-adrenergic blocking agents Certain drugs tend to produce hyperglycemia and may lead to loss of blood glucose control.

These being Thiazides, and other diuretics, Corticosteroids, Phenothiazines, Thyroid products, Estrogens, Oral contraceptives, Phenytoin, Estrogens,Nicotinic acid,Calcium channel blocking agents, Isoniazid. Potential interaction between oral miconazole and hyoglycemic agents leading to hypoglycemia. Absorption of Glypizide is delayed by about 40 minutes when taken with food. The drug is more effective when given 30 minutes before a meal

Hyperglycemia- Adjunct to diet to lower blood glucose

Glypizide Hypoglycemia. Gastrointestinal disturbances, gastralgia, nausea, diarrhea, and possible allergic skin reactions, including erythema, morbiliform, or maculopapulae eruptions, urticaria, and pruritus, eczema, that may occur rarely. Porphyria and photosensitive reactions have also been reported. on use with sulphonylureas. Metformin Lactic acididosis is rare but a serious complication that can occur. due to accumulaton of Metformin during treatment. When it occurs, it is fatal in 50% of cases particularly in those with renal insufficiency.

Diabetes patients with unstable angina, or acute congestive failure are at greater risk of developing lactic acidosis. Severe irreversible adverse effects include Vitamin B12 and folate malabsorption occuring during long term treatment Hypoglycemia does not usually occur when Metformin is given alone, but has been reported when drug is given with sulfonylurea and or alcohol. Other symptomatic side effects being gastrointestinal adverse effects, like metallic taste, nausea, abdominal distention, diarrhea, and anorexia occuring in 5-30% of Metformin treated patients.

Glipizide Contraindicated in patienst with: known hypersensitivity to the drug Diabetes ketosis with or without coma Metformin Contraindicated in patients with: Hypersensitivity to Metformin Acute or chronic metabolic acidosis, including ketoaciddosis with or without coma. Special precautions: Glipizide Patients should be informed of potential risks and advantages of Glipizide and alternative modes of therapy. Renal or hepatic impairment may result in elevated blood levels of Glipizide leading to hypoglycemia.

Proper patient selection dosage and instructions to the patients are important. Elderly debilitated and mal nourished patients. When exposed to stress, like fever trauma, infection or surgery on stabililization with any diabetic regimen, a loss of control of blood glucose may occur. Glypizides and sulponylureas should not be given to neonates. Not recommended for use in nursing mothers and in pregnancy. Metformin Metformin should be promptly withheld in presence of any condition associated with dehydration, and sepsis because of impaired ability of the body to clear lactate in these conditions. Caution against excessive intake of alcohol because alcohol potentiates the effect of Metformin on lactate metabolism.

Metformin therapy should be suspended temporarily in case of any surgical procedures and not to be restarted until patients oral intake and renal function have been normnalised. Metformin therapy should be temporarily discontinued in patients undergoing radiological studies involving intravascular administration of iodinated contrast material because use of such products may result in alteration of renal function.

Indication Hyperglycemia As directed by physician

Caution against excessive intake of alcohol because alcohol potentiates the effect of Metformin on lactate metabolism.

Pharmacology:

Glypizide Glypizide is one of the most rapid and short acting blood glucose-lowering second generation sulphonylurea drug. It brings about acute insulin release, owing to its short duration of action it is not liable to provoke long lasting hypoglycemia. Metformin Metformin is an oral antihyperglycemic drug used in the management of non-insulin dependent diabetes melitus (NIDDM). However when used in conjuntion with a sulfonylurea like GLipizide, it augments the hypoglycemic effect of the latter thereby effecting efficient control of blood glucose.

Phramocokinetics:

Glipizide Gatrointestinal absorption is uniform, rapid, and essentially complete. The half life occurs 1-3 hrs after a single oral dose. Whether administered orally or intervenously, the half life elimination ranges 2-4 hrs in normal subjects. The primary metabolites are inactive hydroxylation producrs and polar conjugates and are excreted mainly in urine. Metformin Under fasting conditions , the bioavailablity of Metformin is 50-60%.. Food decreases the extent and slighly delays the absorption of Metformin.Metformin is excreted unchanged in urine and does not undergo hepatic metabolism. Following oral route 90% of the drug is eliminated via the renal route in the first 24 hrs. with a plasma elimination half life of 6.2hrs.

Absorption of Glypizide is delayed by about 40 minutes when taken with food. The drug is more effective when given 30 minutes before a meal

Not recommended for use in nursing mothers and in pregnancy.