Glipizide
๐ Glipizide is a short-acting sulphonylurea used in the management of Type 2 Diabetes Mellitus (T2DM).
โ ๏ธ It can cause hypoglycaemia (especially if meals are missed), but the risk is lower than with long-acting agents like glibenclamide.
๐ Always check the BNF for the latest details.
โ๏ธ Mode of Action
- Stimulates pancreatic ฮฒ-cell receptors โ insulin release ๐ฌ.
- Suppresses hepatic gluconeogenesis ๐, reducing glucose output from the liver.
- Overall: lowers blood glucose by โ insulin and โ hepatic glucose production.
๐ Indications
- Type 2 Diabetes Mellitus (T2DM) โ when lifestyle ยฑ metformin are inadequate.
๐ Dose
- 2.5โ5 mg with food (usual max: 20 mg/day).
- Take with meals to reduce risk of hypos.
๐ Interactions
- โฌ๏ธ Risk of hypoglycaemia with:
- Chloramphenicol
- Sulphonamides, Co-trimoxazole
- Warfarin
- Fibrates
- Alcohol ๐ท can potentiate hypo risk.
โ ๏ธ Cautions
- ๐ก Use with caution in elderly or those with renal/hepatic impairment โ โ hypo risk.
- Obesity: metformin usually preferred first-line.
- Acute illness/surgery: consider switching to VRIII (Variable Rate IV Insulin Infusion).
โ Contraindications
- Type 1 Diabetes Mellitus.
- Diabetic ketoacidosis.
- See BNF for full list.
๐ฅ Side Effects
- ๐ฌ Hypoglycaemia (classic exam pearl).
- โ๏ธ Weight gain.
- ๐ฃ GI upset (nausea, diarrhoea).
- ๐ธ Rash or hypersensitivity reactions.
- ๐ฉธ Rare: blood dyscrasias (agranulocytosis, haemolytic anaemia).
- Hepatic toxicity (rare but important).
๐ง Clinical Pearls
- Safer than glibenclamide in the elderly due to its shorter duration of action.
- Still carries hypo risk โ always counsel on "hypo rules" (carry glucose, donโt skip meals, recognise warning signs).
- Useful when patients cannot tolerate metformin or need additional control before insulin is started.
๐ References
