Adult Dosing
Type 2 diabetes mellitus
Initial therapy (patient on diet and exercise)
- 1.25 mg/250 mg PO qd
- 1.25 mg/250 mg PO bid, if HbA1c >9% or an FPG >200 mg/dL
- Titer: Increase by 1.25 mg/250 mg q2 wks up to the minimum effective dose
- Max: 10 mg/2000 mg/day
2nd Line therapy (Patients already on Sulfonylurea and/or Metformin)
- 2.5 mg/500 mg - 5 mg/500 mg bid
- Titer: Increase by 5 mg/500 mg, up to the minimum effective dose
- Max: 20 mg/2000 mg/day
Note:
- Tablet to be taken with meals
Pediatric Dosing
- Pediatric dosing is not applicable
[Outline]
See Supplemental Patient Information
- Oral hypoglycemic drugs increases the risk of cardiovascular mortality as compared to treatment with diet alone or diet plus insulin [US Black Box warnings]
- Glyburide/metformin therapy does not reduce macrovascular risk
- Glyburide/metformin therapy causes hypoglycemia, the risk of hypoglycemia increases with renal or hepatic insufficiency and also in elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication, follow proper patient selection, dosing, and instructions to avoid potential hypoglycemia
- Sulfonylurea agents cause hemolytic anemia in glucose-6-phosphate dehydrogenase (G6PD) deficiency. Use cautiously in G6PD deficiency or consider non-sulfonylurea alternative
- Impairment of renal function increases the risk of metformin accumulation and lactic acidosis. Monitor renal function prior to initiation of therapy and periodically thereafter, carefully titrated to establish the minimum dose for adequate glycemic effect. Discontinue the therapy on the evidence of renal dysfunction
- Be cautious while concomitant administration of drug that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin such as cationic drugs
- Metformin therapy can cause a decrease to subnormal levels of previously normal serum vitamin B12 levels; measure hematologic parameters annually
- Temporarily discontinue the therapy in patients undergoing intravascular contrast studies with iodinated materials as it is associated with increased risk of renal dysfunction and lactic acidosis
- Immediately discontinue the therapy in case of cardiovascular collapse, acute CHF, acute MI and other conditions of hypoxemia associated with lactic acidosis and prerenal azotemia
- Temporarily discontinue the therapy in patients undergoing major surgical procedure, associated with restricted intake of food and fluids
- Avoid glyburide/metformin in impaired hepatic function
- Evaluate serum electrolytes and ketones, blood glucose, pyruvate and metformin levels in type 2 diabetic patient, previously well controlled on metformin who developed laboratory abnormalities or clinical illness, if acidosis, stop therapy and start alternative treatment
- Addition of thiazolidinediones to glyburide/metformin increase the risk of hypoglycemia, weight gain, and increase in liver enzymes
- Caution patients about possible induction of ovulation
Cautions: Use cautiously in
- CHF
- Alcohol abuse
- Risk of hypoglycemia
- Elderly patients
- G6PD deficiency
- Concomitant use of cationic drugs
Supplemental Patient Information
- Patients should be instructed to avoid excessive use of alcohol while receiving treatment
Pregnancy Category:B
Breastfeeding: Limited data indicate negligible levels of glyburide secretion in milk. It is advisable to monitor breastfed infant's blood glucose during maternal therapy with hypoglycemic agents. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 17 December 2010)Well-conducted studies indicates very low level of metformin in milk and less than 0.5% of their mother's dosage received, in infants. Metformin levels in milk are relatively constant during maternal use, so breastfeeding timing with respect to the administration times is of little benefit. No adverse effects were found in breastfed infants in one prospective study. Use cautiously when, nursing newborn and premature infants and those with renal impairment. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 17 December 2010)As per manufacturer data, because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Consider insulin therapy if diet alone is inadequate for controlling blood glucose.
US Trade Name(s)
US Availability
glyburide/metformin (generic)
- TABS:
- 1.25 mg/250 mg
- 2.5 mg/500 mg
- 5 mg/500 mg
Glucovance (glyburide/metformin )
- TABS:
- 1.25 mg/250 mg
- 2.5 mg/500 mg
- 5 mg/500 mg
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
Glucovance (glyburide/metformin )
- TABS:
- 1.25 mg/250 mg
- 2.5 mg/500 mg
- 5 mg/500 mg
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Glucovance 5-500 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
60 mg = $92
180 mg = $246.06 - GlyBURIDE-MetFORMIN 5-500 MG TABS [Bottle] (TEVA PHARMACEUTICALS USA)
100 mg = $83.99
300 mg = $246.97 - Glucovance 2.5-500 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
60 mg = $85.99
180 mg = $249.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
80 years of age. Start with minimum effective dose of metformin and carefully monitor renal function of the patients taking metformin. Immediately discontinue the therapy in the presence of any condition associated with hypoxemia, dehydration, or sepsis
