Select therapeutic use:
Indications for GLUCOVANCE:
Adjunct to diet and exercise in type 2 diabetes.
Take with meals. Individualize. Not controlled on diet/exercise (use individual components): initially glyburide 1.25mg and metformin 250mg once daily (twice daily [AM & PM] if baseline HbA1c >9% or FPG >200mg/dL). May increase by increments of 1.25mg glyburide and 250mg metformin per day every 2 weeks. Not controlled on sulfonylurea and/or metformin: initially 2.5mg/500mg or 5mg/500mg twice daily in AM & PM (initial dose should not exceed previous daily doses of individual components). May increase by increments of up to 5mg/500mg. Both: max 20mg/2000mg per day. May add a thiazolidinedione or use in renal impairment: see full labeling.
Severe renal impairment (eGFR <30mL/min/1.73m2). Metabolic acidosis, diabetic ketoacidosis. Concomitant bosentan.
Increased risk of metformin-associated lactic acidosis in renal or hepatic impairment, concomitant use of certain drugs (eg, cationic drugs), ≥65yrs of age, undergoing radiological contrast study, surgery and other procedures, hypoxic states, and excessive alcohol intake; discontinue if lactic acidosis occurs. Discontinue at time of, or prior to intravascular iodinated contrast imaging in patients with eGFR 30–60mL/min/1.73m2, history of hepatic impairment, alcoholism, heart failure, or will be given intra-arterial contrast; reevaluate eGFR 48hrs after procedure and restart therapy if renally stable. Suspend therapy if dehydration occurs or before surgery. May increase risk of cardiovascular mortality. Avoid if clinical or lab evidence of hepatic disease. Assess renal function prior to starting and periodically thereafter; more frequently in elderly or if eGFR <60mL/min/1.73m2. G6PD deficiency; consider non-sulfonylurea alternatives. Elderly, debilitated, uncompensated strenuous exercise, malnourished or deficient caloric intake, adrenal or pituitary insufficiency, or alcohol intoxication: increased risk of hypoglycemia. Monitor hematology (esp. serum Vit. B12 in susceptible patients). Measure FBG, HbA1c periodically. Pregnancy (Cat.B), nursing mothers: not recommended; consider using insulin instead; if glyburide/metformin needed, discontinue ≥2 weeks before delivery date.
See Contraindications. Increased risk of lactic acidosis with topiramate, other carbonic anhydrase inhibitors (eg, zonisamide, acetazolamide, dichlorphenamide); monitor. Concomitant cationic drugs that interfere with renal tubular transport systems (eg, ranolazine, vandetanib, dolutegravir, cimetidine) may increase metformin levels; monitor. Metformin may affect or be affected by furosemide, nifedipine. Avoid excessive alcohol intake (potentiates effects of metformin on lactate). Diuretics, steroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, sympathomimetics, calcium channel blockers, isoniazid, nicotinic acid, others may cause hyperglycemia; monitor. Glyburide may be potentiated by NSAIDs, highly protein-bound drugs, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, MAOIs, β-blockers, ciprofloxacin, oral miconazole. β-blockers may mask hypoglycemia. Concomitant thiazolidinediones: monitor LFTs periodically. Administer glyburide >4hrs prior to colesevelam.
Sulfonylurea + biguanide.
Upper respiratory infection, diarrhea, headache, nausea/vomiting, abdominal pain, dizziness, hypoglycemia; rare: lactic acidosis (may be fatal), disulfiram-like reactions, cholestatic jaundice, hepatitis, skin reactions.