November 29, 2022

I cover Glipizide (Glucotrol) pharmacology, adverse effects, and drug interactions.

Hey all welcome back to the real life pharmacology podcast i’m your host pharmacist eric christensen thank you so much for listening today as always i want to remind you to go to reallifepharmacology.com and pick up your free 31-page pdf it’s a little study guide i put together on the top 200 drugs definitely a good resource if you’re out in clinical practice just

A great refresher or if you’re studying for board exams things of that nature it’s a nice resource to to kind of have and lean on just to pick up some important clinical pearls or re-remember some of the clinical pearls with these medications so again reallifepharmacology.com go snag that free pdf all right the drug of the day today is glippazide a brand name of

This medication is glucotrol and this medication is used for type 2 diabetes going back thinking about type 2 diabetes and and why blood sugars are elevated that type of thing insulin is going to play a huge role in lowering blood sugars and helping us get our patients to our a1c goal insulin is released from the pancreas specifically from from beta cells and

Glyphozide actually stimulates the pancreas or beta cells to release that insulin and obviously as we get more insulin into the bloodstream having its effects we lower blood sugar insulin remember promotes uh the storing of glucose essentially in the liver as glycogen and so that’s going to ultimately uh lower blood sugar now side effects very very similar to

Uh insulin okay hypoglycemia and weight gain those are by far the two things that you’re going to want to worry about and monitor for the most on upon initiation there have been rare cases of you know skin reactions and and things like that as well with glipozide but again not not incredibly common and probably not much more so than any other medication as well

But hypoglycemia weight gain and because of those two adverse effects that’s one of the reasons why this class of drugs has really fallen out of favor you know 10 15 20 years ago these drugs were reused all the time but now we’ve got a lot of newer agents uh sglt2s that uh glp ones so which are generally better tolerated and we don’t have as much hypoglycemia

Risk and we don’t have as much weight gain risk which is always a concern in our type 2 diabetes patients who are often already overweight uh dosing typically going to be dosed once daily uh however as those doses escalate you will likely see that that dose split up particularly with the immediate release dosage form there is an extended release dosage form

As well and it’s important to note that the administration of those two does differ a little bit so immediate release is typically 30 minutes before meals and that’s done to kind of help ensure that it’s absorbed at a you know fairly stable or regular rate because if you give it with food there have been reports of of that absorption being very variable and

Then kind of affecting um blood sugars in a variable manner as well now the extended release giving that one with breakfast is fine and and that’s typically how it’s done it’s given with meals and like i said typically breakfast so that that’s an important distinction i think to remember uh between dosage forms is the timing of administration now you may get

Into situations clinically where you know a patient has said well i’ve taken my immediate release you know with meals all my life i’ve never had an issue and you know that’s a situation where you’re probably going to have some common sense in clinical judgment and you know maybe rely on the patient’s history and consistency there so um you know use some common

Sense with with that information that type of thing but typically if we’re going to start a ir or extend immediate release or extended release in patients we’re going to typically want to try to recommend it as the manufacturer intended there let’s talk about ckd which is often you know a common complication from long-term diabetes so if we’re going to use a

Sophomoria these drugs have definitely fallen out of favor a little bit and aren’t used as much gallipozide is the preferred sulfonylurea in chronic kidney disease okay so medication like glyburide that’s another sophon area that one’s a little bit more concerning about you know changes in absorption or excuse me elimination and things like that uh where the

Dosages can accumulate a little bit more so we’re still going to want to use caution in patients on glyphoside with ckd and maybe monitor them a little bit more closely particularly if we’re changing doses and or there’s renal function changes but glipozide is the preferred agent there and then of course in our geriatric patient population as patients get older

We’re we’re generally going to um have less aggressive a1c goals and so we you know we might do slower titration um and or less aggressive dosing um with you know a drug like sophoniurias and that’s to prevent the negative side of hypoglycemia or at least lower the risk of hypoglycemia i did i do get asked about uh the sulfur warning so glipozide is a sulfonylurea

So theoretically there could be some cross-reactivity with a patient that’s had like a bacterm allergy or an allergy to a sulfonamide antibiotic this is really quite low extremely low in the literature as far as the cross reactivity risk now you’re probably going to want to find out at least you know what the reaction was let’s say you’ve got a bactrim allergy

On the list definitely find out what that allergy was and you know if it was a minor rash that resolved right away or something or you know gi upset uh you know obviously that’s probably a situation where it’s it’s probably not going to be any higher risk to use a sophomore than it would be to you know use any other drug or that type of thing so again find out

What the reaction was you know if they had a situation where they had a stephen johnson syndrome and almost died or something um because of an allergic reaction to uh bactrim that’s a situation like okay well you know we might uh want to do a little bit further digging and you know maybe try to figure out another option for their diabetes or you know at least

Weigh that risk versus benefit of using a sophomorea compared to selecting another agent so um kind of use some some common sense with that obviously the literature changes over time so um definitely do some some digging and and that sort of thing if you’re considering using glip azide in a patient with a significant sulfur allergy all right let’s take a quick

Break from our sponsor and we will wrap up with drug interactions if you’re in the market for pharmacist board certification study material like pharmacotherapy ambulatory care medication therapy management geriatrics definitely go check out meded101.com store if you’re a pharmacy student we’ve got links to our naplex content as well so definitely go check out

Those resources if you’re a healthcare professional nurse med student or any other professional that has to go through pharmacology courses that type of thing we’ve got a lot of resources books case studies drug interactions all sorts of different stuff through our amazon links and as well as our audible links too so again all those links slash metadata101.com

Story all right so let’s talk drug interactions a little bit first and foremost you know any diabetes medication is going to potentially increase the risk for hypoglycemia okay that’s pretty common sense you add a diabetes medication that’s going to lower blood sugar and they’re taking off sulfonylurea we could lower that blood sugar further and potentially

Cause a low blood sugar event other medications quinolone antibiotics beta blockers and their potential to maybe mask hypoglycemia those are all potential medications that could raise the risk for hypoglycemia and then of course i’ve covered these in in other topics as well but you got to think about meds that raise blood sugar and could potentially oppose the

Beneficial effects of glyphoside so your corticosteroids for example your antipsychotics you know lanzapine clozapine come to mind stimulants may raise blood sugars some of the transplant medications cyclosporine tacrolimus these are all meds that could raise blood sugars and potentially oppose glyphosides beneficial effects and then there are some potential

Sip interactions i would not categorize them as very significant but something to maybe think about and usually you’re probably going to recognize these drugs as having notorious drug interactions so fluconazoles one that i’ve seen happen this is a can inhibit sip2c9 to a certain extent and in that setting that could increase the concentration of glyphoside on

The flip side classic enzyme inducer rifampin that could induce sip2c9 and that may lower concentrations of glyphoside which subsequently could potentially raise blood sugars so again we’re going to monitor those patients you know watch for hypoglycemia if concentrations are going to grow go up you know watch for hyperglycemia if concentrations of the drug are

Going to go down so i think it’s important to to recognize that as far as other you know drug interactions not an incredible amount i would say obviously that’s just a quick list of some of the most important ones i mean in my opinion there but certainly there is a much longer list if you go look at uh up-to-date or other resources there that’s about it for glib

Azide today thank you so much for listening if you got suggestions comments definitely don’t hesitate to reach out med education 101 at gmail dot com or else you can track me down eric christensen pharmd bcgp bcps at linkedin definitely don’t hesitate to connect with me there and leave us a rating review on itunes if you picked up a clinical pearl or enjoyed this

Episode today also go ahead support our sponsor metaed101.com store i’m greatly appreciative to all of you who have done that again lots of different options books case studies study materials go support our sponsor there and help keep this podcast free and educational for all to enjoy all right well i’m going to sign off again thank you so much for listening

I appreciate you all being here and have a great rest of your day

Transcribed from video
Glipizide (Glucotrol) Pharmacology By Eric Christianson