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glyburide/ metformin
generic
Black Box Warnings .
Lactic Acidosis
post-marketing cases of hypothermia, hypotension, resistant bradyarrhythmias, and death; onset may be subtle with nonspecific symptoms including malaise, myalgias, respiratory distress, somnolence, abdominal pain; lab findings include lactate >5 mmol/L, anion gap acidosis (without evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may include renal impairment, concomitant meds, patients 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immediately if lactic acidosis suspected, hospitalize patient and institute general supportive care, prompt HD recommended
Adult Dosing .
Dosage forms: TAB: 1.25 mg/250 mg, 2.5 mg/500 mg, 5 mg/500 mg
diabetes mellitus, type 2
- [conversion from either sulfonylurea or metformin]
- Dose: 1-2 tabs PO bid; Start: 2.5 mg/500 mg PO bid or 5 mg/500 mg PO bid, then may incr. by 1 tab/day q2wk; Max: 20 mg/2000 mg/day; Info: give with meals; hold tx for surgery if restricting food/fluid; D/C for iodinated contrast study if eGFR 30-60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
- [conversion from sulfonylurea plus metformin]
- Dose: 1-2 tabs PO bid; Start: equivalent total daily dose of each component in current regimen PO divided bid; Max: 20 mg/2000 mg/day; Info: give with meals; hold tx for surgery if restricting food/fluid; D/C for iodinated contrast study if eGFR 30-60, hepatic disease history, alcoholism history, heart failure history, or receiving contrast intra-arterially; restart after 48h if stable renal function
renal dosing
- [see below]
- eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit if eGFR 30-44 during tx
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.