Sulfonylurea (2nd generation) Pregnancy: US label: there are no adequate and well controlled studies in pregnant women; glipizide should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus. Because abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities, many experts recommend that insulin be used during pregnancy. Glipizide was mildly fetotoxic in rat reproductive studies at all dose levels (5 to 50 mg/kg); no teratogenic effects were found in rats or rabbits. Prolonged severe hypoglycaemia (4 to 10 days) has been reported in neonates born to mothers receiving a sulfonylurea at the time of delivery — if glipizide is used during pregnancy it should be discontinued at least one month before the expected delivery date.

Glipizide

Brand names: Glibenese, Minodiab

Glipizide is a short-acting sulfonylurea oral hypoglycaemic used to improve glycaemic control in type 2 diabetes mellitus.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Initial dose 5 mg given before breakfast. Geriatric patients or those with liver disease may be started on 2.5 mg. Titrate in increments of 2.5 to 5 mg as determined by blood glucose response, allowing at least several days between titration steps.

Route: Oral — given approximately 30 minutes before a meal to achieve the greatest reduction in postprandial hyperglycaemia

Frequency: Once daily before breakfast initially. Some patients may be effectively controlled on a once-a-day regimen, while others show better response with divided dosing; total daily doses above 15 mg should ordinarily be divided and given before meals of adequate caloric content.

Max: Maximum recommended once-daily dose 15 mg. Maximum recommended total daily dose 40 mg.

PROVENANCE: no UK SPC (eMC) record was retrieved in this bundle — the regimen above is taken from the US FDA prescribing information for glipizide immediate-release tablets (Bryant Ranch Prepack, label date 2026-03-19). US labelling may differ from the UK SPC (including the maximum daily dose) — verify against the UK SPC before use. This source describes the IMMEDIATE-RELEASE tablet; it is not the extended-release (ER) product, which has separate posology. 'There is no fixed dosage regimen for the management of diabetes mellitus with glipizide or any other hypoglycemic agent' — blood glucose must be monitored periodically to determine the minimum effective dose and to detect primary and secondary failure; glycosylated haemoglobin may also be of value. Total daily doses above 30 mg have been safely given on a b.i.d. basis to long-term patients. If response to a single dose is not satisfactory, dividing that dose may prove effective. Short-term administration may be sufficient during periods of transient loss of control in patients usually controlled well on diet. ELDERLY, DEBILITATED OR MALNOURISHED PATIENTS, AND PATIENTS WITH IMPAIRED RENAL OR HEPATIC FUNCTION: the initial and maintenance dosing should be conservative to avoid hypoglycaemic reactions. TRANSFER FROM INSULIN: if the daily insulin requirement is 20 units or less, insulin may be discontinued and glipizide started at usual dosages; if greater than 20 units, reduce the insulin dose by 50% and start glipizide at usual dosages, with subsequent insulin reductions depending on individual response — several days should elapse between titration steps, urine should be tested for sugar and ketones at least three times daily during withdrawal, and hospitalisation during transition may be advisable where the patient has been receiving more than 40 units of insulin daily. TRANSFER FROM OTHER ORAL HYPOGLYCAEMICS: no transition period is necessary, but observe carefully for 1 to 2 weeks for hypoglycaemia when transferring from longer half-life sulfonylureas (e.g. chlorpropamide). COLESEVELAM: glipizide tablets should be administered at least 4 hours prior to colesevelam. PAEDIATRIC (§8.4): 'Safety and effectiveness in children have not been established.' — no paediatric regimen is recorded; verify against a children's formulary. §7 (drug interactions) and §6 (adverse reactions) are marked truncated at the source-fetch limit.

Dose adjustments

Renal

No fixed dose reduction is specified. 'In elderly patients, debilitated or malnourished patients, and patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions.'

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to the drug
Type 1 diabetes mellitus, and diabetic ketoacidosis with or without coma — this condition should be treated with insulin

Side effects

Hypoglycaemia
Gastrointestinal disturbances are the most common reactions — nausea and diarrhoea (about one in seventy patients), constipation and gastralgia (about one in one hundred); these appear to be dose-related and may disappear on division or reduction of dosage
Allergic skin reactions including erythema, morbilliform or maculopapular eruptions, urticaria, pruritus and eczema (about one in seventy patients); porphyria cutanea tarda and photosensitivity reactions have been reported with sulfonylureas
Cholestatic jaundice may occur rarely with sulfonylureas — glipizide should be discontinued if this occurs
Haematological: leukopenia, agranulocytosis, thrombocytopenia, haemolytic anaemia, aplastic anaemia and pancytopenia have been reported with sulfonylureas

Interactions

Drugs that may potentiate the hypoglycaemic action of sulfonylureas — non-steroidal anti-inflammatory agents, some azoles and other highly protein-bound drugs, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, monoamine oxidase inhibitors, quinolones and beta-adrenergic blocking agents; observe closely for hypoglycaemia when these are added, and for loss of control when they are withdrawn
Drugs that tend to produce hyperglycaemia and may lead to loss of control — thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs and isoniazid
Colesevelam — reduces the maximum plasma concentration and total exposure to glipizide; administer glipizide tablets at least 4 hours prior to colesevelam

Clinical monograph

How it works

It stimulates insulin release from pancreatic beta cells by closing ATP-sensitive potassium channels, an effect dependent on residual beta-cell function.

Prescribing in practice

Hypoglycaemia is the principal hazard, especially in the elderly, those with renal or hepatic impairment, and when meals are missed.
Take shortly before food and use cautiously alongside other glucose-lowering agents that increase hypoglycaemia risk.
Weight gain may occur; review suitability against current prescribing references and individual patient factors.

Monitoring

Monitor blood glucose and HbA1c to guide titration, with closer review where hypoglycaemia risk is increased.

Counselling the patient

Recognise and treat hypoglycaemia (sweating, tremor, confusion) and always carry a fast-acting sugar source.
Do not skip meals after taking your tablet and limit alcohol, which increases low-glucose risk.
Continue diet, exercise and regular blood-glucose checks as advised.

Evidence & guidelines

Sulfonylureas are an established second-line option in type 2 diabetes within NICE management pathways.

Reference: NICE NG28; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways