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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 w/ nonspecific sx incl. malaise, myalgias, resp. distress, somnolence, abdominal pain; lab findings incl. lactate >5 mmol/L, anion gap acidosis (w/o evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may incl. renal impairment, concomitant meds, pts 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immed. if lactic acidosis suspected, hospitalize pt 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 w/ meals; hold tx for surgery if restricting food/fluid; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
- [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 w/ meals; hold tx for surgery if restricting food/fluid; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
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.