Glucovance: Advanced Dual-Mechanism Control for Type 2 Diabetes
Glucovance
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| Product dosage: 5mg/500mg | |||
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Glucovance represents a significant advancement in the pharmacological management of type 2 diabetes mellitus, combining two well-established antihyperglycemic agents into a single, convenient tablet. This fixed-dose combination therapy integrates metformin hydrochloride with glyburide, targeting distinct yet complementary pathways of glucose regulation. By addressing both hepatic glucose production and insulin secretion, Glucovance offers a robust approach to achieving and maintaining glycemic targets. It is specifically indicated as an adjunct to diet and exercise in patients who have not achieved adequate glycemic control on metformin or a sulfonylurea alone, or in those already being treated with both agents separately. This formulation simplifies complex regimens, potentially enhancing adherence and reducing the therapeutic burden for individuals managing this chronic metabolic disorder.
Features
- Contains metformin hydrochloride and glyburide in a single oral tablet
- Available in multiple strength combinations (e.g., 1.25 mg/250 mg, 2.5 mg/500 mg, 5 mg/500 mg glyburide/metformin)
- Dual mechanism of action targeting insulin resistance and beta-cell function
- Film-coated tablets for ease of administration
- Typically administered twice daily with meals
Benefits
- Provides synergistic glycemic control through complementary mechanisms of action
- Reduces hemoglobin A1c significantly more effectively than monotherapy with either component
- May decrease the total number of tablets required compared to separate component therapy
- Addresses both fasting and postprandial hyperglycemia
- Potential for improved medication adherence through regimen simplification
- Established safety profile based on extensive clinical experience with both components
Common use
Glucovance is primarily prescribed for the management of type 2 diabetes mellitus in adults when glycemic control has not been achieved through diet and exercise alone, and when monotherapy with metformin or a sulfonylurea has proven insufficient. It is particularly appropriate for patients who demonstrate both insulin resistance and impaired insulin secretion, as the combination addresses both pathophysiological defects. The medication is commonly initiated in patients with HbA1c levels significantly above target despite lifestyle modifications and single-agent therapy. Clinical decision-making should consider the patient’s renal function, hypoglycemia risk, and overall cardiovascular risk profile before initiating treatment.
Dosage and direction
The dosage of Glucovance must be individualized based on the patient’s current regimen, glycemic control, and renal function. Typically, the initial dose is based on the patient’s previous metformin and/or glyburide dosage. The usual starting dose is Glucovance 1.25 mg/250 mg or 2.5 mg/500 mg twice daily with meals. Dosage adjustments should be made in increments of no more than 5 mg glyburide/500 mg metformin per day, at approximately two-week intervals, based on fasting blood glucose measurements. The maximum recommended daily dose is 20 mg glyburide/2000 mg metformin. Administration with meals is essential to minimize gastrointestinal adverse effects and reduce the risk of hypoglycemia. Renal function should be assessed before initiation and regularly during treatment.
Precautions
Glucovance carries a boxed warning regarding the risk of lactic acidosis associated with metformin accumulation, particularly in patients with renal impairment. Regular monitoring of renal function is mandatory before and during treatment. Hypoglycemia may occur, especially during the initial dose titration period, when caloric intake is deficient, or after vigorous exercise. Patients should be educated to recognize and manage hypoglycemic symptoms. Periodic monitoring of hematological parameters is recommended, as metformin may interfere with vitamin B12 absorption. Hepatic impairment warrants caution due to altered glucose metabolism and potential drug accumulation. Elderly patients require careful dose selection due to decreased renal function. Adequate hydration is important during episodes of vomiting, diarrhea, or fever to reduce lactic acidosis risk.
Contraindications
Glucovance is contraindicated in patients with known hypersensitivity to metformin, glyburide, or other sulfonylureas. It must not be used in patients with renal disease or renal dysfunction, as indicated by serum creatinine levels ≥1.5 mg/dL in males or ≥1.4 mg/dL in females, or abnormal creatinine clearance. Contraindications include metabolic acidosis, including diabetic ketoacidosis, which should be treated with insulin. The medication is contraindicated in patients undergoing radiographic studies involving intravascular iodinated contrast materials, requiring temporary discontinuation. Severe hepatic impairment, acute or chronic disease which may cause tissue hypoxia, and excessive alcohol intake are additional contraindications.
Possible side effects
The most common adverse reactions include gastrointestinal symptoms such as diarrhea, nausea, vomiting, abdominal discomfort, and flatulence, which typically occur during initiation and often resolve with continued therapy. Hypoglycemia represents a significant concern, with symptoms including dizziness, tremor, sweating, hunger, and tachycardia. Other potential side effects include headache, upper respiratory infection, and metallic taste. Rare but serious adverse effects include lactic acidosis (symptoms include malaise, myalgias, respiratory distress), hemolytic anemia, photosensitivity reactions, and hyponatremia. Liver enzyme elevations and disulfiram-like reactions have been reported occasionally. Patients should report any unusual symptoms, particularly those suggestive of lactic acidosis or severe hypoglycemia.
Drug interaction
Glucovance has numerous potentially significant drug interactions. Drugs that may increase hypoglycemic risk include insulin, other oral antidiabetic agents, ACE inhibitors, beta-blockers, fibrates, fluconazole, MAO inhibitors, probenecid, salicylates, and sulfonamide antibiotics. Conversely, drugs that may reduce efficacy include corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid. Cationic drugs eliminated by renal tubular secretion may interact with metformin. Alcohol potentiates both the hypoglycemic effect of glyburide and the risk of lactic acidosis with metformin. Beta-blockers may mask hypoglycemic symptoms and impair counter-regulatory mechanisms.
Missed dose
If a dose of Glucovance is missed, the patient should take it as soon as remembered, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one, as this significantly increases the risk of hypoglycemia. Blood glucose monitoring is recommended following a missed dose to assess glycemic control. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy, as dose adjustment may be necessary.
Overdose
Overdose of Glucovance may produce hypoglycemia, which can be severe and prolonged, particularly due to the sulfonylurea component. Symptoms include confusion, palpitations, sweating, and loss of consciousness. Metformin overdose may result in lactic acidosis, characterized by acid-base imbalance, hyperventilation, hypothermia, and circulatory collapse. Management involves immediate glucose administration for hypoglycemia, with continuous glucose monitoring for at least 24-48 hours due to the prolonged effect of glyburide. For metformin-associated lactic acidosis, hemodialysis effectively removes both metformin and corrects the acidosis. Supportive measures include intravenous fluids and correction of electrolyte abnormalities. Gastric lavage may be considered if presentation is immediate.
Storage
Glucovance tablets should be stored at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). The medication must be kept in its original container, tightly closed, and protected from moisture and light. Tablets should not be stored in bathroom cabinets or other areas subject to high humidity. Keep out of reach of children and pets. Do not use tablets that show signs of discoloration, cracking, or other physical deterioration. Proper disposal of expired or unused medication is essential to prevent accidental ingestion or environmental contamination.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Glucovance is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual patient responses may vary, and treatment decisions must be based on the healthcare provider’s assessment of the specific clinical situation. The prescriber should be familiar with the complete prescribing information, including boxed warnings, before initiating therapy. Patients should not adjust their dosage or discontinue treatment without consulting their healthcare provider. Regular monitoring and follow-up are essential for safe and effective use of this medication.
Reviews
Clinical studies demonstrate that Glucovance provides superior glycemic control compared to monotherapy with either metformin or glyburide alone. In a 16-week randomized trial, patients receiving Glucovance achieved significantly greater reductions in HbA1c and fasting plasma glucose compared to either component as monotherapy. The combination therapy allowed approximately 40% more patients to achieve target HbA1c levels below 7%. Real-world evidence supports these findings, with many clinicians reporting improved patient adherence and satisfaction due to the simplified regimen. However, experts emphasize the importance of appropriate patient selection, noting that the combination may not be suitable for all patients with type 2 diabetes, particularly those at high risk for hypoglycemia or with impaired renal function.