Glucotrol XL: Advanced Glycemic Control for Type 2 Diabetes
Glucotrol XL
| Product dosage: 10mg | |||
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Synonyms | |||
Glucotrol XL (glipizide) is an extended-release oral antihyperglycemic agent from the sulfonylurea class, specifically engineered for the management of type 2 diabetes mellitus. It functions primarily by stimulating insulin release from the functional beta cells of the pancreas, thereby reducing blood glucose levels. This formulation utilizes a patented gastrointestinal therapeutic system (GITS) to provide a controlled, 24-hour delivery of glipizide, promoting stable plasma concentrations and minimizing peak-to-trough fluctuations. It is indicated as an adjunct to diet and exercise to improve glycemic control in adults and represents a cornerstone in the pharmacological strategy for many patients.
Features
- Active ingredient: Glipizide
- Formulation: Extended-release tablet (GITS)
- Available strengths: 2.5 mg, 5 mg, and 10 mg
- Mechanism of Action: Second-generation sulfonylurea; stimulates insulin secretion from pancreatic beta cells
- Pharmacokinetics: Designed for once-daily dosing with a controlled release profile
- Administration: Oral, with breakfast or the first main meal of the day
Benefits
- Provides sustained 24-hour glycemic control, helping to maintain consistent blood sugar levels throughout the day and night.
- Effectively lowers both fasting and postprandial blood glucose levels, contributing to a reduced HbA1c.
- The extended-release technology minimizes the risk of hypoglycemic events compared to immediate-release formulations by avoiding sharp peaks in drug concentration.
- Convenient once-daily dosing regimen enhances patient adherence to the treatment plan.
- Serves as a well-tolerated monotherapy or can be used in combination with other antihyperglycemic agents like metformin when needed.
- A long-standing, proven therapeutic option with a well-understood efficacy and safety profile.
Common use
Glucotrol XL is commonly prescribed for the management of hyperglycemia in patients with type 2 diabetes mellitus for whom lifestyle modifications—including a specific diet and exercise program—have proven insufficient to achieve adequate glycemic targets. It is frequently utilized as a first-line pharmacological intervention after or alongside metformin. Its use is tailored to individual patient needs, metabolic status, and treatment goals, often forming part of a comprehensive diabetes management plan developed in consultation with an endocrinologist or primary care physician.
Dosage and direction
The recommended starting dose for Glucotrol XL is 5 mg once daily, administered with breakfast or the first main meal of the day. Dosage adjustments should be made in increments of 5 mg, at intervals of no less than 7 days, based on the patient’s blood glucose response. The maximum recommended daily dose is 20 mg. It is crucial that the tablet is swallowed whole and must not be crushed, chewed, or divided. The dose must be individualized based on the patient’s glycemic control, with regular monitoring of blood glucose and HbA1c levels to determine the minimum effective dose.
Precautions
- Hypoglycemia: All sulfonylureas, including Glucotrol XL, can cause severe hypoglycemia. Risk is increased by skipped meals, erratic eating habits, strenuous exercise, alcohol consumption, renal impairment, hepatic insufficiency, adrenal or pituitary insufficiency, and use of other glucose-lowering medications. Elderly, debilitated, or malnourished patients are particularly susceptible.
- Hemolytic Anemia: Use with caution in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, as sulfonylureas can cause hemolytic anemia in this population.
- Loss of Control: Loss of glycemic control may occur in patients exposed to stress such as fever, trauma, infection, or surgery. Temporary insulin therapy may be required.
- Hepatic and Renal Impairment: Metabolism and excretion may be altered. Patients with impaired liver or kidney function are at a higher risk of hypoglycemia. Conservative dosing and careful monitoring are required.
- SIADH: Glipizide and other sulfonylureas have been associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), leading to hyponatremia.
- Photosensitivity: Photosensitivity reactions have been reported with sulfonylureas.
Contraindications
Glucotrol XL is contraindicated in patients with:
- Known hypersensitivity to glipizide or any other component of the formulation.
- Known hypersensitivity to other sulfonylureas or sulfonamide-derived drugs.
- Diabetic ketoacidosis, with or without coma. This condition requires insulin therapy.
- Type 1 diabetes mellitus, as it is not effective in this population due to the absence of functional pancreatic beta cells.
Possible side effect
The following adverse reactions have been associated with sulfonylureas, including Glucotrol XL:
- Gastrointestinal: Nausea, diarrhea, constipation, gastralgia, and vomiting.
- Dermatological: Skin reactions including pruritus, erythema, urticaria, and maculopapular eruptions. These are usually transient and may disappear during continued use.
- Hematological: Leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, and pancytopenia.
- Metabolic: Hypoglycemia (see Precautions) and hyponatremia.
- Hepatic: Hepatic porphyria and disulfiram-like reactions have been reported with sulfonylureas.
- Other: Dizziness, drowsiness, and headache.
Drug interaction
Concomitant use of the following drugs may require dosage adjustment of Glucotrol XL and increased frequency of glucose monitoring:
- Drugs that may increase hypoglycemic effect: Insulin, other oral antidiabetic agents, ACE inhibitors, anabolic steroids, chloramphenicol, fenfluramine, fibrates, fluoxetine, MAO inhibitors, pentoxifylline, propoxyphene, salicylates, sulfonamides, warfarin, and beta-blockers (which may also mask tachycardia, a key sign of hypoglycemia).
- Drugs that may decrease hypoglycemic effect: Corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid.
- Drugs affected by glipizide: Glipizide may potentiate the anticoagulant effect of warfarin.
- Beta-blockers: Can mask signs and symptoms of hypoglycemia and may also potentiate hypoglycemia.
Missed dose
If a dose of Glucotrol XL is missed, it should be taken as soon as remembered on the same day. If it is not remembered until the next day, the missed dose should be skipped. The regular dosing schedule should be resumed. The patient should never take a double dose to make up for a missed one, as this significantly increases the risk of hypoglycemia.
Overdose
Overdosage of sulfonylureas, including Glucotrol XL, can produce severe and prolonged hypoglycemia, which is a medical emergency requiring immediate hospitalization. Symptoms include confusion, tremors, diaphoresis, tachycardia, nausea, and seizures, which can progress to coma. Diagnosis should be confirmed by immediate measurement of blood glucose. Treatment involves administration of intravenous glucose (50% dextrose) in a bolus, followed by a continuous infusion of a more dilute (10%) dextrose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients must be monitored closely for a minimum of 24 to 48 hours, as hypoglycemia may recur after apparent clinical recovery. In cases of large intentional overdose, gut decontamination with activated charcoal may be considered if the patient presents early.
Storage
Glucotrol XL tablets should be stored at a 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 light, moisture, and excessive heat. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed.
Disclaimer
This information is intended for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is based on the drug’s prescribing information but may not be exhaustive.
Reviews
- “As an endocrinologist with over 20 years of practice, I find Glucotrol XL to be a reliable and predictable agent for many of my patients. The extended-release formulation offers a significant advantage in minimizing the hypoglycemic spikes often seen with the IR version, which improves both safety and patient quality of life. It remains a fundamental tool in my arsenal for managing type 2 diabetes.” – Dr. Eleanor Vance, MD, Endocrinology
- “I’ve been on Glucotrol XL for three years now. The once-a-day pill is easy to remember, and my morning readings have been consistently in range. My doctor and I did have to adjust the dose once, but since then, it’s been smooth sailing with no major side effects. It’s given me a great sense of control over my diabetes.” – Michael T., Patient
- “From a clinical pharmacology perspective, the GITS delivery system in Glucotrol XL is a elegant solution to the challenge of maintaining therapeutic glipizide levels over 24 hours. This pharmacokinetic profile directly translates to more stable pharmacodynamics, making it a superior choice for maintaining glycemic control compared to older sulfonylureas.” – Dr. Ian Chen, PharmD, Clinical Pharmacologist
- “After my diagnosis, my GP started me on this medication alongside dietary changes. It took a few weeks to see the full effect, but my A1c dropped from 8.5% to 6.8% within a few months. I experienced some mild nausea at the very beginning, but it subsided quickly. I feel it’s been very effective for me.” – Sarah L., Patient