Metaglip for Type 2 Diabetes - Metaglip Patient Information

Brand Name: Metaglip

Generic Name: Glipizide and Metformin Hydrochloride

Metaglip, glipizide and metformin, full prescribing information

Why is Metaglip Prescribed?

Metaglip is an oral medication used to control blood sugar levels in people with type 2 (non-insulin-dependent) diabetes. It contains two drugs commonly used to lower blood sugar, glipizide and metformin. Metaglip replaces the need to take these two drugs separately. It is prescribed when diet and exercise alone do not control blood sugar levels, or when treatment with another antidiabetic medication does not work.

Blood sugar levels are ordinarily controlled by the body's natural supply of insulin, which helps sugar move out of the bloodstream and into the cells to be used for energy. People who have type 2 diabetes do not make enough insulin or do not respond normally to the insulin their bodies make, causing a buildup of unused sugar in the bloodstream. Metaglip helps remedy this problem in two ways: by causing your body to release more insulin and by helping your body use insulin more effectively.

Most Important Fact about Metaglip

Metaglip could cause a very rare—but potentially fatal—side effect known as lactic acidosis. It is caused by a buildup of lactic acid in the blood. The problem is most likely to occur in people whose liver or kidneys are not working well, and in those who have multiple medical problems, take several medications, or have congestive heart failure. The risk also is higher if you are an older adult or drink alcohol. Lactic acidosis is a medical emergency that must be treated in a hospital. Notify your doctor immediately if you experience any of the following:

  • Symptoms of lactic acidosis may include:
    Dizziness, extreme weakness or tiredness, light-headedness, low blood pressure, low body temperature, slow or irregular heartbeat, rapid breathing or trouble breathing, sleepiness, unexpected or unusual stomach discomfort, unusual muscle pain

How Should You Take Metaglip?

Do not take more or less of Metaglip than directed by your doctor. Metaglip should be taken in divided doses with meals to reduce the possibility of nausea or diarrhea, especially during the first few weeks of therapy.

  • If you miss a dose...
    Take the forgotten dose as soon as you remember. However, if it is almost time for your next dose, skip the one you missed and return to your regular schedule. Never take two doses at once.
  • Storage instructions...
    Store at room temperature.

What Side Effects may Occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Metaglip.

  • Side effects may include:
    Abdominal pain, diarrhea, dizziness, headache, high blood pressure, hypoglycemia (low blood sugar), muscle pain, upper respiratory infection

Why Should Metaglip Not Be Prescribed?

Metaglip is processed primarily by the kidneys, and can build up to excessive levels in the body if the kidneys aren't working properly. It should be avoided if you have kidney disease or your kidney function has been impaired by a condition such as shock, blood poisoning, or a heart attack.

You should not use Metaglip if you need to take medicine for congestive heart failure.

Do not take Metaglip if you have ever had an allergic reaction to glipizide or metformin.

Do not take Metaglip if you have metabolic or diabetic ketoacidosis (a life-threatening medical emergency caused by insufficient insulin and marked by excessive thirst, nausea, fatigue, pain below the breastbone, and fruity breath).

Special Warnings about Metaglip

Some studies suggest that the glipizide component of Metaglip may lead to more heart problems than treatment with diet alone, or diet plus insulin. In a long-term trial of a similar drug, researchers noted an increase in heart-related deaths (though the overall mortality rate remained unchanged). If you have a heart condition or you're at risk for heart disease, you should discuss this potential danger with your doctor.

Because Metaglip can cause hypoglycemia (low blood sugar), it's very important to follow your doctor's instructions carefully. Low blood sugar is more likely to happen if you're older, weak, or undernourished, or if you have kidney, liver, adrenal, or pituitary gland problems. Your risk also increases if you miss meals or fail to eat after doing strenuous exercise. Combining Metaglip with other diabetes medications can also cause blood sugar to drop. Symptoms of a mild case include cold sweats, dizziness, shakiness, a light-headed feeling, and hunger. Check with your doctor immediately if you notice any of these warning signs, since severe low blood sugar can occasionally lead to seizures or coma.

Before you start therapy with Metaglip, and at least once a year thereafter, your doctor will do a complete assessment of your kidney function. If you develop kidney problems while on Metaglip, your doctor will discontinue Metaglip. If you are an older person, you will need to have your kidney function monitored more frequently, and your doctor may want to start you at a lower dosage.

You should temporarily stop taking Metaglip for 2 days before and after having an X-ray procedure (such as an angiogram) that uses an injectable dye. Also, if you are going to have surgery, except minor surgery, you should stop taking Metaglip. Once you have resumed normal food and fluid intake, your doctor will tell you when you can start drug therapy again.

Avoid drinking too much alcohol while taking Metaglip. Heavy drinking increases the danger of lactic acidosis and can also trigger an attack of low blood sugar.

Because poor liver function could increase the risk of lactic acidosis, your doctor may decide to check your liver function before prescribing Metaglip and periodically thereafter. If you develop liver problems, your doctor may stop treatment with Metaglip.

Metaglip occasionally causes a mild deficiency of vitamin B12. Your doctor will check for this with yearly blood tests and may prescribe a supplement if necessary.

You should stop taking Metaglip if you become seriously dehydrated, since this increases the likelihood of developing lactic acidosis. Tell your doctor if you lose a significant amount of fluid due to vomiting, diarrhea, fever, or some other condition.

While taking Metaglip, you should check your blood or urine periodically for abnormal sugar levels. If you notice sudden changes after you've been stabilized for a while, tell your doctor immediately. It could be a sign you're developing lactic acidosis or ketoacidosis.

Possible Food and Drug Interactions when Taking Metaglip

If Metaglip is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Metaglip with the following:

Amiloride

Antibiotics known as sulfonamides, including sulfamethoxazole

Antidepressants known as MAO inhibitors, including phenelzine and tranylcypromine

Antifungal drugs that are taken orally, such as fluconazole and miconazole

Anti-inflammatories that contain salicylates, such as aspirin, diflunisal, and mesalamine

Beta-blocking blood pressure medicines such as atenolol, metoprolol, and propranolol

Calcium channel blockers (heart medications) such as nifedipine and verapamil

Chloramphenicol

Cimetidine

Decongestant, airway-opening drugs such as albuterol and pseudoephedrine

Digoxin

Estrogens

Furosemide

Isoniazid, a drug used for tuberculosis

Morphine

Niacin

Nifedipine

Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen

Oral contraceptives

Phenytoin

Probenecid

Procainamide

Quinidine

Quinine

Ranitidine

Steroids such as prednisone

Thyroid hormones such as levothyroxine

Tranquilizers such as chlorpromazine

Triamterene

Trimethoprim

Vancomycin

Warfarin sodium

Water pills (diuretics) such as hydrochlorothiazide

Do not drink too much alcohol, since excessive alcohol consumption can cause low blood sugar and increase the risk of developing lactic acidosis.

Special Information if You Are Pregnant or Breastfeeding

If you are pregnant or plan to become pregnant, tell your doctor immediately. Metaglip has not been adequately studied in pregnant women and should not be taken during pregnancy unless the potential benefit outweighs the potential risk. Since studies suggest the importance of maintaining normal blood sugar levels during pregnancy, your doctor may prescribe insulin injections instead.

It is not known whether Metaglip appears in human breast milk. Therefore, you should discuss with your doctor whether to discontinue the medication or to stop breastfeeding. If the medication is discontinued and if diet alone does not control blood sugar levels, your doctor may prescribe insulin injections.

Recommended Dosage for Metaglip

ADULTS

Your doctor will start therapy at a low dose and increase it until your blood sugar levels are under control.

For patients not previously treated with diabetes medications

The recommended starting dose is 2.5 milligrams of glipizide with 250 milligrams of metformin once a day. If your fasting blood sugar levels are particularly high, you doctor may have you take 2.5 milligrams of glipizide with 500 milligrams of metformin twice a day.

The daily dosage can be increased by one tablet every 2 weeks until blood sugar levels are controlled. The maximum daily dose is 10 milligrams of glipizide with 2,000 milligrams of metformin.

For patients previously treated with glipizide (or a similar drug) or metformin

The recommended starting dose of Metaglip is either 2.5 or 5 milligrams of glipizide with 500 milligrams of metformin twice a day. If this regimen doesn't control your blood sugar, the daily dose can be increased by increments of up to 5 milligrams (glipizide)/500 milligrams (metformin). The maximum daily dose is 20 milligrams of glipizide with 2,000 milligrams of metformin.

For patients on combination therapy taking separate doses of glipizide and metformin

The maximum daily dose should not exceed your current doses of glipizide and metformin. The usual daily starting dose is either 2.5 or 5 milligrams of glipizide with 500 milligrams of metformin. If this regimen doesn't control your blood sugar, the daily dose can be increased by increments of up to 5 milligrams (glipizide)/500 milligrams (metformin). The maximum daily dose is 20 milligrams of glipizide with 2,000 milligrams of metformin.

CHILDREN

Children should not take Metaglip, since the safety and effectiveness of the drug have not been studied in this group.

Overdosage

An overdose of Metaglip can cause an attack of low blood sugar requiring immediate treatment. If you experience any of the symptoms listed in "Special warnings about Metaglip," see a doctor immediately.

An excessive dose of Metaglip can also trigger lactic acidosis. If you begin to notice the warning signs listed in "Most important fact about Metaglip," seek emergency treatment.

Last Updated: 07/09

Metaglip, glipizide and metformin, full prescribing information

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APA Reference
Staff, H. (2009, July 31). Metaglip for Type 2 Diabetes - Metaglip Patient Information, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/diabetes/medications/metaglip-type-2-diabetes-treatment

Last Updated: January 14, 2014

Metaglip Treatment for Diabetes - Metaglip Full Prescribing Information

Brand Name: Metaglip

Generic Name: Glipizide and Metformin Hydrochloride

Dosage Form: tablet, film coated

Metaglip™ (glipizide and metformin HCl) Tablets

  • 2.5 mg/250 mg
  • 2.5 mg/500 mg
  • 5 mg/500 mg

Contents:

Description
Clinical Pharmacology
Indications and Usage
Contraindications
Warnings
Precautions
Adverse Reactions
Overdose
Dosage and Administration
How Supplied

Metaglip, glipizide and metformin hydrochloride, patient information sheet (in plain English)

Description

Metaglip™ (glipizide and metformin HCl) Tablets contain 2 oral antihyperglycemic drugs used in the management of type 2 diabetes, glipizide and metformin hydrochloride.

Glipizide is an oral antihyperglycemic drug of the sulfonylurea class. The chemical name for glipizide is 1-cyclohexyl-3-[[p-[2-(5-methylpyrazinecarboxamido)ethyl]phenyl]sulfonyl]urea. Glipizide is a whitish, odorless powder with a molecular formula of C21H27N5O4S, a molecular weight of 445.55 and a pKa of 5.9. It is insoluble in water and alcohols, but soluble in 0.1 N NaOH; it is freely soluble in dimethylformamide. The structural formula is represented below.

Metaglip structural formula

Metformin hydrochloride is an oral antihyperglycemic drug used in the management of type 2 diabetes. Metformin hydrochloride (N,N-dimethylimidodicarbonimidic diamide monohydrochloride) is not chemically or pharmacologically related to sulfonylureas, thiazolidinediones, or α-glucosidase inhibitors. It is a white to off-white crystalline compound with a molecular formula of C4H12ClN5 (monohydrochloride) and a molecular weight of 165.63. Metformin hydrochloride is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pKa of metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68. The structural formula is as shown:

Metaglip structural formula

Metaglip is available for oral administration in tablets containing 2.5 mg glipizide with 250 mg metformin hydrochloride, 2.5 mg glipizide with 500 mg metformin hydrochloride, and 5 mg glipizide with 500 mg metformin hydrochloride. In addition, each tablet contains the following inactive ingredients: microcrystalline cellulose, povidone, croscarmellose sodium, and magnesium stearate. The tablets are film coated, which provides color differentiation.

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Clinical Pharmacology

Mechanism of Action

Metaglip combines glipizide and metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action, to improve glycemic control in patients with type 2 diabetes.

Glipizide appears to lower blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. Extrapancreatic effects may play a part in the mechanism of action of oral sulfonylurea hypoglycemic drugs. The mechanism by which glipizide lowers blood glucose during long-term administration has not been clearly established. In man, stimulation of insulin secretion by glipizide in response to a meal is undoubtedly of major importance. Fasting insulin levels are not elevated even on long-term glipizide administration, but the postprandial insulin response continues to be enhanced after at least 6 months of treatment.

Metformin hydrochloride is an antihyperglycemic agent that improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin hydrochloride decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.


 


Pharmacokinetics

Absorption and Bioavailability

Metaglip

In a single-dose study in healthy subjects, the glipizide and metformin components of Metaglip 5 mg/500 mg were bioequivalent to coadministered GLUCOTROL® and GLUCOPHAGE®. Following administration of a single Metaglip 5 mg/500 mg tablet in healthy subjects with either a 20% glucose solution or a 20% glucose solution with food, there was a small effect of food on peak plasma concentration (Cmax) and no effect of food on area under the curve (AUC) of the glipizide component. Time to peak plasma concentration (Tmax) for the glipizide component was delayed 1 hour with food relative to the same tablet strength administered fasting with a 20% glucose solution. Cmax for the metformin component was reduced approximately 14% by food whereas AUC was not affected. Tmax for the metformin component was delayed 1 hour after food.

Glipizide

Gastrointestinal absorption of glipizide is uniform, rapid, and essentially complete. Peak plasma concentrations occur 1 to 3 hours after a single oral dose. Glipizide does not accumulate in plasma on repeated oral administration. Total absorption and disposition of an oral dose was unaffected by food in normal volunteers, but absorption was delayed by about 40 minutes.

Metformin Hydrochloride

The absolute bioavailability of a 500 mg metformin hydrochloride tablet given under fasting conditions is approximately 50% to 60%. Studies using single oral doses of metformin tablets of 500 mg and 1500 mg, and 850 mg to 2550 mg, indicate that there is a lack of dose proportionality with increasing doses, which is due to decreased absorption rather than an alteration in elimination. Food decreases the extent of and slightly delays the absorption of metformin, as shown by approximately a 40% lower peak concentration and a 25% lower AUC in plasma and a 35-minute prolongation of time to peak plasma concentration following administration of a single 850 mg tablet of metformin with food, compared to the same tablet strength administered fasting. The clinical relevance of these decreases is unknown.

Distribution

Glipizide

Protein binding was studied in serum from volunteers who received either oral or intravenous glipizide and found to be 98% to 99% 1 hour after either route of administration. The apparent volume of distribution of glipizide after intravenous administration was 11 liters, indicative of localization within the extracellular fluid compartment. In mice, no glipizide or metabolites were detectable autoradiographically in the brain or spinal cord of males or females, nor in the fetuses of pregnant females. In another study, however, very small amounts of radioactivity were detected in the fetuses of rats given labeled drug.

Metformin Hydrochloride

The apparent volume of distribution (V/F) of metformin following single oral doses of 850 mg averaged 654 ±358 L. Metformin is negligibly bound to plasma proteins. Metformin partitions into erythrocytes, most likely as a function of time. At usual clinical doses and dosing schedules of metformin, steady state plasma concentrations of metformin are reached within 24 to 48 hours and are generally

Metabolism and Elimination

Glipizide

The metabolism of glipizide is extensive and occurs mainly in the liver. The primary metabolites are inactive hydroxylation products and polar conjugates, and are excreted mainly in the urine. Less than 10% unchanged glipizide is found in the urine. The half-life of elimination ranges from 2 to 4 hours in normal subjects, whether given intravenously or orally. The metabolic and excretory patterns are similar with the 2 routes of administration, indicating that first-pass metabolism is not significant.

Metformin Hydrochloride

Intravenous single-dose studies in normal subjects demonstrate that metformin is excreted unchanged in the urine and does not undergo hepatic metabolism (no metabolites have been identified in humans) nor biliary excretion. Renal clearance (see Table 1) is approximately 3.5 times greater than creatinine clearance, which indicates that tubular secretion is the major route of metformin elimination. Following oral administration, approximately 90% of the absorbed drug is eliminated via the renal route within the first 24 hours, with a plasma elimination half-life of approximately 6.2 hours. In blood, the elimination half-life is approximately 17.6 hours, suggesting that the erythrocyte mass may be a compartment of distribution.

Special Populations

Patients With Type 2 Diabetes

In the presence of normal renal function, there are no differences between single- or multiple-dose pharmacokinetics of metformin between patients with type 2 diabetes and normal subjects (see Table 1), nor is there any accumulation of metformin in either group at usual clinical doses.

Hepatic Insufficiency

The metabolism and excretion of glipizide may be slowed in patients with impaired hepatic function (see PRECAUTIONS). No pharmacokinetic studies have been conducted in patients with hepatic insufficiency for metformin.

Renal Insufficiency

The metabolism and excretion of glipizide may be slowed in patients with impaired renal function (see PRECAUTIONS).

In patients with decreased renal function (based on creatinine clearance), the plasma and blood half-life of metformin is prolonged and the renal clearance is decreased in proportion to the decrease in creatinine clearance (see Table 1; also, see WARNINGS).

Geriatrics

There is no information on the pharmacokinetics of glipizide in elderly patients.

Limited data from controlled pharmacokinetic studies of metformin in healthy elderly subjects suggest that total plasma clearance is decreased, the half-life is prolonged, and Cmax is increased, when compared to healthy young subjects. From these data, it appears that the change in metformin pharmacokinetics with aging is primarily accounted for by a change in renal function (see Table 1). Metformin treatment should not be initiated in patients ≥80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced.

Table 1: Select Mean ( ±SD) Metformin Pharmacokinetic Parameters Following Single or Multiple Oral Doses of Metformin

Subject Groups: Metformin Dosea
(Number of Subjects)
Cmaxb
( µg/mL)
Tmaxc
(hrs)
Renal Clearance
(mL/min)
Healthy, Nondiabetic Adults:      
500 mg SDd (24) 1.03 ( ±0.33) 2.75 ( ±0.81) 600 ( ±132)
850 mg SD (74)e 1.60 ( ±0.38) 2.64 ( ±0.82) 552 ( ±139)
850 mg t.i.d. for 19 dosesf (9) 2.01 ( ±0.42) 1.79 ( ±0.94) 642 ( ±173)
Adults with Type 2 Diabetes:      
850 mg SD (23) 1.48 ( ±0.5) 3.32 ( ±1.08) 491 ( ±138)
850 mg t.i.d. for 19 dosesf (9) 1.90 ( ±0.62) 2.01 ( ±1.22) 550 ( ±160)
Elderlyg, Healthy Nondiabetic Adults:      
850 mg SD (12) 2.45 ( ±0.70) 2.71 ( ±1.05) 412 ( ±98)
Renal-impaired Adults: 850 mg SD      
Mild (CLcrh 61-90 mL/min) (5) 1.86 ( ±0.52) 3.20 ( ±0.45) 384 ( ±122)
Moderate (CLcr 31-60 mL/min) (4) 4.12 ( ±1.83) 3.75 ( ±0.50) 108 ( ±57)
Severe (CLcr 10-30 mL/min) (6) 3.93 ( ±0.92) 4.01 ( ±1.10) 130 ( ±90)
a All doses given fasting except the first 18 doses of the multiple-dose studies
b Peak plasma concentration
c Time to peak plasma concentration
d SD=single dose
e Combined results (average means) of 5 studies: mean age 32 years (range 23-59 years)
f Kinetic study done following dose 19, given fasting
g Elderly subjects, mean age 71 years (range 65-81 years)
h CLcr=creatinine clearance normalized to body surface area of 1.73 m2

Pediatrics

No data from pharmacokinetic studies in pediatric subjects are available for glipizide.

After administration of a single oral GLUCOPHAGE 500 mg tablet with food, geometric mean metformin Cmax and AUC differed <5% between pediatric type 2 diabetic patients (12-16 years of age) and gender- and weight-matched healthy adults (20-45 years of age), all with normal renal function.

Gender

There is no information on the effect of gender on the pharmacokinetics of glipizide.

Metformin pharmacokinetic parameters did not differ significantly in subjects with or without type 2 diabetes when analyzed according to gender (males=19, females=16). Similarly, in controlled clinical studies in patients with type 2 diabetes, the antihyperglycemic effect of metformin was comparable in males and females.

Race

No information is available on race differences in the pharmacokinetics of glipizide.

No studies of metformin pharmacokinetic parameters according to race have been performed. In controlled clinical studies of metformin in patients with type 2 diabetes, the antihyperglycemic effect was comparable in whites (n=249), blacks (n=51), and Hispanics (n=24).

Clinical Studies

Patients with Inadequate Glycemic Control on Diet and Exercise Alone

In a 24-week, double-blind, active-controlled, multicenter international clinical trial, patients with type 2 diabetes, whose hyperglycemia was not adequately controlled with diet and exercise alone (hemoglobin A1c [HbA1c] >7.5% and ≤12%, and fasting plasma glucose [FPG]

Table 2: Active-Controlled Trial of Metaglip in Patients with Inadequate Glycemic Control on Diet and Exercise Alone: Summary of Trial Data at 24 Weeks

 Glipizide
5 mg
tablets
Metformin
500 mg
tablets
Metaglip
2.5 mg/250 mg
tablets
Metaglip
2.5 mg/500 mg
tablets
ap<0.001
Mean Final Dose 16.7 mg 1749 mg 7.9 mg/
791 mg
7.4 mg/
1477 mg
Hemoglobin A1c (%) N=168 N=171 N=166 N=163
Baseline Mean 9.17 9.15 9.06 9.10
Final Mean 7.36 7.67 6.93 6.95
Adjusted Mean Change from Baseline −1.77 −1.46 −2.15 −2.14
Difference from Glipizide     −0.38a −0.37a
Difference from Metformin     −0.70a −0.69a
% Patients with Final HbA1c <7% 43.5% 35.1% 59.6% 57.1%
Fasting Plasma Glucose (mg/dL) N=169 N=176 N=170 N=169
Baseline Mean 210.7 207.4 206.8 203.1
Final Mean 162.1 163.8 152.1 148.7
Adjusted Mean Change from Baseline −46.2 −42.9 −54.2 −56.5
Difference from Glipizide     −8.0 −10.4
Difference from Metformin     −11.3 −13.6

After 24 weeks, treatment with Metaglip 2.5 mg/250 mg and 2.5 mg/500 mg resulted in significantly greater reduction in HbA1c compared to glipizide and metformin therapy. Also, Metaglip 2.5 mg/250 mg therapy resulted in significant reductions in FPG versus metformin therapy.

Increases above fasting glucose and insulin levels were determined at baseline and final study visits by measurement of plasma glucose and insulin for 3 hours following a standard mixed liquid meal. Treatment with Metaglip lowered the 3-hour postprandial glucose AUC, compared to baseline, to a significantly greater extent than did the glipizide and the metformin therapies. Compared to baseline, Metaglip enhanced the postprandial insulin response, but did not significantly affect fasting insulin levels.

There were no clinically meaningful differences in changes from baseline for all lipid parameters between Metaglip therapy and either metformin therapy or glipizide therapy. The adjusted mean changes from baseline in body weight were: Metaglip 2.5 mg/250 mg, −0.4 kg; Metaglip 2.5 mg/500 mg, −0.5 kg; glipizide, −0.2 kg; and metformin, −1.9 kg. Weight loss was greater with metformin than with Metaglip.

Patients with Inadequate Glycemic Control on Sulfonylurea Monotherapy

In an 18-week, double-blind, active-controlled U.S. clinical trial, a total of 247 patients with type 2 diabetes not adequately controlled (HbA1c ≥7.5% and ≤12%, and FPG

In an 18-week, double-blind, active-controlled U.S. clinical trial, a total of 247 patients with type 2 diabetes not adequately controlled (HbA1c ≥7.5% and ≤12%, and FPG

Table 3: Metaglip in Patients with Inadequate Glycemic Control on Sulfonylurea Alone: Summary of Trial Data at 18 Weeks

 Glipizide
5 mg
tablets
Metformin
500 mg
tablets
Metaglip
5 mg/500mg
tablets
ap<0.001
Mean Final Dose 30.0 mg 1927 mg 17.5 mg/
1747 mg
Hemoglobin A1c(%) N=79 N=71 N=80
Baseline Mean 8.87 8.61 8.66
Final Adjusted Mean 8.45 8.36 7.39
Difference from Glipizide     −1.06a
Difference from Metformin     −0.98a
% Patients with Final HbA1c <7% 8.9% 9.9% 36.3%
Fasting Plasma Glucose (mg/dL) N=82 N=75 N=81
Baseline Mean 203.6 191.3 194.3
Adjusted Mean Change from Baseline 7.0 6.7 −30.4
Difference from Glipizide     −37.4
Difference from Metformin     −37.2

After 18 weeks, treatment with Metaglip at doses up to 20 mg/2000 mg per day resulted in significantly lower mean final HbA1c and significantly greater mean reductions in FPG compared to glipizide and metformin therapy. Treatment with Metaglip lowered the 3-hour postprandial glucose AUC, compared to baseline, to a significantly greater extent than did the glipizide and the metformin therapies. Metaglip did not significantly affect fasting insulin levels.

There were no clinically meaningful differences in changes from baseline for all lipid parameters between Metaglip therapy and either metformin therapy or glipizide therapy. The adjusted mean changes from baseline in body weight were: Metaglip 5 mg/500 mg, −0.3 kg; glipizide, −0.4 kg; and metformin, −2.7 kg. Weight loss was greater with metformin than with Metaglip.

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Indications and Usage

Metaglip (glipizide and metformin HCl) Tablets is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

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Contraindications

Metaglip is contraindicated in patients with:

  1. Renal disease or renal dysfunction (eg, as suggested by serum creatinine levels ≥1.5 mg/dL [males], ≥1.4 mg/dL [females], or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia (see WARNINGS and PRECAUTIONS).
  2. Known hypersensitivity to glipizide or metformin hydrochloride.
  3. Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin.

Metaglip should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function. (See also PRECAUTIONS.)

Warnings

Metformin Hydrochloride

Lactic acidosis

Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with METAGLIP; when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis may also occur in association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever there is significant tissue hypoperfusion and hypoxemia. Lactic acidosis is characterized by elevated blood lactate levels ( > 5 mmol/L), decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. When metformin is implicated as the cause of lactic acidosis, metformin plasma levels > 5 μg/mL are generally found.

The reported incidence of lactic acidosis in patients receiving metformin hydrochloride is very low (approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient-years). In more than 20,000 patient-years exposure to metformin in clinical trials, there were no reports of lactic acidosis. Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications. Patients with congestive heart failure requiring pharmacologic management, in particular those with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia, are at increased risk of lactic acidosis. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient's age. The risk of lactic acidosis may, therefore, be significantly decreased by regular monitoring of renal function in patients taking metformin and by use of the minimum effective dose of metformin. In particular, treatment of the elderly should be accompanied by careful monitoring of renal function. METAGLIP treatment should not be initiated in patients ≥ 80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced, as these patients are more susceptible to developing lactic acidosis. In addition, METAGLIP should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis. Because impaired hepatic function may significantly limit the ability to clear lactate, METAGLIP should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or chronic, when taking METAGLIP, since alcohol potentiates the effects of metformin hydrochloride on lactate metabolism. In addition, METAGLIP should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure (see also PRECAUTIONS).

The onset of lactic acidosis often is subtle, and accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress. There may be associated hypothermia, hypotension, and resistant bradyarrhythmias with more marked acidosis. The patient and the patient's physician must be aware of the possible importance of such symptoms and the patient should be instructed to notify the physician immediately if they occur (see also PRECAUTIONS). METAGLIP should be withdrawn until the situation is clarified. Serum electrolytes, ketones, blood glucose, and if indicated, blood pH, lactate levels, and even blood metformin levels may be useful. Once a patient is stabilized on any dose level of METAGLIP, gastrointestinal symptoms, which are common during initiation of therapy with metformin, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

Levels of fasting venous plasma lactate above the upper limit of normal but less than mmol/L in patients taking METAGLIP do not necessarily indicate impending lactic acidosis and may be explainable by other mechanisms, such as poorly controlled diabetes or obesity, vigorous physical activity, or technical problems in sample handling. (See also PRECAUTIONS.)

Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia).

Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking METAGLIP, the drug should be discontinued immediately and general supportive measures promptly instituted. Because metformin hydrochloride is dialyzable (with a clearance of up to 170 mL/min under good hemodynamic conditions), prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin. Such management often results in prompt reversal of symptoms and recovery. (See also CONTRAINDICATIONS and PRECAUTIONS.)

Special Warning on Increased risk of Cardiovascular Mortality

The administration of oral hypoglycemic drugs has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. This warning is based on the study conducted by the University Group Diabetes Program (UGDP), a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. The study involved 823 patients who were randomly assigned to 1 of 4 treatment groups (Diabetes 19 (Suppl. 2):747-830, 1970).

UGDP reported that patients treated for 5 to 8 years with diet plus a fixed dose of tolbutamide (1.5 grams per day) had a rate of cardiovascular mortality approximately 2 ½ times that of patients treated with diet alone. A significant increase in total mortality was not observed, but the use of tolbutamide was discontinued based on the increase in cardiovascular mortality, thus limiting the opportunity for the study to show an increase in overall mortality. Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning. The patient should be informed of the potential risks and benefits of glipizide and of alternative modes of therapy.

Although only 1 drug in the sulfonylurea class (tolbutamide) was included in this study, it is prudent from a safety standpoint to consider that this warning may also apply to other hypoglycemic drugs in this class, in view of their close similarities in mode of action and chemical structure.

Precautions

General

Macrovascular Outcomes

There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Metaglip or any other antidiabetic drug.

Metaglip

Hypoglycemia

Metaglip is capable of producing hypoglycemia; therefore, proper patient selection, dosing, and instructions are important to avoid potential hypoglycemic episodes. The risk of hypoglycemia is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents or ethanol. Renal insufficiency may cause elevated drug levels of both glipizide and metformin hydrochloride. Hepatic insufficiency may increase drug levels of glipizide and may also diminish gluconeogenic capacity, both of which increase the risk of hypoglycemic reactions. Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects. Hypoglycemia may be difficult to recognize in the elderly and people who are taking beta-adrenergic blocking drugs.

Glipizide

Renal and hepatic disease

The metabolism and excretion of glipizide may be slowed in patients with impaired renal and/or hepatic function. If hypoglycemia should occur in such patients, it may be prolonged and appropriate management should be instituted.

Hemolytic anemia

Treatment of patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency with sulfonylurea agents can lead to hemolytic anemia. Because Metaglip belongs to the class of sulfonylurea agents, caution should be used in patients with G6PD deficiency and a non-sulfonylurea alternative should be considered. In postmarketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency.

Metformin Hydrochloride

Monitoring of renal function

Metformin is known to be substantially excreted by the kidney, and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Thus, patients with serum creatinine levels above the upper limit of normal for their age should not receive Metaglip. In patients with advanced age, Metaglip should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function. In elderly patients, particularly those ≥80 years of age, renal function should be monitored regularly and, generally, Metaglip should not be titrated to the maximum dose (see WARNINGS and DOSAGE AND ADMINISTRATION). Before initiation of Metaglip therapy and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal dysfunction is anticipated, renal function should be assessed more frequently and Metaglip discontinued if evidence of renal impairment is present.

Use of concomitant medications that may affect renal function or metformin disposition

Concomitant medication(s) that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin, such as cationic drugs that are eliminated by renal tubular secretion (see PRECAUTIONS: Drug Interactions), should be used with caution.

Radiologic studies involving the use of intravascular iodinated contrast materials (for example, intravenous urogram, intravenous cholangiography, angiography, and computed tomography (CT) scans with intravascular contrast materials)

Intravascular contrast studies with iodinated materials can lead to acute alteration of renal function and have been associated with lactic acidosis in patients receiving metformin (see CONTRAINDICATIONS). Therefore, in patients in whom any such study is planned, Metaglip should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been reevaluated and found to be normal.

Hypoxic states

Cardiovascular collapse (shock) from whatever cause, acute congestive heart failure, acute myocardial infarction, and other conditions characterized by hypoxemia have been associated with lactic acidosis and may also cause prerenal azotemia. When such events occur in patients on Metaglip therapy, the drug should be promptly discontinued.

Surgical procedures

Metaglip therapy should be temporarily suspended for any surgical procedure (except minor procedures not associated with restricted intake of food and fluids) and should not be restarted until the patient's oral intake has resumed and renal function has been evaluated as normal.

Alcohol intake

Alcohol is known to potentiate the effect of metformin on lactate metabolism. Patients, therefore, should be warned against excessive alcohol intake, acute or chronic, while receiving Metaglip. Due to its effect on the gluconeogenic capacity of the liver, alcohol may also increase the risk of hypoglycemia.

Impaired hepatic function

Since impaired hepatic function has been associated with some cases of lactic acidosis, Metaglip should generally be avoided in patients with clinical or laboratory evidence of hepatic disease.

Vitamin B12 levels

In controlled clinical trials with metformin of 29 weeks duration, a decrease to subnormal levels of previously normal serum vitamin B12, without clinical manifestations, was observed in approximately 7% of patients. Such decrease, possibly due to interference with B12 absorption from the B12-intrinsic factor complex is, however, very rarely associated with anemia and appears to be rapidly reversible with discontinuation of metformin or vitamin B12 supplementation. Measurement of hematologic parameters on an annual basis is advised in patients on metformin and any apparent abnormalities should be appropriately investigated and managed (see PRECAUTIONS: Laboratory Tests).

Certain individuals (those with inadequate vitamin B12 or calcium intake or absorption) appear to be predisposed to developing subnormal vitamin B12 levels. In these patients, routine serum vitamin B12 measurements at 2- to 3-year intervals may be useful.

Change in clinical status of patients with previously controlled type 2 diabetes

A patient with type 2 diabetes previously well controlled on metformin who develops laboratory abnormalities or clinical illness (especially vague and poorly defined illness) should be evaluated promptly for evidence of ketoacidosis or lactic acidosis. Evaluation should include serum electrolytes and ketones, blood glucose and, if indicated, blood pH, lactate, pyruvate, and metformin levels. If acidosis of either form occurs, Metaglip must be stopped immediately and other appropriate corrective measures initiated (see also WARNINGS).

Information for Patients

Metaglip

Patients should be informed of the potential risks and benefits of Metaglip and alternative modes of therapy. They should also be informed about the importance of adherence to dietary instructions; a regular exercise program; and regular testing of blood glucose, glycosylated hemoglobin, renal function, and hematologic parameters.

The risks of lactic acidosis associated with metformin therapy, its symptoms, and conditions that predispose to its development, as noted in the WARNINGS and PRECAUTIONS sections, should be explained to patients. Patients should be advised to discontinue Metaglip immediately and promptly notify their health practitioner if unexplained hyperventilation, myalgia, malaise, unusual somnolence, or other nonspecific symptoms occur. Once a patient is stabilized on any dose level of Metaglip, gastrointestinal symptoms, which are common during initiation of metformin therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members.

Patients should be counseled against excessive alcohol intake, either acute or chronic, while receiving Metaglip.

Laboratory Tests

Periodic fasting blood glucose (FBG) and HbA1c measurements should be performed to monitor therapeutic response.

Initial and periodic monitoring of hematologic parameters (eg, hemoglobin/hematocrit and red blood cell indices) and renal function (serum creatinine) should be performed, at least on an annual basis. While megaloblastic anemia has rarely been seen with metformin therapy, if this is suspected, vitamin B12 deficiency should be excluded.

Drug Interactions

Metaglip

Certain drugs tend to produce hyperglycemia and may lead to loss of blood glucose control. These drugs include thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. When such drugs are administered to a patient receiving Metaglip, the patient should be closely observed for loss of blood glucose control. When such drugs are withdrawn from a patient receiving Metaglip, the patient should be observed closely for hypoglycemia. Metformin is negligibly bound to plasma proteins and is, therefore, less likely to interact with highly protein-bound drugs such as salicylates, sulfonamides, chloramphenicol, and probenecid as compared to sulfonylureas, which are extensively bound to serum proteins.

Glipizide

The hypoglycemic action of sulfonylureas may be potentiated by certain drugs, including nonsteroidal anti-inflammatory agents, some azoles, and other drugs that are highly protein-bound, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, monoamine oxidase inhibitors, and beta-adrenergic blocking agents. When such drugs are administered to a patient receiving Metaglip, the patient should be observed closely for hypoglycemia. When such drugs are withdrawn from a patient receiving Metaglip, the patient should be observed closely for loss of blood glucose control. In vitro binding studies with human serum proteins indicate that glipizide binds differently than tolbutamide and does not interact with salicylate or dicumarol. However, caution must be exercised in extrapolating these findings to the clinical situation and in the use of Metaglip with these drugs.

A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known. The effect of concomitant administration of fluconazole and glipizide has been demonstrated in a placebo-controlled crossover study in normal volunteers. All subjects received glipizide alone and following treatment with 100 mg of fluconazole as a single oral daily dose for 7 days, the mean percent increase in the glipizide AUC after fluconazole administration was 56.9% (range: 35%-81%).


 


Metformin Hydrochloride

Furosemide

A single-dose, metformin-furosemide drug interaction study in healthy subjects demonstrated that pharmacokinetic parameters of both compounds were affected by coadministration. Furosemide increased the metformin plasma and blood Cmax by 22% and blood AUC by 15%, without any significant change in metformin renal clearance. When administered with metformin, the Cmax and AUC of furosemide were 31% and 12% smaller, respectively, than when administered alone, and the terminal half-life was decreased by 32%, without any significant change in furosemide renal clearance. No information is available about the interaction of metformin and furosemide when coadministered chronically.

Nifedipine

A single-dose, metformin-nifedipine drug interaction study in normal healthy volunteers demonstrated that coadministration of nifedipine increased plasma metformin Cmax and AUC by 20% and 9%, respectively, and increased the amount excreted in the urine. Tmax and half-life were unaffected. Nifedipine appears to enhance the absorption of metformin. Metformin had minimal effects on nifedipine.

Cationic drugs

Cationic drugs (eg, amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, or vancomycin) that are eliminated by renal tubular secretion theoretically have the potential for interaction with metformin by competing for common renal tubular transport systems. Such interaction between metformin and oral cimetidine has been observed in normal healthy volunteers in both single- and multiple-dose, metformin-cimetidine drug interaction studies, with a 60% increase in peak metformin plasma and whole blood concentrations and a 40% increase in plasma and whole blood metformin AUC. There was no change in elimination half-life in the single-dose study. Metformin had no effect on cimetidine pharmacokinetics. Although such interactions remain theoretical (except for cimetidine), careful patient monitoring and dose adjustment of Metaglip and/or the interfering drug is recommended in patients who are taking cationic medications that are excreted via the proximal renal tubular secretory system.

Other

In healthy volunteers, the pharmacokinetics of metformin and propranolol and metformin and ibuprofen were not affected when coadministered in single-dose interaction studies.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No animal studies have been conducted with the combined products in Metaglip. The following data are based on findings in studies performed with the individual products.

Glipizide

A 20-month study in rats and an 18-month study in mice at doses up to 75 times the maximum human dose revealed no evidence of drug-related carcinogenicity. Bacterial and in vivo mutagenicity tests were uniformly negative. Studies in rats of both sexes at doses up to 75 times the human dose showed no effects on fertility.

Metformin Hydrochloride

Long-term carcinogenicity studies were performed with metformin alone in rats (dosing duration of 104 weeks) and mice (dosing duration of 91 weeks) at doses up to and including 900 mg/kg/day and 1500 mg/kg/day, respectively. These doses are both approximately 4 times the maximum recommended human daily (MRHD) dose of 2000 mg of the metformin component of Metaglip based on body surface area comparisons. No evidence of carcinogenicity with metformin alone was found in either male or female mice. Similarly, there was no tumorigenic potential observed with metformin alone in male rats. There was, however, an increased incidence of benign stromal uterine polyps in female rats treated with 900 mg/kg/day of metformin alone.

There was no evidence of a mutagenic potential of metformin alone in the following in vitro tests: Ames test (S. typhimurium), gene mutation test (mouse lymphoma cells), or chromosomal aberrations test (human lymphocytes). Results in the in vivo mouse micronucleus test were also negative.

Fertility of male or female rats was unaffected by metformin alone when administered at doses as high as 600 mg/kg/day, which is approximately 3 times the MRHD dose of the metformin component of Metaglip based on body surface area comparisons.

Pregnancy

Teratogenic Effects: Pregnancy Category C

Recent information strongly suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities. Most experts recommend that insulin be used during pregnancy to maintain blood glucose as close to normal as possible. Because animal reproduction studies are not always predictive of human response, Metaglip should not be used during pregnancy unless clearly needed. (See below.)

There are no adequate and well-controlled studies in pregnant women with Metaglip or its individual components. No animal studies have been conducted with the combined products in Metaglip. The following data are based on findings in studies performed with the individual products.

Glipizide

Glipizide was found to be mildly fetotoxic in rat reproductive studies at all dose levels (5-50 mg/kg). This fetotoxicity has been similarly noted with other sulfonylureas, such as tolbutamide and tolazamide. The effect is perinatal and believed to be directly related to the pharmacologic (hypoglycemic) action of glipizide. In studies in rats and rabbits, no teratogenic effects were found.

Metformin Hydrochloride

Metformin alone was not teratogenic in rats or rabbits at doses up to 600 mg/kg/day. This represents an exposure of about 2 and 6 times the MRHD dose of 2000 mg of the metformin component of Metaglip based on body surface area comparisons for rats and rabbits, respectively. Determination of fetal concentrations demonstrated a partial placental barrier to metformin.

Nonteratogenic Effects

Prolonged severe hypoglycemia (4-10 days) has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. It is not recommended that Metaglip be used during pregnancy. However, if it is used, Metaglip should be discontinued at least 1 month before the expected delivery date. (See WARNINGS: Pregnancy: Teratogenic Effects: Pregnancy Category C.)

Nursing Mothers

Although it is not known whether glipizide is excreted in human milk, some sulfonylurea drugs are known to be excreted in human milk. Studies in lactating rats show that metformin is excreted into milk and reaches levels comparable to those in plasma. Similar studies have not been conducted in nursing mothers. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or to discontinue Metaglip, taking into account the importance of the drug to the mother. If Metaglip is discontinued, and if diet alone is inadequate for controlling blood glucose, insulin therapy should be considered.

Pediatric Use

Safety and effectiveness of Metaglip in pediatric patients have not been established.

Geriatric Use

Of the 345 patients who received Metaglip 2.5 mg/250 mg and 2.5 mg/500 mg in the initial therapy trial, 67 (19.4%) were aged 65 and older while 5 (1.4%) were aged 75 and older. Of the 87 patients who received Metaglip in the second-line therapy trial, 17 (19.5%) were aged 65 and older while 1 (1.1%) was at least aged 75. No overall differences in effectiveness or safety were observed between these patients and younger patients in either the initial therapy trial or the second-line therapy trial, and other reported clinical experience has not identified differences in response between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

Metformin hydrochloride is known to be substantially excreted by the kidney and because the risk of serious adverse reactions to the drug is greater in patients with impaired renal function, Metaglip should only be used in patients with normal renal function (see CONTRAINDICATIONS, WARNINGS, and CLINICAL PHARMACOLOGY: Pharmacokinetics). Because aging is associated with reduced renal function, Metaglip should be used with caution as age increases. Care should be taken in dose selection and should be based on careful and regular monitoring of renal function. Generally, elderly patients should not be titrated to the maximum dose of Metaglip (see also WARNINGS and DOSAGE AND ADMINISTRATION).

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Adverse Reactions

Metaglip

In a double-blind 24-week clinical trial involving Metaglip as initial therapy, a total of 172 patients received Metaglip 2.5 mg/250 mg, 173 received Metaglip 2.5 mg/500 mg, 170 received glipizide, and 177 received metformin. The most common clinical adverse events in these treatment groups are listed in Table 4.

Table 4: Clinical Adverse Events >5% in any Treatment Group, by Primary Term, in Initial Therapy Study

 Number (%) of Patients
Adverse EventGlipizide
5 mg
tablets
N=170
Metformin
500 mg
tablets
N=177
Metaglip
2.5 mg/250 mg
tablets
N=172
Metaglip
2.5 mg/500 mg
tablets
N=173
Upper respiratory infection 12 (7.1) 15 (8.5) 17 (9.9) 14 (8.1)
Diarrhea 8 (4.7) 15 (8.5) 4 (2.3) 9 (5.2)
Dizziness 9 (5.3) 2 (1.1) 3 (1.7) 9 (5.2)
Hypertension 17 (10.0) 10 (5.6) 5 (2.9) 6 (3.5)
Nausea/vomiting 6 (3.5) 9 (5.1) 1 (0.6) 3 (1.7)

In a double-blind 18-week clinical trial involving Metaglip as second-line therapy, a total of 87 patients received Metaglip, 84 received glipizide, and 75 received metformin. The most common clinical adverse events in this clinical trial are listed in Table 5.

Table 5: Clinical Adverse Events >5% in any Treatment Group, by Primary Term, in Second-Line Therapy Study

 Number (%) of Patients
Adverse EventGlipizide
5 mg
tabletsa
N=84
Metformin
500 mg
tabletsa
N=75
Metaglip
5 mg/500 mg
tabletsa
N=87
Diarrhea 11 (13.1) 13 (17.3) 16 (18.4)
Headache 5 (6.0) 4 (5.3) 11 (12.6)
Upper respiratory infection 11 (13.1) 8 (10.7) 9 (10.3)
Musculoskeletal pain 6 (7.1) 5 (6.7) 7 (8.0)
Nausea/vomiting 5 (6.0) 6 (8.0) 7 (8.0)
Abdominal pain 7 (8.3) 5 (6.7) 5 (5.7)
UTI 4 (4.8) 6 (8.0) 1 (1.1)
a The dose of glipizide was fixed at 30 mg daily; doses of metformin and Metaglip were titrated.

Hypoglycemia

In a controlled initial therapy trial of Metaglip 2.5 mg/250 mg and 2.5 mg/500 mg the numbers of patients with hypoglycemia documented by symptoms (such as dizziness, shakiness, sweating, and hunger) and a fingerstick blood glucose measurement ≤50 mg/dL were 5 (2.9%) for glipizide, 0 (0%) for metformin, 13 (7.6%) for Metaglip 2.5 mg/250 mg, and 16 (9.3%) for Metaglip 2.5 mg/500 mg. Among patients taking either Metaglip 2.5 mg/250 mg or Metaglip 2.5 mg/500 mg, 9 (2.6%) patients discontinued Metaglip due to hypoglycemic symptoms and 1 required medical intervention due to hypoglycemia. In a controlled second-line therapy trial of Metaglip 5 mg/500 mg, the numbers of patients with hypoglycemia documented by symptoms and a fingerstick blood glucose measurement ≤50 mg/dL were 0 (0%) for glipizide, 1 (1.3%) for metformin, and 11 (12.6%) for Metaglip. One (1.1%) patient discontinued Metaglip therapy due to hypoglycemic symptoms and none required medical intervention due to hypoglycemia. (See PRECAUTIONS.)

Gastrointestinal Reactions

Among the most common clinical adverse events in the initial therapy trial were diarrhea and nausea/vomiting; the incidences of these events were lower with both Metaglip dosage strengths than with metformin therapy. There were 4 (1.2%) patients in the initial therapy trial who discontinued Metaglip therapy due to gastrointestinal (GI) adverse events. Gastrointestinal symptoms of diarrhea, nausea/vomiting, and abdominal pain were comparable among Metaglip, glipizide and metformin in the second-line therapy trial. There were 4 (4.6%) patients in the second-line therapy trial who discontinued Metaglip therapy due to GI adverse events.

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Overdose

Glipizide

Overdosage of sulfonylureas, including glipizide, can produce hypoglycemia. Mild hypoglycemic symptoms, without loss of consciousness or neurological findings, should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns. Close monitoring should continue until the physician is assured that the patient is out of danger. Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution. This should be followed by a continuous infusion of a more dilute (10%) glucose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients should be closely monitored for a minimum of 24 to 48 hours, since hypoglycemia may recur after apparent clinical recovery. Clearance of glipizide from plasma would be prolonged in persons with liver disease. Because of the extensive protein binding of glipizide, dialysis is unlikely to be of benefit.

Metformin Hydrochloride

Overdose of metformin hydrochloride has occurred, including ingestion of amounts >50 g. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin hydrochloride has been established. Lactic acidosis has been reported in approximately 32% of metformin overdose cases (see WARNINGS). Metformin is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected.

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Dosage and Administration

General Considerations

Dosage of Metaglip must be individualized on the basis of both effectiveness and tolerance while not exceeding the maximum recommended daily dose of 20 mg glipizide/2000 mg metformin. Metaglip should be given with meals and should be initiated at a low dose, with gradual dose escalation as described below, in order to avoid hypoglycemia (largely due to glipizide), reduce GI side effects (largely due to metformin), and permit determination of the minimum effective dose for adequate control of blood glucose for the individual patient.

With initial treatment and during dose titration, appropriate blood glucose monitoring should be used to determine the therapeutic response to Metaglip and to identify the minimum effective dose for the patient. Thereafter, HbA1c should be measured at intervals of approximately 3 months to assess the effectiveness of therapy. The therapeutic goal in all patients with type 2 diabetes is to decrease FPG, PPG, and HbA1c to normal or as near normal as possible. Ideally, the response to therapy should be evaluated using HbA1c, which is a better indicator of long-term glycemic control than FPG alone.

No studies have been performed specifically examining the safety and efficacy of switching to Metaglip therapy in patients taking concomitant glipizide (or other sulfonylurea) plus metformin. Changes in glycemic control may occur in such patients, with either hyperglycemia or hypoglycemia possible. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring.

Metaglip in Patients with Inadequate Glycemic Control on Diet and Exercise Alone

For patients with type 2 diabetes whose hyperglycemia cannot be satisfactorily managed with diet and exercise alone, the recommended starting dose of Metaglip is 2.5 mg/250 mg once a day with a meal. For patients whose FPG is 280 mg/dL to 320 mg/dL a starting dose of Metaglip 2.5 mg/500 mg twice daily should be considered. The efficacy of Metaglip in patients whose FPG exceeds 320 mg/dL has not been established. Dosage increases to achieve adequate glycemic control should be made in increments of 1 tablet per day every 2 weeks up to maximum of 10 mg/1000 mg or 10 mg/2000 mg Metaglip per day given in divided doses. In clinical trials of Metaglip as initial therapy, there was no experience with total daily doses >10 mg/2000 mg per day.

Metaglip in Patients with Inadequate Glycemic Control on a Sulfonylurea and/or Metformin

For patients not adequately controlled on either glipizide (or another sulfonylurea) or metformin alone, the recommended starting dose of Metaglip is 2.5 mg/500 mg or 5 mg/500 mg twice daily with the morning and evening meals. In order to avoid hypoglycemia, the starting dose of Metaglip should not exceed the daily doses of glipizide or metformin already being taken. The daily dose should be titrated in increments of no more than 5 mg/500 mg up to the minimum effective dose to achieve adequate control of blood glucose or to a maximum dose of 20 mg/2000 mg per day.

Patients previously treated with combination therapy of glipizide (or another sulfonylurea) plus metformin may be switched to Metaglip 2.5 mg/500 mg or 5 mg/500 mg; the starting dose should not exceed the daily dose of glipizide (or equivalent dose of another sulfonylurea) and metformin already being taken. The decision to switch to the nearest equivalent dose or to titrate should be based on clinical judgment. Patients should be monitored closely for signs and symptoms of hypoglycemia following such a switch and the dose of Metaglip should be titrated as described above to achieve adequate control of blood glucose.

Specific Patient Populations

Metaglip is not recommended for use during pregnancy or for use in pediatric patients. The initial and maintenance dosing of Metaglip should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment requires a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of Metaglip to avoid the risk of hypoglycemia. Monitoring of renal function is necessary to aid in prevention of metformin-associated lactic acidosis, particularly in the elderly. (See WARNINGS.)

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How Supplied

Metaglip™(glipizide and metformin HCl) Tablets

Metaglip 2.5 mg/250 mg tablet is a pink oval-shaped, biconvex film-coated tablet with "BMS" debossed on one side and "6081" debossed on the opposite side.

Metaglip 2.5 mg/500 mg tablet is a white oval-shaped, biconvex film-coated tablet with "BMS" debossed on one side and "6077" debossed on the opposite side.

Metaglip 5 mg/500 mg tablet is a pink oval-shaped, biconvex film-coated tablet with "BMS" debossed on one side and "6078" debossed on the opposite side.

MetaglipNDC 0087-xxxx-xx for unit of use
Glipizide (mg)Metformin hydrochloride (mg)Bottle of 100
2.5 250 6081-31
2.5 500 6077-31
5.0 500 6078-31

Storage

Store at 20°-25°C (68°-77°F); excursions permitted to 15°-30°C (59°-86°F). [See USP Controlled Room Temperature.]

Metaglip™ is a trademark of Merck Santé S.A.S., an associate of Merck KGaA of Darmstadt, Germany. Licensed to Bristol-Myers Squibb Company.

GLUCOPHAGE® is a registered trademark of Merck Santé S.A.S., an associate of Merck KGaA of Darmstadt, Germany. Licensed to Bristol-Myers Squibb Company.

GLUCOTROL® is a registered trademark of Pfizer Inc.

Distributed by:

Bristol-Myers Squibb Company

Princeton, NJ 08543 USA

Last Updated: 07/09

Metaglip, glipizide and metformin hydrochloride, patient information sheet (in plain English)

Detailed Info on Signs, Symptoms, Causes, Treatments of Diabetes


The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse.

back to: Browse all Medications for Diabetes

APA Reference
Staff, H. (2009, July 31). Metaglip Treatment for Diabetes - Metaglip Full Prescribing Information, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/diabetes/medications/metaglip-glipizide-and-metformin-hcl-diabetic-treatment

Last Updated: March 10, 2016

What do I do?????

This is my first time doing this. I think it is something that I need to do. I am use to taking care of everyone else and not doing anything for me. But something has to change. I wish I could say no more. Actually, I wish I could say it alot. I am going to therapy and I am just now starting to trust my therapist just a little. It may sound weird to some, but I dont trust anybody. I am on guard all the time and have to put on a show to make people think that everything is going good for me ALL the time. I am scared all the time. The nightmares were getting alittle better but now they are back, and with a vengence.

 How do I tell my therapist what I am thinking? My mind races all the time and sometimes I cant seem to get the words out. Sometimes, I dont know what words to use to describe what I have been through. Oh well, maybe someday I will be able to go in and tell her exactly what I want to say. I have a bad habit about thinking about what I want to tell her and what she doesnt "need" to hear. But in all actuality, she needs to know it all to help me to heal I suppose. Ugh, this is so hard. Oh well, Im going to bed. Maybe it will get easier as I work with my therapist.

APA Reference
(2009, July 29). What do I do?????, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/support-blogs/myblog/What-do-I-do%3F%3F%3F%3F%3F

Last Updated: January 14, 2014

Does having sex mean I'll fall in love

Being in love sometimes leads to sex, but having sex will not guarantee that you or your partner will fall in love.

So, if you're using sex to get love, you'll probably be disappointed.

Sex means something different to everyone. So does love. Sometimes, having sex makes you feel like you're in love, but it can fool you. You think you're in love because of the way a person makes you feel physically -- not because of who they are and what you give to each other.

Also, strange as it sounds, having sex too soon can actually stymie love. When two people get too physical, too quickly, they sometimes get embarrassed and pull away from each other. It's easy to bare your body -- much harder to bare your soul. So sometimes, sex feels like the fast way to love and intimacy. It's not.

Truth is, couples who take their time -- and that means more than a couple of months -- to become friends before having sex usually become closer and more intimate. And that's love.


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next: Date Rape / Acquaintance Rape

APA Reference
Staff, H. (2009, July 28). Does having sex mean I'll fall in love, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/sex/psychology-of-sex/does-having-sex-mean-ill-fall-in-love

Last Updated: August 18, 2014

Living with Narcissism - Dealing with a Narcissist

Here's what's happening on the HealthyPlace site this week:

Narcissism and the Narcissist

You many think I'm exaggerating when I say we receive nearly a hundred emails every month from HealthyPlace visitors who, in one way or another, feel they've been victimized by a narcissist -- but I'm not. Take, for example, Cassie:

"Is there anyone out there who can tell me to be strong - tell me how to terminate a destructive relationship with a Narcissist? I have been a captive victim in an affair for 3 years and every time there has been an 'upset,' I've been blamed for being neurotic, untrusting, unloving, etc. In desperation, three days ago I typed 'emotional abuse' into my computer and your website came up.

Then we have Theresa:

"I have lived with the narcissist for 12 years. I had no idea that these people even existed. He pushed his way into my life. We ended up sharing my home together. I ended up refinancing the mortgage with him and took all his debt with me. It has been a full year since the person was told to leave. I still have my home. I was able to regain my self-esteem and my life. However, I still have too much anger for him afer he abused me for those 12 years. He left me helpless but made sure that I was reminded of him every day. His parting gifts were a huge mortgage payment and leaving behind all his belongings with me as a way to keep control."

Interestingly, there's a common thread to many of the emails, most victims never saw it coming. So you may want to know how to recognize a narcissist.

"Living with Narcissism, Dealing with a Narcissist" On HealthyPlace TV

Sam Vaknin understands narcissism like few other people. Not only has he studied the subject extensively, he is admittedly a narcissist himself. He'll be discussing the impact narcissism has had on his life, why some people are attracted to narcissists and how, eventually, they may suck the life blood out of you - on Tuesday's HealthyPlace Mental Health TV Show.

Join us Tuesday, July 28. This week only, the show starts at 10a PT, 12 noon CT, 1p ET and airs live on our website. Sam Vaknin will be taking your questions during the live show.

In the second half of the show, you get to ask HealthyPlace.com Medical Director, Dr. Harry Croft, your personal mental health questions.


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Coming in August on the HealthyPlace TV Show

  • Overeating
  • My Partner Has Dissociative Identity Disorder
  • Stress and Rewards of Being an Alzheimer's Caregiver
  • Suicidality and Psychiatric Medications

If you would like to be a guest on the show or share you personal story in writing or via video, please write us at: producer AT healthyplace.com

Click here for a list of previous HealthyPlace Mental Health TV Shows.

More Information on Narcissism and NPD

Take a look at Sam Vaknin's extensive website on narcissism: Maligant Self Love - Narcissism Revisisted.

Sexual Addiction

If you didn't have an opportunity to watch last week's HealthyPlace TV Show on the Pain of Sexual Addiction, I want to encourage you to do so.

Our guest, Jonathan Daugherty, was very forthright about his struggle with sexual addiction. There are two things that stood out about the interview:

  1. At the height of his addiction, he was having affairs and visiting prostitutes. When he confessed to his wife, she left him. Jonathan admitted he was shocked and her leaving never crossed his mind.
  2. Even though he's been through treatment for sexual addiction, he has several people who check in on him, his whereabouts and activities every day.

Watch the video: "Sexual Addiction" by clicking the "on-demand" button on the player.

Additional Information on Sexual Addiction:

back to: HealthyPlace.com Mental-Health Newsletter Index

APA Reference
Staff, H. (2009, July 27). Living with Narcissism - Dealing with a Narcissist, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/other-info/mental-health-newsletter/living-with-narcissism-dealing-with-a-narcissist

Last Updated: September 5, 2014

Living with Narcissism, Dealing with a Narcissist - July 28

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Narcissism: An Inflated Sense of Self

It’s always a good idea to have some self-worth. We are often reminded of the old adage “you have to love yourself before you can love someone else.” While this is true for some, there are others in this world that can do without the second part of that cliché. For them, self-love and admiration is extreme and results in problematic and unhealthy relationships.

On Tuesday’s show, we will talk about narcissism and the disorders that stem from it in its excessive form. Dr. Harry Croft, Medical Director of Healthyplace.com, will help us understand why these narcissists are so self-involved and whether or not there is treatment out there to help. Plus learn how to identify the diagnostic warning signs of Narcissistic Personality Disorder and how to recognize a narcissist when you see one.

Our guest, Sam Vaknin, author of Malignant Self Love - Narcissism Revisited and contributor to Healthyplace.com, will take us through his personal journey as a self-proclaimed narcissist and tell us how it impacted his life. He will let us in on some secrets of a true narcissist and give us the information we need to deal with one. If you would like to read more about Sam Vaknin, narcissism and Narcissistic Personality Disorder, visit his website on HealthyPlace.com.

Be sure to join us Tuesday as we examine the world of Narcissistic Personality Disorder. The live show airs at a special time this week only: 10a PT, 12 noon CT, 1p ET. At Healthyplace.com, our purpose is to arm you with as much information as possible to help you tackle your mental health concerns.

If you, or someone you know is suffering with Narcissistic Personality Disorder or ha been victimized by a narcissist, feel free to write me at producer AT healthyplace.com. Sharing your story can be helpful to so many others going through the same thing.

See you Tuesday!

Pain of Sexual Addiction - TV Show Recap

Posted on:

While the term "sexual addiction" may not be accepted in the world of psychiatry, HealthyPlace.com Medical Director, Dr. Harry Croft, says it is very real and carries hefty consequences.

Dr. Croft, who is triple board-certified (Addiction Medicine, Sex Therapy, Adult Psychiatry), maintains that it's a matter of semantics. "If you want to call it sexual addiction or sexual compulsion, the end results are the same," he says.

"The definition of addiction applies no matter what the habit of choice may be. Any behavior that is chronic, compulsive, and carries negative consequences is considered an addiction. Make no mistake, sexual addiction does fit into these categories."

“An addiction left un-helped is an addiction that will keep growing”
- Jonathan Daugherty

Sexual Addiction Can Destroy Your Life

Our guest, Jonathan Daugherty, was the definition of a sexual addict. For 13 years, Jonathan lived a secret life and stopped at nothing until he got his fix.

At the young age of 12, he recalls being introduced into the world of pornography by way of a Playboy magazine. That’s all it took for this young boy to begin searching for more. This led to excessive masturbation during middle school and high school, which later turned into something much more serious.

As he got older, Jonathan hoped getting married would resolve his addiction to sex. Little did he know it would end up tearing his life apart.

Addicted to Sex - Crossing the Lines

During the HealthyPlace TV Show, Jonathan discussed in great detail the power of his addiction and the great lengths he would go through to keep this secret life from everyone around him. He crossed lines and rationalized every step of the way. His addiction to sex took him from looking at JC Penney catalogs to soliciting prostitutes. He was at the point of no return. After countless indiscretions and thousands of dollars later, he confessed to his wife and got the help he needed.

Helping Others Recover From Sexual Addiction

Now, the founder of Be Broken Ministries, he commits his life to helping others who suffer with sexual addiction. Although Jonathan has come a long way from his days as a sexual addict, he confesses that he can’t do it alone. He credits his recovery to his counseling and group sessions, people in his life that hold him accountable, and of course, his wife. He is happy to report that after a 9-month separation, they have been back together for over 9 years.

Being Addicted to Sex is No Laughing Matter

Dr. Croft wants viewers to know that this addiction is severe. Don’t let the controversy surrounding the validity sexual addiction fool you. The pain and end results are real.

If you are engaging in illicit behavior such as countless one night stands, having affairs if you are married, soliciting prostitutes, or spending countless hours and dollars viewing internet porn, you should seek help before you spiral out of control. As Jonathan mentioned in his candid interview, it requires much more than just "saying no."

If you think you might be struggling with this problem, take a minute to evaluate yourself with our online sexual addiction test. Together with Jonathan’s story, it could be just what you need to take that first step to freeing yourself and living a better life.

If you missed our show on the Pain of Sexual Addiction, you can watch it "on-demand".

Next Tuesday on the HealthyPlace TV Show

Join us next Tuesday evening at 5:30 PT, 7:30 CT, 8:30 ET as we look into the fascinating world of Narcissism with our guest, Samuel Vaknin. If you have experience with this subject, either as a narcissist or someone who has been victimized by a narcissist, you're welcome to drop me a comment or share your story at producer AT healthplace.com.

Remember, at Healthyplace.com, you’re never alone.

Feeling Hollow

There's something wrong.
I trusted you with my life.
You tried to take it away.
I sit here in the dark and call out for help,
But no sound surpasses the barriers
Of the secrets behind my teeth.
I try to get away from you,
But you haunt me like no other.
I see you as you were,
8 years ago.
Angry, ravenous,
And willing to succeed
In your minute-long quest
To choke the breath out of me.
I can't stand the anger,
I can't stand the pain.
Leave me be,
I don't want to remain
Strangled by your hands,
The salt in my veins.
You take the life from me,
There's not much that remains.
I'm willing to give up,
I'm willing to let go.
My secret goes unbelieved,
My tears never seem to show.
They didn't believe me then,
They don't believe me now.
They waved their little girl crying,
And pushed it to the backs of their minds somehow.
Well I'm not like them,
I can't forget.
And life is too short,
To have such regrets.
You broke me down
Like no other could,
And even now,
I feel more hollow than I should.
I don't trust as easily
Because of what you've done,
And I push others away
Because I fear what's to come.
I need some help to get away
From this nightmare I call my own.
My threaded ends have begun to frey,
And my tears have finally shown.
I need to get out
Of this god-forsaken place.
Otherwise all the pain I've held back
Will sit clear on my face.
I can't stand the hurt,
I can't stand the shame.
But you always said to me
That I looked beautiful in pain.
You swore you'd never hurt me.
You swore you'd never lie.
And now I see in the mirror
All that's broken up inside.
I can't get away from these awful things!
Someone,
Please,
Help me spread my glorious wings.

APA Reference
(2009, July 23). Feeling Hollow, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/support-blogs/myblog/Feeling-Hollow

Last Updated: January 14, 2014

Does Sexual Addiction Really Exist?

Can you really be addicted to sex? There's a question about whether sexual addiction is truly an addiction.

What is Sexual Addiction?

"Sexual addiction" is a term that is used to describe disordered behavior in which someone has an unusually intense sex drive or seems to be obsessed with sexual functioning. It involves habitual, repetitive, and compulsively driven sexual behavior that causes either in impairment in day-to-day function or distress -- either directly -- or indirectly in terms of affecting relationships and job functioning. All addictive behaviors involve such things as: chronic compulsive repetitive behaviors, continued repetition of the behavior despite negative consequences, as well as covering up and denial of the behaviors.

Compulsive Sexual Behavior vs. Sexual Addiction

As many of you know, DSM-V, the next version of the Diagnostic and Statistical Manual of the American Psychiatric Association is in development at the present time. It is due for release as early as 2012. In preparation of DSM-V, there is a lot of ongoing discussion as to whether certain compulsive ritualistic behaviors such as sex, gambling, Internet usage, shopping, and others are the same as addiction that is due to alcohol or drugs. Although this controversy is ongoing, few would deny the fact that compulsive sexual behavior can greatly impair one's day-to-day functioning, and even destroy one's life.

Symptoms of Sexual Addiction

People who suffer from what is now known as "sexual addiction" may engage in sex with multiple partners, may consistently and compulsively use pornography (pornography addiction test), may have multiple extramarital affairs, can involve themselves in prostitution, exhibitionism, watching others have sex, or engaging in compulsive self-stimulation. It is the chronic, compulsive, habitual performance of these behaviors, along with continued behavior despite actual or possible negative consequences of that behavior that characterize sexual addiction. Most people who suffer from the habitual behaviors also have a great deal of anxiety, guilt and shame associated with them. (take Sexual Addiction Self-Test)

Treatment for Sex Addicts

Treatment of sexual addiction and other compulsive behaviors involves the use of psychotherapy, group therapy, and sometimes medication. There are rehab centers that specialize in the treatment of those suffering from this disorder, and there are now available 12-step support groups for sexual addiction (specifically for those suffering from addiction to sex).

Extensive information on sex addiction.

Watch HealthyPlace TV Show on Sexual Addiction

On Tuesday's (July 21, 2009) HealthyPlace TV show on sexual addiction, we will talk to someone who suffered from the disorder and will look into the symptoms, causes, and treatment of sexual addiction. You can watch it live (7:30p CT, 8:30 ET) and on-demand on our website.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of HealthyPlace.com. Dr. Croft is also the co-host of the HealthyPlace TV Show.

next: Parents Surviving the Suicide of Their Child
~ other mental health articles by Dr. Croft

APA Reference
(2009, July 21). Does Sexual Addiction Really Exist?, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/about-hptv/croft-blog/does-sexual-addiction-really-exist

Last Updated: January 14, 2014

CRAZY OR NOT? TIS THAT THE QUESTION

Some of you might think that I am crazy why some of you might say I am brave but I am saving my hair tomorrow for two reasons a friend of mine daughter has cancer, my mom survived cancer and the main reason is to get over the loss of my uncle who died of cancer. I plan to donate my hair to locks of love. SO am I crazy, I will let you know more tomorrow.

APA Reference
(2009, July 20). CRAZY OR NOT? TIS THAT THE QUESTION, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/support-blogs/myblog/CRAZY-OR-NOT%3F-TIS-THAT-THE-QUESTION

Last Updated: January 14, 2014