Why is this drug prescribed?
Glucovance is used in the treatment of type 2 (noninsulin dependent)
diabetes. Diabetes develops when the body's ability to burn
sugar declines and the unused sugar builds up in the bloodstream.
Ordinarily, sugar is moved out of the blood and into the body's
cells by the hormone insulin. A buildup occurs when the body
either fails to make enough insulin or doesn't respond to it
properly.
Glucovance is a combination of 2 drugs--glyburide (DiaBeta,
Micronase) and metformin (Glucophage)--that attack high blood
sugar levels in several ways. The glyburide component stimulates
the pancreas to produce more insulin and helps the body use
it properly. The metformin component also encourages proper
insulin utilization, and in addition works to decrease sugar
production and absorption. Glucovance is prescribed when diet
and exercise prove insufficient to keep sugar levels under control.
Most important fact about this drug
Very rarely, Glucovance has been known to cause a dangerous
condition called lactic acidosis, a buildup of lactic acid in
the blood. Lactic acidosis is a medical emergency that requires
immediate treatment in the hospital. Notify your doctor without
delay if you experience any of the following symptoms:
A slow or irregular heartbeat; a cold, dizzy, or light-headed
feeling; a weak, tired, or uncomfortable feeling; stomach discomfort;
trouble breathing; unusual muscle pain
GLUCOVANCE is available for oral administration in tablets containing
1.25 mg glyburide with 250 mg metformin hydrochloride, 2.5 mg
glyburide with 500 mg metformin hydrochloride, and 5 mg glyburide
with 500 mg metformin hydrochloride. In addition, each tablet
contains the following inactive ingredients: microcrystalline
cellulose, povidone, croscarmellose sodium, and magne-sium stearate.
The tablets are film coated, which provides color differentiation.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change
in intensity, inform your doctor as soon as possible. Only your
doctor can determine if it is safe for you to continue taking
Glucovance.
More common side effects may include:
Cold sweats, diarrhea, dizziness, headache, hunger, nausea,
shakiness, stomach pain, upper respiratory infections, vomiting
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
GLUCOVANCE. In patients with advanced age, GLUCOVANCE 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,
GLUCOVANCE should not be titrated to the maximum dose (see WARNINGS
and DOSAGE AND ADMINISTRATION ). Before initiation of GLUCOVANCE
(Glyburide and Metformin HCl Tablets) 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 GLUCOVANCE discontinued if evidence of renal impairment
is present.
Special warnings about this medication
Avoid excessive alcohol intake while taking Glucovance. Heavy
drinking increases the danger of lactic acidosis and can also
trigger an attack of low blood sugar (hypoglycemia).
Missed meals, malnutrition, general debility, liver or kidney
problems, other medications, and over-exertion also increase
the risk of hypoglycemia. Symptoms of a mild case include cold
sweats, dizziness, shakiness, and hunger. Severe hypoglycemia
can lead to seizures and coma. If you notice any of the warning
signs, check with your doctor immediately.
Lactic acidosis also becomes more likely when you become dehydrated.
If you experience severe vomiting, diarrhea, fever, or if your
fluid intake is significantly reduced, tell your doctor.
Glucovance occasionally causes a mild deficiency of vitamin
B12. Your doctor will check annually and may prescribe a supplement
if necessary.
Some experts suspect that the glyburide component of Glucovance
may lead to more heart problems than treatment with diet alone.
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, you
may want to discuss this potential risk with your doctor.
Glucovance has been proven safe and effective in clinical trials.
In rare cases, Glucovance (or glucophage) may cause lactic acidosis,
which can be fatal in up to half of the cases. Lactic acidosis
occurs mainly in people whose kidneys are not functioning properly.
Patients should not take these drugs if they have kidney problems,
if they are 80 or older (unless they have their kidneys tested
first), if they are taking medication for heart failure, if
they have a history of liver disease or if they drink alcohol
excessively. The most common side effects of Glucovance are
normally minor ones such as diarrhea, nausea, and upset stomach.
Less frequently, symptoms of hypoglycemia (low blood sugar)
such as lightheadedness, dizziness, shakiness, or hunger may
occur.
Special information if you are pregnant or breastfeeding
Glucovance is not recommended during pregnancy. To control blood
sugar during this crucial period, most doctors prefer insulin
instead of Glucovance. If you are pregnant or plan to become
pregnant, inform your doctor immediately.
You'll also need to avoid Glucovance while breastfeeding. If
blood sugar becomes a problem, your doctor can prescribe insulin.
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