Glucovance ( glyburide + metformin )

CAUTION:
Metformin may cause a serious condition called lactic acidosis. Inform your doctor if you are over 80 years old and if you have ever had kidney or liver disease. Do not drink large amounts of alcohol while taking glyburide and metformin. If you are having a radiologic test with injectable contrast agents (for example, a CT scan, angiogram, urogram, or MRI), talk to your doctor about stopping glyburide and metformin a few days before the test. If you are having surgery, including dental surgery, Inform your doctor or dentist that you are taking glyburide and metformin. If you experience any of the following symptoms, stop taking glyburide and metformin and call your doctor without delay: severe shortness of breath, extreme tiredness (fatigue), muscle aches, stomach pain after the first few weeks of treatment, feeling cold, dizziness, or a slow or irregular heartbeat.

O  General Information and Indications:

Glucovance, the combination of glyburide and metformin is used to treat type 2 (noninsulin-dependent) diabetes (formerly called 'adult-onset') in people whose diabetes cannot be controlled by diet and exercise alone. Glyburide belongs to a class of drugs called sulfonylureas, and metformin is in a class of drugs called biguanides. Glyburide lowers blood sugar by stimulating the pancreas, the organ that makes insulin. Insulin helps control blood sugar levels. The pancreas must produce insulin for this medication to work. Metformin helps your body regulate the amount of glucose (sugar) in your blood. It decreases the amount of glucose you get from your diet and the amount made by your liver. It also helps your body use its own insulin more effectively. Glyburide and metformin are not used to treat type 1 (insulin-dependent) diabetes (formerly called 'juvenile-onset').

O  Information For Users:

Glyburide and metformin combination comes as a tablet to take by mouth. It is usually taken one to two times daily with meals. Your doctor may gradually increase your dose, depending on your response to glyburide and metformin. Monitor your blood glucose closely. Follow the directions on your prescription label, ask your doctor or pharmacist If you have any questions. Take glyburide and metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your health care provider.

Glyburide and metformin combination controls diabetes but does not cure it. Continue taking glyburide and metformin even if you feel well. Do not discontinue taking glyburide and metformin without informing your doctor.
Other uses for this medicine

O  Special precautions:

o Inform your doctor or pharmacist if you have allergy to glyburide, metformin, or any other medications.
o Inform your doctor and pharmacist what prescription and nonprescription medications you are taking, especially albuterol (Proventil, Ventolin); allergy or cold medications; anticoagulants ('blood thinners') such as warfarin (Coumadin); antipsychotics such as mesoridazine (Serentil) or thioridazine (Mellaril); aspirin or other nonsteroidal antiflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn); beta-blockers such as propranolol (Inderal); calcium channel blockers such as diltiazem (Cardizem, Tiazac), nifedipine (Adalat, Procardia), or verapamil (Calan, Verelan); chloramphenicol (Chloromycetin); chlorpromazine (Thorazine); cimetidine (Tagamet); ciprofloxacin (Cipro); corticosteroids such as dexamethasone (Decadron), methylprednisolone (Medrol), or prednisone (Deltasone, Orasone); digoxin (Lanoxin); diuretics ('water pills'); epinephrine; estrogens; isoniazid (INH); medications that contain alcohol or sugar; miconazole (Lotrimin, others); morphine (MS Contin, others); niacin; oral contraceptives (birth control pills); phenelzine (Nardil); phenytoin (Dilantin); probenecid (Benemid); procainamide (Procanbid, Pronestyl); prochlorperazine (Compazine); promethazine (Phenergan); quinidine (Quinalan, Quinidex); quinine (Quinamm); ranitidine (Zantac); salicylates such as diflunisal (Dolobid) or salsalate (Disalcid); terbutaline (Brethine, Bricanyl); thyroid medications; tranylcypromine (Parnate); trimethoprim (Proloprim, Trimpex); vancomycin (Vancocin, others); and vitamins or herbal products.
o in addition to the conditions listed in the CAUTION section, inform your doctor if you are breast-feeding heart, pituitary, or thyroid disease; adrenal insufficiency; acute or chronic metabolic acidosis; diabetic ketoacidosis; hormone problems; or gastrointestinal absorption problems.
o Inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking glyburide and metformin, call your doctor without delay.
o you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
o remember that alcohol can add to the drowsiness caused by this drug.
o Inform your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of glyburide and metformin.
o plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Glyburide and metformin may make your skin sensitive to sunlight.
o Inform your doctor if you have fever, infection, injury, or illness with vomiting or diarrhea. These may affect your blood sugar level.

Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. Calorie reduction, weight loss, and exercise will help control your diabetes and will also make glyburide and metformin work better. It is important to eat a healthy diet.

Alcohol may decrease blood sugar and can affect the amount of lactic acid made. Ask your doctor about the safe use of alcoholic beverages while you are taking glyburide and metformin.

To monitor the effectiveness of glyburide and metformin, measure the amount of sugar (glucose) in your blood or urine (when blood sugar is above a certain high level, you will have sugar in your urine). For measuring the amount of glucose in your blood, you can use a blood glucose meter. For the urine measurements, you will need special paper tapes, tablets, or plastic strips that change color depending on how much sugar is present. Your doctor also may ask you to test your urine for ketones (substances present when diabetes is not under control). Follow your doctor's recommendations for testing your urine and blood and for recording the results. If your blood sugar is high or if sugar or ketones are present in your urine, call your doctor.

O  Possible Adverse Effects:

You should know the symptoms of low and high blood sugar and what to do if you have them.

Eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, and call your doctor without delay if you have any of the symptoms of hypoglycemia (low blood sugar):

o shakiness
o lightheadedness or dizziness
o sweating
o confusion
o nervousness or irritability
o sudden changes in behavior or mood
o headache
o numbness or tingling around the mouth
o weakness
o pale skin
o sudden hunger
o clumsy or jerky movements
o seizures

call your doctor without delay if you have any of the following symptoms of hyperglycemia (high blood sugar):

o extreme thirst
o frequent urination
o extreme hunger
o weakness
o blurred vision (Impaired vision)

If high blood sugar is not treated, a serious, life-threatening condition called diabetic ketoacidosis could develop. call your doctor without delay if you have any of the these symptoms:

o dry mouth
o upset stomach and vomiting
o shortness of breath
o breath that smells fruity
o decreased consciousness

Glyburide and metformin may cause adverse effects. Inform your doctor if any of the following symptoms are severe or do not go away:

o headache
o nasal congestion
o runny nose
o stomach pain
o cough
o diarrhea

If you experience any of the following symptoms or those listed in the CAUTION section, call your doctor without delay:

o skin rash or hives (Urticaria)
o itching or redness
o exaggerated sunburn
o yellowing of the skin or eyes, jaundice
o light-colored stools
o dark or clay-colored urine
o unusual bruising or bleeding
o fever
o sore throat