7 Glipizide Interactions and How to Manage Them

If you have diabetes, glipizide may have come up in conversation with your healthcare professional (HCP). It’s an oral medication that has been used for decades to treat Type 2 diabetes. It belongs to a class of medications called sulfonylureas, which lower blood glucose (sugar) by telling your pancreas to release more insulin.

If you’re picking up a new glipizide prescription, a pharmacist will likely talk to you about the best way to take it. This conversation may include reviewing glipizide’s interactions with other medications you’re taking. Some interactions make blood glucose levels drop too low, while others can make it harder to keep them in your target range.

Here, we’ll highlight the most common glipizide interactions. Keep in mind, this isn’t a complete list of every interaction that’s possible. Make sure to share your complete medication list with your pharmacist so they can check for other potential interactions.

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1. Other diabetes medications

Many people take glipizide with another diabetes medication. This is common because you often need multiple medications to reach your hemoglobin A1C (HbA1c or A1C) or blood glucose goals. But taking more than one diabetes medication can also increase the risk of hypoglycemia (low blood glucose), which is when blood glucose drops below 70 mg/dL. This risk can vary depending on the combination.

Symptoms of hypoglycemia include hunger, dizziness, or sweating. 

Before taking glipizide, tell your prescriber if you also take one of these medications:

• Insulin

• Glinides, such as repaglinide or nateglinide

• Glitazones, such as pioglitazone (Actos)

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as empagliflozin (Jardiance) or canagliflozin (Invokana)

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For many people, these interactions can be managed with dose adjustments. There are also steps you can take to lower your hypoglycemia risk, such as fueling up properly before exercise, eating regular meals, and avoiding or minimizing alcohol.

Some people may not easily feel the symptoms of hypoglycemia. So it’s important to check your blood glucose routinely if you’re taking these medications together. If your blood glucose drops below 70 mg/dL, follow your healthcare team’s instructions. This usually includes taking a fast-acting sugar product (such as four glucose tablets or a half cup of non-diet soda) to bring it back up.

2. Beta blockers like propranolol

Taking glipizide with beta blockers can raise the risk of complications from hypoglycemia. These are medications that end with –olol, such as propranolol or atenolol (Tenormin). Many people take them as heart medications, but they can also treat migraine headaches and tremors.

Beta blockers have a unique interaction with all medications that lower blood glucose, including glipizide: They can hide or “mask” symptoms of hypoglycemia. This can be dangerous because it’s important to quickly recognize and act when your glucose is too low.

Because of this risk, check your blood glucose regularly if you’re taking a beta blocker with glipizide. You’ll be able to reliably recognize hypoglycemia based on your readings.

Good to know: If you’re taking a beta blocker, you may not notice hypoglycemia symptoms, such as a fast heart beat, tremors, and irritability. But sweating is usually not masked, so you may still be able to feel this symptom when you have low blood glucose.

3. Certain antifungals and antibiotics

Certain antifungals and antibiotics also stir up trouble with glipizide.

Azole antifungals, such as fluconazole (Diflucan) and miconazole, are used to treat fungal infections. If you take either of them with glipizide, the amount of glipizide in the body can go up. The effect will be as if you took a higher dose of glipizide than you intended. This raises the risk of glipizide’s most common side effect: hypoglycemia.

Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin, cause a similar problem. Taking either of these with glipizide can also cause your blood glucose to drop too low.

Antifungal and antibiotic medications are usually taken for a short time. So these risks are generally temporary. But if you need to take them with glipizide, make sure to check your blood glucose more closely during that time.

4. Alcohol

Drinking any amount of alcohol raises the risk of hypoglycemia. That’s because alcohol demands your liver’s attention. After you consume it, your liver will spend energy breaking it down rather than making more glucose.

Glipizide adds to this dilemma. Drinking alcohol while taking glipizide leads to an even higher risk of hypoglycemia. The combination makes it harder for your body to regulate your glucose.

It’s important to be cautious with this combination, especially when you start taking glipizide or change your dose. Talk to your HCP about how to safely consume alcohol if you’re taking glipizide.

5. Highly protein-bound medications

Glipizide and other sulfonylureas are “highly protein bound.” That means these medications easily attach to proteins, such as albumin, in your bloodstream. That’s how they travel around your body.

Glipizide can interact with other highly protein-bound medications, such as clarithromycin and warfarin. These other medications can kick glipizide off its protein and take its place. This means more glipizide is freely floating around the body. The higher amounts of “free” glipizide in the body can raise the risk of hypoglycemia.

Your pharmacist can tell you if any of your other medications are considered highly protein bound.

6. Medications that can raise your blood glucose levels

Some medications have the opposite effect as the interactions above. They can affect glipizide’s ability to lower blood glucose. This competition can lead to higher-than-expected sugar readings. Notable medications include:

• Atypical antipsychotics, such as clozapine (Clozaril) or olanzapine (Zyprexa)

• Corticosteroids, such as prednisone or dexamethasone

• Diuretics, such as hydrochlorothiazide (Microzide)

If you start one of these medications while taking glipizide, let your HCP know. They’ll want to track your blood glucose more closely. You may need a higher dose of glipizide.

7. Colesevelam

Colesevelam (Welchol) is a cholesterol and diabetes medication. It lowers both “bad” cholesterol and blood glucose. But taking glipizide with colesevelam can cause another interaction.

When these two are taken around the same time, colesevelam blocks glipizide from entering your bloodstream as it should. This doesn’t let glipizide do its job to lower blood glucose, harming its effectiveness.

To avoid this interaction, take glipizide at least 4 hours before taking colesevelam.

When to contact a healthcare professional about glipizide interactions

Glipizide can be sensitive to interactions. Ideally, you should talk to your HCPs about all the medications you take before you start taking glipizide. It’s especially helpful if your pharmacist and prescriber have access to a complete list of medications and supplements that you take.

You should also talk to an HCP if you’re planning to start a new medication or supplement while taking glipizide. They can help you identify a potential interaction and adjust the dose of glipizide if needed. This can also help you avoid hypoglycemia, which is a life-threatening side effect if left unmanaged.

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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