Glucovance (Glyburide/Metformin)

GLUCOVANCE comes as a tablet and is typically taken by mouth once or twice a day with meals.

Dosage is based on your condition and response to treatment.

Your doctor will probably start you on a low dose and gradually increase it.

Follow the instructions on your prescription label carefully. Don't take more or less of the drug than prescribed.

GLUCOVANCE Overdose

If you suspect an overdose of GLUCOVANCE, you should contact a poison-control center or emergency room immediately.

Missed Dose of GLUCOVANCE

If you miss a dose of GLUCOVANCE, take it as soon as you remember, but be sure to take it with food.

If it's almost time for your next dose, skip the missed dose and continue on your regular schedule.

Don't take extra medicine to make up for a missed dose.

Tell your doctor if any of the following side effects become severe or don't go away:

• Mild stomach pain
• Mild nausea
• Mild diarrhea
• Mild dizziness

Serious Side Effects of GLUCOVANCE

Call your doctor immediately if you experience any of the symptoms listed in the Warning section or any of the following serious side effects:

• Chest pain
• Rash
• Yellowing of the eyes or skin (jaundice)
• Light-colored stools
• Dark-colored urine
• Fever
• Pain in the right upper portion of the stomach
• Unusual bruising or bleeding
• Sore throat
• Swelling of the eyes, face, lips, tongue, or throat

The FDA requires a black-box warning for GLUCOVANCE, because it may cause a rare but serious condition called lactic acidosis (a buildup of lactic acid in the blood).

Stop taking the drug and call your doctor immediately or get emergency help if you experience any of the following side effects:

• Extreme weakness, fatigue, or discomfort
• Nausea, vomiting, or stomach pain
• Decreased appetite
• Deep and rapid breathing or shortness of breath
• Dizziness or lightheadedness
• Fast or slow heartbeat
• Flushing of the skin
• Muscle pain
• Feeling cold or blue skin

Also, tell your physician if you've recently experienced any of the following:

• Severe diarrhea
• Vomiting
• Fever
• A serious infection
• Dehydration
• Less fluid consumption than usual

Tell your healthcare provider you are taking GLUCOVANCE before having any surgery (including a dental procedure).

You should not take GLUCOVANCE when you have an imagining scan that uses an injected dye (such as a CT scan, MRI, PET, or SPECT scan with contrast).

Older adults may be more sensitive to the side effects of this GLUCOVANCE, especially lactic acidosis or low blood sugar.

Talk to your doctor about this risk if you are 80 years old or older before taking GLUCOVANCE.

Before taking the drug, also tell your doctor if you have or have ever had:

• G6PD deficiency (an inherited enzyme condition)
• Hormone disorders involving the adrenal, pituitary, or thyroid gland
• Acute or chronic metabolic acidosis
• Heart disease
• A heart attack
• Stroke
• Liver disease
• Kidney disease
• Fertility issues

GLUCOVANCE shouldn't be taken by people who have type 1 diabetes (the body doesn't produce insulin) or diabetic ketoacidosis (extremely high blood sugar that requires emergency medical attention).

Your doctor might have you take extra vitamin B12 while you are on GLUCOVANCE.

In one study, people who took a drug similar to glyburide were more likely to die of heart problems than those who took insulin and made dietary changes. Talk to your doctor about this risk.

In animals, high doses of metformin caused females to develop non-cancerous polyps in the uterus. It's not known whether this drug increases the risk of polyps in humans.

Continue to take GLUCOVANCE even if you feel well. It may take up to two weeks before you experience its full benefits.

This medicine may cause changes in your blood sugar. You should know the symptoms of high (hyperglycemic) or low (hypoglycemic) blood-sugar episodes and be prepared to treat them.

Talk to your physician if you experience an illness, fever, injury, or unusual stress, because these events can affect your blood-sugar levels and how much GLUCOVANCE you need.

Your doctor will probably want to check your glucose levels often while you are taking GLUCOVANCE.

Keep all healthcare appointments, including those for lab tests.

Always wear a diabetic ID bracelet to be sure you get proper treatment in case of an emergency.

Pregnancy and GLUCOVANCE

GLUCOVANCE is not expected to harm an unborn baby.

Similar drugs have caused severe low blood sugar levels in newborns whose mothers used the medicine near the time of delivery.

Tell your doctor if you're pregnant or plan to become pregnant before taking GLUCOVANCE.

The drug may also increase the chance that you will become pregnant. Talk to your doctor about effective birth control methods.

It's not known whether the medicine passes into breast milk or if it could harm a breastfeeding baby.

You shouldn't breastfeed while taking GLUCOVANCE without talking to your doctor first.

Tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you're taking, especially:

• Allergy medicines
• Antibiotics known as quinolone or fluoroquinolone, such as cinoxacin (Cinobac), ciprofloxacin (Cipro), enoxacin (Penetrex), gatifloxacin (Tequin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), nalidixic acid (NegGram), norfloxacin (Noroxin), ofloxacin (Floxin), sparfloxacin (Zagam), or trovafloxacin and alatrofloxacin combination (Trovan)
• Antibiotics for tuberculosis, such as isoniazid and rifampin
• Sulfonamide antibiotics, such as sulfamethoxazole, trimethoprim-sulfamethoxazole or co-trimoxazole (Bactrim, Septra)
• Asthma medications
• Bosentan (Tracleer), used to treat high blood pressure in the lungs (pulmonary hypertension)
• Acetazolamide (Diamox), for altitude sickness
• Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik)
• Anticoagulants (blood thinners), such as warfarin (Coumadin)
• Aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)
• Beta blockers, such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal)
• Calcium channel blockers, such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), or verapamil (Calan, Isoptin, Verelan)
• Chloramphenicol, an antibiotic
• Clarithromycin (Biaxin), an antibiotic
• Cold medicine
• Contraceptive (birth control) pills
• Cyclosporine (Neoral, Sandimmune), an immunosuppressant
• Diabetes and blood-sugar medications, such as insulin and others
• Epilepsy or seizure drugs, such as phenytoin (Dilantin Phenytek), topiramate (Topamax), and zonisamide (Zonegran), a sulfa anti-convulsant
• Fluconazole (Diflucan), for fungal infections
• Heart drugs, such as digoxin (Lanoxin) and disopyramide (Norpace)
• Heart rhythm drugs, such as procainamide (Procanbid) and quinidineHormone replacement therapy
• MAOIs, such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate)
• Mental illness medicines, such as fluoxetine (Prozac, Sarafem) and others
• Nausea medications
• Miconazole (Lotrimin, Monistat, others), for athlete's foot and yeast infections
• Morphine (MS Contin, others)
• Niacin, a type of vitamin B used for many conditions
• Probenecid (Benemid, in Col-Benemid), for gout, kidney stones, and other uses
• Quinine, for malaria and sometimes for babesiosis (a parasite infection)
• Salicylate pain relievers, such as choline magnesium trisalicylate, choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan's, others), or salsalate (Argesic, Disalcid, Salgesic)
• Steroid pills such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone)
• Stomach-acid drugs, such as cimetidine (Tagamet), and ranitidine (Zantac)
• Sulfasalazine (Azulfidine), for ulcerative colitis and rheumatoid arthritis
• Thyroid medications
• Trimethoprim (Primsol)
• Vancomycin (Vancocin, others)
• Diuretics (water pills) such as amiloride (Midamor, in Moduretic), furosemide (Lasix), and triamterene (in Dyazide, Maxzide, others),

If you take colesevelam (Welchol), a drug for lowering "bad" (LDL) cholesterol, don't take it until four hours after you've taken GLUCOVANCE.

Alcohol and GLUCOVANCE

Drinking alcohol may increase your risk of developing lactic acidosis or a decrease in blood sugar.

Talk to your doctor about how much alcohol is safe to consume while taking GLUCOVANCE.

Other Interactions and GLUCOVANCE

GLUCOVANCE may make your skin more sensitive to sunlight.

Try to avoid unnecessary or prolonged exposure to the sun, and wear protective clothing and sunscreen when you're outside.

Be cautious when exposed to extreme heat or when exercising.

The medication can increase your risk of dehydration, so make sure you drink plenty of fluids.