Glucovance is a prescription medication combining two distinct antidiabetic agents, glyburide and metformin, into a single tablet. It is specifically formulated for the management of type 2 diabetes mellitus in adults, particularly when hyperglycemia cannot be adequately controlled by diet and exercise alone or by monotherapy with either metformin or a sulfonylurea. This combination therapy targets two key physiological defects of the disease: insulin resistance and inadequate insulin secretion. By addressing both pathophysiologic mechanisms simultaneously, Glucovance offers a comprehensive approach to glycemic control, helping patients achieve and maintain target HbA1c levels.

Features

• Contains two active pharmaceutical ingredients: glyburide (a sulfonylurea) and metformin hydrochloride (a biguanide).
• Available in multiple fixed-dose combinations (e.g., 1.25 mg/250 mg, 2.5 mg/500 mg, 5 mg/500 mg).
• Film-coated, oral tablet for convenient once- or twice-daily dosing.
• Works by both increasing insulin sensitivity and stimulating pancreatic insulin release.
• Designed to lower both basal (fasting) and postprandial (after-meal) plasma glucose.

Benefits

• Provides superior glycemic control compared to monotherapy with either metformin or a sulfonylurea alone.
• Reduces the need for multiple pills, potentially improving patient adherence to the treatment regimen.
• Helps lower HbA1c, fasting plasma glucose, and postprandial glucose levels effectively.
• May assist in weight management or result in less weight gain compared to some other antidiabetic regimens.
• Addresses the dual core defects of type 2 diabetes—insulin resistance and beta-cell dysfunction.
• Can be used as an adjunct to diet and exercise, forming a cornerstone of a comprehensive diabetes management plan.

Common use

Glucovance is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is typically prescribed when treatment with metformin or a sulfonylurea alone has provided insufficient glycemic control. It may also be used as initial drug therapy in patients presenting with significantly elevated HbA1c levels, where a more aggressive approach to lowering blood glucose is deemed necessary by a healthcare provider. Its use is reserved for cases where the benefits of dual-action therapy outweigh the potential risks.

Dosage and direction

The dosage of Glucovance must be individualized based on the patient’s current regimen, effectiveness, and tolerability. It is usually administered twice daily with meals to reduce the potential for gastrointestinal upset. The recommended starting dose is often 1.25 mg/250 mg once or twice daily with meals. Dosage adjustments should be made in increments of no more than 5 mg/500 mg per day, at intervals of every two weeks. The maximum recommended daily dose is 20 mg glyburide/2000 mg metformin. It is crucial to follow the prescribing physician’s instructions precisely and not to crush or chew the tablets.

Precautions

• Lactic Acidosis: A rare but serious metabolic complication that can occur due to metformin accumulation. Risk factors include renal impairment, congestive heart failure, old age, dehydration, and excessive alcohol intake.
• Hypoglycemia: May occur, particularly when caloric intake is deficient, after strenuous exercise, or when alcohol is ingested. Symptoms include dizziness, shaking, sweating, and confusion.
• Renal Function: Renal function should be assessed before initiation and regularly thereafter. Therapy should not be initiated if serum creatinine levels are above the normal range.
• Vitamin B12 Deficiency: Long-term use of metformin has been associated with decreased Vitamin B12 absorption. Levels should be monitored periodically.
• Hepatic Disease: Use with caution in patients with impaired hepatic function.
• Surgery/Radiologic Procedures: Glucovance should be temporarily discontinued at the time of, or prior to, surgical procedures or radiologic studies involving intravascular iodinated contrast materials.

Contraindications

• Severe renal impairment (eGFR below 30 mL/min) or renal disease.
• Known hypersensitivity to glyburide, metformin, or any component of the formulation.
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis.
• History of lactic acidosis while on metformin therapy.
• During periods of hemodynamic instability, such as in shock or acute congestive heart failure requiring pharmacological treatment.

Possible side effect

Common side effects are often related to the gastrointestinal system and may include diarrhea, nausea, vomiting, abdominal bloating, flatulence, and indigestion. These effects are frequently transient. Hypoglycemia (symptoms include dizziness, tremor, sweating, and hunger) may also occur. Other potential side effects include:

• Headache
• Unusual or metallic taste
• Mild skin reactions (e.g., rash, urticaria)
• Transient asthenia (weakness)
• Decreased vitamin B12 levels

Drug interaction

Glucovance has a significant potential for drug interactions. Key interactions include:

• Other Antidiabetic Agents: Concomitant use with insulin, thiazolidinediones, or other sulfonylureas may increase the risk of hypoglycemia.
• Drugs that May Increase Hypoglycemic Risk: Beta-blockers, chloramphenicol, coumarins, MAO inhibitors, fluconazole, probenecid, salicylates, and sulfonamides.
• Drugs that May Increase Blood Glucose: Corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid.
• Alcohol: Potentiates the effect of metformin on lactate metabolism and increases the risk of lactic acidosis and hypoglycemia. Avoid excessive alcohol intake.
• Cationic Drugs: Drugs eliminated by renal tubular secretion (e.g., cimetidine, ranitidine) may compete for common renal tubular transport systems, potentially increasing metformin plasma levels.

Missed dose

If a dose is missed, it should be taken as soon as remembered with food, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Do not take a double dose to make up for a missed one.

Overdose

Overdose of Glucovance may lead to hypoglycemia (from the glyburide component) and lactic acidosis (from the metformin component). Hypoglycemia may require urgent treatment with oral carbohydrates, glucagon, or intravenous glucose. Lactic acidosis is a medical emergency that must be treated in a hospital setting, often requiring hemodialysis to correct the acidosis and remove accumulated metformin. Symptoms of overdose include severe hypoglycemia (extreme weakness, confusion, tremors, sweating, fast heartbeat), and symptoms of lactic acidosis (nausea, vomiting, diarrhea, hyperventilation, malaise). Immediate medical attention is critical.

Storage

Store Glucovance tablets at room temperature, between 20°C to 25°C (68°F to 77°F), in a tightly closed container. Protect from light, moisture, and excessive heat. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them into a drain. Dispose of unused or expired medication through a medicine take-back program or according to FDA guidelines.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• “As an endocrinologist with over 20 years of experience, I find Glucovance to be a highly effective second-line agent. Its dual mechanism allows me to achieve significant HbA1c reductions in patients struggling on monotherapy. The fixed-dose combination improves compliance, which is a constant challenge in chronic disease management. I am always mindful of the contraindications, particularly renal function, but for the appropriate patient, it’s a cornerstone therapy.” – Dr. E. Vance, MD, Endocrinology
• “I’ve been on Glucovance 2.5/500 for three years now. It brought my A1c down from 9.2% to 6.5% where it has stayed. The initial stomach upset lasted about two weeks but went away completely. I appreciate only having to take one pill with my evening meal instead of two separate medications.” – Patient M., 58
• “From a clinical pharmacy perspective, Glucovance is a valuable tool. It simplifies regimens and can be cost-effective for patients. Counseling points are critical: we emphasize taking it with food, recognizing hypoglycemia symptoms, and absolutely avoiding it in renal impairment. The risk of lactic acidosis, while low, requires vigilant patient selection and monitoring.” – Clinical Pharmacist R. Thompson
• “After my diagnosis, my doctor started me on this. The first month was an adjustment, but my blood sugar readings stabilized remarkably. It integrated well into my lifestyle. My only note is that the importance of not skipping meals became very real very quickly due to the risk of low blood sugar.” – Patient J.K., 47
• “In our internal medicine practice, we use Glucovance frequently. Its efficacy is well-documented. The key to safety is strict adherence to prescribing guidelines—meticulous screening for renal and cardiac contraindications pre-initiation and at least annual monitoring thereafter. When used correctly, the benefits far outweigh the risks for most patients.” – Dr. A. Silva, Internal Medicine