Glipizide-Metformin 2.5mg/500mg Tab
WARNING: Rarely, metformin may cause too much lactic acid in the blood (lactic acidosis). The risk is higher in people who have kidney problems, liver problems, heart failure, use alcohol, or take certain other drugs, including topiramate. The risk is also higher in people who are 65 or older and in people who are having surgery, an exam or test with contrast, or other procedures. If lactic acidosis happens, it can lead to other health problems and can be deadly. Kidney tests may be done while taking this drug.Do not take this drug if you have a very bad infection, low oxygen, or a lot of fluid loss (dehydration).Call your doctor right away if you have signs of too much lactic acid in the blood (lactic acidosis) like confusion; fast breathing; fast or slow heartbeat; a heartbeat that does not feel normal; very bad stomach pain, upset stomach, or throwing up; feeling very sleepy; shortness of breath; feeling very tired or weak; very bad dizziness; feeling cold; or muscle pain or cramps. @ COMMON USES: It is used to lower blood sugar in patients with high blood sugar (diabetes).
Drug Class
Antidiabetic, Oral
Pharmacologic Class
Sulfonylurea; Biguanide
Pregnancy Category
Category C
FDA Approved
Dec 2000
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a combination of two drugs, glipizide and metformin, used to help control high blood sugar in people with type 2 diabetes. Glipizide helps your body release more insulin, and metformin helps your body use insulin better and reduces the amount of sugar your liver makes. It's important to take this medicine with meals to help reduce stomach upset and to lower the risk of low blood sugar.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, it's essential to follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. Take your medication with meals as directed. Additionally, adhere to the diet and exercise plan recommended by your doctor. Continue taking your medication as prescribed by your doctor or healthcare provider, even if you're feeling well.
Storing and Disposing of Your Medication
To ensure your medication remains effective and safe, store it at room temperature in a dry place, avoiding the bathroom. Keep all medications in a secure location, out of the reach of children and pets. When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so. Instead, consult with your pharmacist for guidance on the best disposal method. You may also want to explore drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember, with a meal. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, it's essential to follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. Take your medication with meals as directed. Additionally, adhere to the diet and exercise plan recommended by your doctor. Continue taking your medication as prescribed by your doctor or healthcare provider, even if you're feeling well.
Storing and Disposing of Your Medication
To ensure your medication remains effective and safe, store it at room temperature in a dry place, avoiding the bathroom. Keep all medications in a secure location, out of the reach of children and pets. When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so. Instead, consult with your pharmacist for guidance on the best disposal method. You may also want to explore drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember, with a meal. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Follow a healthy diet plan recommended by your doctor or dietitian.
- Engage in regular physical activity as advised by your healthcare provider.
- Monitor your blood sugar levels regularly as instructed.
- Limit alcohol intake, as it can increase the risk of low blood sugar and a serious side effect called lactic acidosis.
- Maintain good hydration, especially during illness or exercise.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 2.5 mg glipizide/250 mg metformin once daily with a meal. For 2.5mg/500mg strength, typically 1 tablet once or twice daily with meals.
Dose Range:
2.5 - 10 mg
Condition-Specific Dosing:
Type 2 Diabetes Mellitus:
Initial: 2.5 mg glipizide/250 mg metformin once daily with a meal. May titrate gradually, typically in increments of 2.5 mg glipizide/250 mg metformin or 2.5 mg glipizide/500 mg metformin, every 1-2 weeks. Maximum daily dose: 10 mg glipizide/2000 mg metformin.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
eGFR 60-89 mL/min/1.73m2: Monitor renal function regularly. No specific dose adjustment for glipizide, but metformin accumulation risk is low.
Moderate:
eGFR 45-59 mL/min/1.73m2: Initiate metformin at 50% of the maximum dose; maximum daily dose of metformin should not exceed 1000 mg. eGFR 30-44 mL/min/1.73m2: Not recommended to initiate. If already on therapy, reduce dose by 50% and monitor renal function every 3 months. Glipizide: Use with caution, consider lower doses due to potential for accumulation and increased risk of hypoglycemia.
Severe:
eGFR <30 mL/min/1.73m2: Contraindicated due to increased risk of lactic acidosis with metformin.
Dialysis:
Contraindicated. Metformin is significantly removed by hemodialysis, but its use is not recommended due to the risk of lactic acidosis.
Hepatic Impairment:
Mild:
Glipizide: Use with caution, consider lower starting doses and careful titration. Metformin: Increased risk of lactic acidosis; use with caution.
Moderate:
Glipizide: Dose reduction likely necessary, monitor closely for hypoglycemia. Metformin: Generally not recommended due to increased risk of lactic acidosis.
Severe:
Glipizide: Contraindicated or not recommended. Metformin: Contraindicated due to significantly increased risk of lactic acidosis.
Pharmacology
Mechanism of Action
Glipizide: A sulfonylurea that stimulates insulin release from pancreatic beta cells by binding to ATP-sensitive potassium channels, leading to depolarization and calcium influx. Metformin: A biguanide that decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Pharmacokinetics
Absorption:
Bioavailability:
Glipizide: ~90-100%; Metformin: ~50-60% (absolute oral bioavailability)
Tmax:
Glipizide: 2-4 hours; Metformin: 2-3 hours (IR)
FoodEffect:
Glipizide: Food delays absorption and decreases peak concentration. Metformin: Food decreases the extent and slightly delays the absorption.
Distribution:
Vd:
Glipizide: ~10 L; Metformin: ~654 L
ProteinBinding:
Glipizide: >98%; Metformin: Negligible
CnssPenetration:
Limited
Elimination:
HalfLife:
Glipizide: 2-5 hours; Metformin: Plasma elimination half-life ~6.2 hours (blood half-life ~17.6 hours)
Clearance:
Glipizide: Not available; Metformin: Renal clearance is ~3.5 times greater than creatinine clearance, indicating tubular secretion.
ExcretionRoute:
Glipizide: Urine (80%), Feces (10%); Metformin: Renal (unchanged)
Unchanged:
Glipizide: <10%; Metformin: ~90% (renal)
Pharmacodynamics
OnsetOfAction:
Glipizide: ~30 minutes; Metformin: Within days, full effect in 1-2 weeks
PeakEffect:
Glipizide: 1.5-2 hours; Metformin: 2-3 hours (IR)
DurationOfAction:
Glipizide: 10-24 hours; Metformin: 12-24 hours
Safety & Warnings
BLACK BOX WARNING
Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal distress. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), and an increased lactate/pyruvate ratio; metformin plasma levels were generally >5 mcg/mL. If acidosis is suspected, discontinue Glipizide-Metformin and institute general supportive measures in a hospital setting along with prompt hemodialysis.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Feeling extremely tired or weak
Low blood sugar (hypoglycemia), which may be more likely when taking this medication with other diabetes drugs. Symptoms may include:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
If you experience any of these symptoms, call your doctor right away and follow their instructions for managing low blood sugar, which may include taking glucose tablets, liquid glucose, or some fruit juices.
Stomach Problems
It's common to experience stomach issues like upset stomach, vomiting, or diarrhea when starting this medication. However, if you develop stomach problems later during treatment, contact your doctor immediately, as this could be a sign of a serious condition called lactic acidosis.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or don't go away, contact your doctor:
Dizziness or headache
Diarrhea, upset stomach, or vomiting
Stomach pain
Muscle pain
Signs of a common cold
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Feeling extremely tired or weak
Low blood sugar (hypoglycemia), which may be more likely when taking this medication with other diabetes drugs. Symptoms may include:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
If you experience any of these symptoms, call your doctor right away and follow their instructions for managing low blood sugar, which may include taking glucose tablets, liquid glucose, or some fruit juices.
Stomach Problems
It's common to experience stomach issues like upset stomach, vomiting, or diarrhea when starting this medication. However, if you develop stomach problems later during treatment, contact your doctor immediately, as this could be a sign of a serious condition called lactic acidosis.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or don't go away, contact your doctor:
Dizziness or headache
Diarrhea, upset stomach, or vomiting
Stomach pain
Muscle pain
Signs of a common cold
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Symptoms of low blood sugar (hypoglycemia): sweating, shaking, fast heartbeat, dizziness, hunger, confusion, irritability. Carry a source of sugar (e.g., glucose tablets, juice) to treat low blood sugar.
- Symptoms of lactic acidosis (a rare but serious side effect): unusual muscle pain, trouble breathing, stomach pain, unusual tiredness, dizziness, feeling cold, slow or irregular heartbeat. Seek immediate medical attention if these occur.
- Symptoms of allergic reaction: rash, itching, swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Acidic blood problems
+ Kidney disease
+ Liver disease
+ Type 1 diabetes
Recent medical events, such as a heart attack or stroke
Any difficulties with eating or drinking, including situations where you may be required to fast before a procedure or surgery
Upcoming or recent exams or tests that involve contrast agents (within the past 48 hours)
Additionally, if you:
Are pregnant or think you may be pregnant (do not take this medication if you are pregnant)
Are breast-feeding or plan to breast-feed
This medication can interact with other drugs and health conditions. Therefore, it is crucial to provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter medications you are taking
Natural products and vitamins you are using
Any health problems you have
Your doctor will help you determine whether it is safe to take this medication with your other medications and health conditions. Do not start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Acidic blood problems
+ Kidney disease
+ Liver disease
+ Type 1 diabetes
Recent medical events, such as a heart attack or stroke
Any difficulties with eating or drinking, including situations where you may be required to fast before a procedure or surgery
Upcoming or recent exams or tests that involve contrast agents (within the past 48 hours)
Additionally, if you:
Are pregnant or think you may be pregnant (do not take this medication if you are pregnant)
Are breast-feeding or plan to breast-feed
This medication can interact with other drugs and health conditions. Therefore, it is crucial to provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter medications you are taking
Natural products and vitamins you are using
Any health problems you have
Your doctor will help you determine whether it is safe to take this medication with your other medications and health conditions. Do not start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Before consuming alcohol, discuss the potential risks with your doctor.
To ensure your safety, avoid driving and other activities that require alertness until you understand how this medication affects you. Additionally, do not drive if you have experienced low blood sugar, as this increases the risk of accidents.
If you have a deficiency of the enzyme G6PD, exercise caution, as you may be more prone to anemia. This enzyme deficiency is more common in individuals of African, South Asian, Middle Eastern, and Mediterranean descent.
Adhere to your doctor's instructions for monitoring your blood sugar levels and undergo blood tests as recommended by your doctor. It is crucial to discuss your test results with your doctor.
Long-term treatment with metformin may lead to a decrease in vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor.
If you are also taking colesevelam, take it at least 4 hours after taking this medication. Be aware that this medication may increase the risk of heart disease-related death; discuss this with your doctor.
During periods of stress, such as fever, infection, injury, or surgery, it may be more challenging to control your blood sugar levels. Changes in physical activity, exercise, or diet can also impact your blood sugar levels.
If you experience diarrhea or vomiting, contact your doctor promptly, as you will need to drink more fluids to prevent excessive fluid loss. In hot weather or during physical activity, drink plenty of fluids to avoid dehydration.
Prolonged use of this medication or taking it at high doses may lead to tolerance, reducing its effectiveness. If you notice that the medication is no longer working as well, contact your doctor. Do not exceed the prescribed dose.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
To ensure your safety, avoid driving and other activities that require alertness until you understand how this medication affects you. Additionally, do not drive if you have experienced low blood sugar, as this increases the risk of accidents.
If you have a deficiency of the enzyme G6PD, exercise caution, as you may be more prone to anemia. This enzyme deficiency is more common in individuals of African, South Asian, Middle Eastern, and Mediterranean descent.
Adhere to your doctor's instructions for monitoring your blood sugar levels and undergo blood tests as recommended by your doctor. It is crucial to discuss your test results with your doctor.
Long-term treatment with metformin may lead to a decrease in vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor.
If you are also taking colesevelam, take it at least 4 hours after taking this medication. Be aware that this medication may increase the risk of heart disease-related death; discuss this with your doctor.
During periods of stress, such as fever, infection, injury, or surgery, it may be more challenging to control your blood sugar levels. Changes in physical activity, exercise, or diet can also impact your blood sugar levels.
If you experience diarrhea or vomiting, contact your doctor promptly, as you will need to drink more fluids to prevent excessive fluid loss. In hot weather or during physical activity, drink plenty of fluids to avoid dehydration.
Prolonged use of this medication or taking it at high doses may lead to tolerance, reducing its effectiveness. If you notice that the medication is no longer working as well, contact your doctor. Do not exceed the prescribed dose.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
Overdose Information
Overdose Symptoms:
- Severe hypoglycemia (extremely low blood sugar)
- Lactic acidosis (severe muscle pain, trouble breathing, stomach pain, dizziness, unusual tiredness, coldness)
- Gastrointestinal upset (nausea, vomiting, diarrhea)
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment may involve glucose administration for hypoglycemia and supportive care, potentially including hemodialysis for lactic acidosis.
Drug Interactions
Contraindicated Interactions
- Iodinated contrast media (temporarily discontinue metformin at time of or prior to procedure)
- Severe renal impairment (eGFR <30 mL/min/1.73m2)
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis
Major Interactions
- Alcohol (increased risk of lactic acidosis with metformin)
- Carbonic anhydrase inhibitors (e.g., topiramate, acetazolamide, zonisamide, dichlorphenamide) (increased risk of lactic acidosis with metformin)
- Cimetidine (increases metformin plasma concentration)
- Drugs that affect renal function (e.g., NSAIDs, ACE inhibitors, ARBs, diuretics) (may increase metformin accumulation and lactic acidosis risk)
- Sulfonylurea potentiators (e.g., fluconazole, miconazole, sulfonamides, NSAIDs, salicylates, probenecid, chloramphenicol, coumarins) (increased risk of hypoglycemia with glipizide)
- Beta-blockers (may mask symptoms of hypoglycemia)
Moderate Interactions
- Corticosteroids, thiazide diuretics, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid (may cause hyperglycemia, requiring dose adjustment of glipizide/metformin)
- Colesevelam (may decrease glipizide absorption)
- Digoxin (glipizide may increase digoxin levels)
Minor Interactions
- Chromium (may enhance glucose-lowering effect)
Monitoring
Baseline Monitoring
HbA1c
Rationale: To establish baseline glycemic control.
Timing: Prior to initiation
Fasting Plasma Glucose (FPG)
Rationale: To establish baseline glycemic control.
Timing: Prior to initiation
Renal Function (eGFR, serum creatinine)
Rationale: To assess kidney function, critical for metformin dosing and safety.
Timing: Prior to initiation
Liver Function Tests (ALT, AST)
Rationale: To assess hepatic function, relevant for glipizide metabolism and metformin lactic acidosis risk.
Timing: Prior to initiation
Vitamin B12 levels
Rationale: To establish baseline, as long-term metformin use can be associated with B12 deficiency.
Timing: Prior to initiation
Routine Monitoring
HbA1c
Frequency: Every 3-6 months
Target: Individualized, typically <7%
Action Threshold: Above target, consider dose adjustment or additional therapy
Fasting Plasma Glucose (FPG) and/or Postprandial Glucose (PPG)
Frequency: Daily (patient self-monitoring) or as clinically indicated
Target: FPG: 80-130 mg/dL; PPG: <180 mg/dL
Action Threshold: Persistent readings outside target range, consider dose adjustment
Renal Function (eGFR, serum creatinine)
Frequency: At least annually; more frequently (every 3-6 months) in elderly, those with impaired renal function, or those at risk of renal impairment.
Target: eGFR >60 mL/min/1.73m2 (ideally)
Action Threshold: eGFR <45 mL/min/1.73m2 requires dose adjustment or discontinuation; eGFR <30 mL/min/1.73m2 is a contraindication.
Vitamin B12 levels
Frequency: Annually or every 2-3 years, or if symptoms of deficiency occur.
Target: Normal range
Action Threshold: Low levels, consider supplementation.
Symptom Monitoring
- Symptoms of hypoglycemia (e.g., sweating, tremor, dizziness, confusion, hunger, irritability)
- Symptoms of lactic acidosis (e.g., malaise, myalgia, respiratory distress, somnolence, abdominal distress, unusual fatigue)
- Gastrointestinal side effects (e.g., nausea, vomiting, diarrhea, abdominal discomfort)
- Symptoms of vitamin B12 deficiency (e.g., peripheral neuropathy, anemia)
Special Patient Groups
Pregnancy
Generally not recommended during pregnancy. Insulin is typically the preferred treatment for glycemic control in pregnant women with diabetes. Poorly controlled diabetes during pregnancy increases the risk of maternal and fetal complications. If used, monitor blood glucose closely.
Trimester-Specific Risks:
First Trimester:
Limited data, potential for fetal harm not ruled out.
Second Trimester:
Risk of fetal macrosomia and other complications if diabetes is uncontrolled.
Third Trimester:
Increased risk of neonatal hypoglycemia with sulfonylureas (glipizide) if used close to delivery. Metformin crosses the placenta.
Lactation
Metformin is excreted into breast milk in small amounts and is generally considered compatible with breastfeeding by many experts, though long-term data are limited. Glipizide is also excreted into breast milk and carries a risk of hypoglycemia in the infant. Weigh the benefits of breastfeeding against the potential risks to the infant. Monitor the infant for signs of hypoglycemia.
Infant Risk:
Glipizide: Moderate risk (L3) due to potential for infant hypoglycemia. Metformin: Low risk (L2) due to low levels in milk and no reported adverse effects.
Pediatric Use
Safety and effectiveness have not been established in pediatric patients. Not recommended for use in children.
Geriatric Use
Use with caution in elderly patients due to increased risk of renal impairment (which increases metformin accumulation and lactic acidosis risk) and increased susceptibility to hypoglycemia with glipizide. Start with lower doses and titrate slowly. Monitor renal function more frequently.
Clinical Information
Clinical Pearls
- Always take Glipizide-Metformin with meals to minimize gastrointestinal side effects and reduce the risk of hypoglycemia.
- Educate patients thoroughly on the symptoms and management of hypoglycemia and the rare but serious symptoms of lactic acidosis.
- Ensure patients are well-hydrated, especially during illness, exercise, or hot weather, to reduce the risk of lactic acidosis.
- Metformin should be temporarily discontinued before or at the time of iodinated contrast imaging procedures and for any surgical procedures requiring restricted food/fluid intake, and not restarted until renal function is stable and normal.
- Long-term metformin use can lead to vitamin B12 deficiency; consider periodic monitoring and supplementation if needed.
- This combination is not for type 1 diabetes or diabetic ketoacidosis.
Alternative Therapies
- Other oral antidiabetic agents (e.g., DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, TZDs, alpha-glucosidase inhibitors, meglitinides)
- Insulin therapy
- Lifestyle modifications (diet, exercise)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.