Drugs In Palliative Care 3rd Edition – Andrew Dickman

• Fluconazole—​increases plasma concentration of glipizide. • Miconazole—​contraindicated for use (enhanced hypoglycaemic effect, presumably CYP2C9 inhibition). • Warfarin—​increased risk of hypoglycaemia. Pharmacodynamic • ACE-​Is—​increased risk of hypoglycaemia. • β2-​agonists—​hypoglycaemic effect may be antagonized. • Corticosteroids—​hypoglycaemic effect antagonized. • Diuretics—​hypoglycaemic effect may be antagonized. • SSRIs—​increased risk of hypoglycaemia. G Dose • Initial dose 2.5mg to ​5mg PO OD, taken before breakfast or lunch.

The dose can be increased as necessary by 2.5mg to 5mg PO OD over several days. The maximum recommended single dose is 5mg PO daily; doses above 5mg should be divided. The maximum daily dose is 20mg. Dose adjustments Elderly • Usual adult doses can be used, although the elderly are more susceptible to adverse effects. The initial dose should be 2.5mg PO OD and should be titrated to effect. Hepatic/​renal impairment • Care should be exercised in patients with hepatic and/​or renal impairment and a smaller initial dose should be used, with careful patient monitoring.

Dose should be titrated to effect. • Glipizide should be avoided in patients with severe hepatic and/​or renal impairment and insulin treatment should be initiated. Additional information • Tablets can be crushed and dispersed in water immediately prior to administration if necessary. u Pharmacology Glipizide is a sulfonylurea which stimulates β-​cells of the islets of Langerhans in the pancreas to release insulin. It also enhances peripheral insulin sensi- tivity. It restores the first peak of insulin secretion in response to glucose and increases the second phase of insulin secretion.

The metabolism of many sulfonylureas is catalysed by CYP2C9. Glyceryl trinitrate Glyceryl trinitrate Rectogesic® (POM) Rectal ointment: GTN 0.4% (30 g). Generic (P) Sublingual tablet: 300 micrograms (00); 500 micrograms (00); 600 micrograms (00). NB—​tablets should be stored in the original container and discarded 8 weeks from opening. Proprietary formulations are available (see current BNF). Other formulations are available (e.g. parenteral, transdermal) but are not dis- cussed (see current BNF). Indications • Anal fissure.

• ✢Smooth muscle spasm pain (e.g. anus, oesophagus, rectum). • Angina (not discussed). Contraindications and cautions • Contraindicated for use in the following: – anaemia (severe) – aortic and/​or mitral stenosis – closed-​angle glaucoma – concomitant use with phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, vardenafil) – constrictive pericarditis – hypertrophic obstructive cardiomyopathy – hypotension – hypovolaemia – migraine or recurrent headache – raised intracranial pressure.

• Use with caution in patients with: – hypothermia – hypothyroidism – malnutrition – recent history of myocardial infarction – severe hepatic impairment – severe renal impairment – susceptibility to angle-​closure glaucoma. • Note that transdermal patches that contain metal must be removed before MRI (to avoid burns).

Consultant Pharmacist –​ Palliative Care Academic Palliative and End of Life Care Centre Liverpool University Hospitals NHS Foundation Trust Liverpool UK With contribution by James Baker MPharm PgDip Principal Pharmacist for Medicines Optimisation Stepping Hill Hospital Stockport NHS Foundation Trust Stockport UK Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford.

It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Andrew Dickman 2023 The moral rights of the authors have been asserted First Edition published in 200 Second Edition published in 202 Third Edition published in 2023 Impression:  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization.

Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 98 Madison Avenue, New York, NY 006, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 202294535 ISBN 978–​0–​9–​874640–​9 DOI: 0.093/​med/​978098746409.00.000 Printed in the UK by Ashford Colour Press Ltd, Gosport, Hampshire Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct.

Readers must therefore always check the product information and clinical procedures with the most up-​to-​date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.

Except where otherwise stated, drug dosages and recommendations are for the non-​pregnant adult who is not breast-​feeding Some of the medication discussed in this book may not be available through normal channels and only available by special arrangements. Other examples used in research studies and recommended in international guidelines are unlicensed or may be subject to being used outside of their licensed dosage ranges within the UK. We suggest consulting the BNF and local prescribing guidelines/protocols before using unfamiliar medication.

This is a short excerpt from the opening of “” by Unknown, quoted for review and introduction purposes. All rights belong to the copyright holders.

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