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Limit alcohol while taking this medication because it can increase the risk of developing low blood sugar and lactic acidosisRarelyalcohol can interact with glyburide and cause a serious reactiondisulfiram-like reactionwith symptoms such as facial flushingnauseavomitingdizzinessor stomach painConsult your doctor or pharmacist about using alcohol safely.

Glucovance is capable of producing hypoglycemia or hypoglycemic symptomsthereforeproper patient selectiondosingand instructions are important to avoid potential hypoglycemic episodesThe risk of hypoglycemia is increased when caloric intake is deficientwhen strenuous exercise is not compensated by caloric supplementationor during concomitant use with other glucose-lowering agents or ethanolRenal or hepatic insufficiency may cause elevated drug levels of both glyburide and metformin hydrochlorideand the hepatic insufficiency may also diminish gluconeogenic capacityboth of which increase the risk of hypoglycemic reactionsElderlydebilitatedor malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effectsHypoglycemia may be difficult to recognize in the elderly and people who are taking beta-adrenergic blocking drugs.

Jay WMarksMDis a board-certified internist and gastroenterologistHe graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

If you are also taking colesevelamtake glyburide/metformin at least 4 hours before colesevelam.

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obtain an egfr at least annually in all patient taking glucovance.