Comet 500

Indications

Management of type 2 diabetes mellitus, especially in overweight individuals, when dietary measures and physical activity alone fail to achieve adequate blood sugar control.

In adults: Comet can be used as a standalone treatment or alongside other oral antidiabetic medications or insulin therapy.

In children aged 10 years and above, as well as adolescents: Comet may be used alone or in combination with insulin.

Research has demonstrated a reduction in diabetic complications among overweight adults with type 2 diabetes treated with metformin as a first-line therapy following dietary interventions.

Pharmacology

Metformin, a biguanide oral antihyperglycemic agent, is employed in managing type 2 diabetes. It effectively lowers both fasting and post-meal blood glucose levels. Unlike sulfonylureas, it does not induce hypoglycemia. Metformin acts by reducing hepatic glucose production, diminishing intestinal glucose absorption, and enhancing insulin sensitivity by promoting peripheral glucose uptake and utilization.

Dosage & Administration

Metformin Immediate Release Tablet: Dosage should be tailored to individual response and tolerance, not exceeding the recommended maximum daily doses.

For adults: Initiate with 500 mg twice daily or 850 mg once daily, taken with meals. Adjustments can be made weekly by 500 mg increments or every 2 weeks by 850 mg increments, up to a total of 2000 mg per day in divided doses. For additional glycemic control needs, Glucomin may be administered up to a maximum daily dose of 2550 mg, preferably divided into three doses with meals.

For children: Start with 500 mg twice daily, adjusted weekly by 500 mg increments up to a maximum of 2000 mg per day in divided doses.

Metformin Extended Release Tablet: Swallow whole and do not crush, cut, or chew.

For adults: Begin with 500 mg once daily with the evening meal. Increase weekly by 500 mg increments, up to a maximum of 2000 mg once daily with the evening meal, or alternatively, up to 1000 mg twice daily with meals. Patients transitioning from immediate release to extended release tablets should not exceed the maximum recommended daily dose.

For children: Extended release tablet use has not been studied.

In patients with renal impairment: Avoid use in those with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Assess risks and benefits if eGFR falls below 45 mL/min/1.73 m2.

Interaction

Limited information is available on potential interactions between Comet and Furosemide when co-administered long-term. Nifedipine may enhance Comet absorption, while Comet has minimal effects on Nifedipine. Cationic drugs eliminated via renal tubular secretion may interact with Comet by competing for common renal transport systems. Comet has negligible effects on Cimetidine pharmacokinetics. Certain medications may induce hyperglycemia, affecting glycemic control. These include thiazides, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and Isoniazid.

Contraindications

Avoid in cases of hypersensitivity to the active substance or any excipients, acute metabolic acidosis (e.g., lactic acidosis, diabetic ketoacidosis), severe renal failure (GFR <30 mL/min), acute conditions affecting renal function (e.g., dehydration, severe infection, shock), and conditions leading to tissue hypoxia (e.g., cardiac/respiratory failure, recent myocardial infarction, hepatic insufficiency, acute alcohol intoxication).

Side Effects

• Hemolytic anemia
• Very rare: Lactic acidosis, decreased vitamin B12 absorption, peripheral neuropathy (in patients with vitamin B12 deficiency), taste disturbance, encephalopathy, gastrointestinal disorders (e.g., nausea, vomiting, diarrhea, abdominal pain, loss of appetite), liver function abnormalities or hepatitis, skin reactions (e.g., erythema, pruritus, urticaria).

Pregnancy & Lactation

During pregnancy, prioritize insulin over metformin to mitigate the risk of fetal malformations. Exercise caution with breastfeeding due to limited data on metformin’s effects on newborns/infants.

Precautions & Warnings

Comet is primarily excreted via the kidneys. Monitor renal function regularly, especially in diabetic patients. Exercise caution during surgery and investigations involving contrast agents. Avoid use in conditions predisposing to dehydration, serious infections, or trauma. Annual vitamin B12 level assessments are advised during prolonged Comet therapy. Monitor blood glucose closely when combining with insulin or insulin secretagogues. Adjust dosage with concomitant use of cimetidine or anticoagulants.

Use in Special Populations

Elderly individuals may require dose adjustments due to potential declines in renal function. Pediatric use requires careful consideration, especially in children aged 10-12 years. Regular renal function assessments are essential, particularly in older adults and those at risk of renal impairment.

Overdose Effects

Hypoglycemia is rare but possible with large Comet doses. Lactic acidosis, if occurs, necessitates immediate medical attention, with hemodialysis being the most effective method for removing lactate and Comet.

Therapeutic Class

Biguanides

Storage Conditions

Keep below 30°C, shielded from light and moisture, and out of children’s reach.