Glitin M 850

Indications:

Glitin M is prescribed as an adjunct to diet and exercise for better glycemic control in adults with type 2 diabetes mellitus when a combination of Linagliptin and Metformin Hydrochloride is deemed appropriate by the doctor.
Consult with a registered healthcare provider before using this medication.

Pharmacology:

Linagliptin helps manage blood sugar levels in type 2 diabetes patients by inhibiting the DPP-4 enzyme. This enzyme breaks down the incretin hormones GLP-1 and GIP, which are responsible for stimulating insulin production and lowering glucagon secretion. By increasing the levels of these hormones, Linagliptin improves insulin release in response to glucose intake.

Metformin Hydrochloride, a biguanide antihyperglycemic agent, works by lowering both basal and post-meal glucose levels. Unlike sulfonylureas, Metformin does not cause hypoglycemia and works through several mechanisms: reducing liver glucose production, decreasing glucose absorption from the intestines, and enhancing insulin sensitivity in peripheral tissues.

Dosage & Administration:

• Linagliptin & Metformin Immediate Release Tablets: Dosage should be tailored to each individual based on effectiveness and tolerance. The maximum recommended dose is 2.5 mg Linagliptin and 1000 mg Metformin Hydrochloride twice a day with meals. Start with a lower dose and gradually increase to minimize gastrointestinal side effects.
  • For patients not on Metformin: Start with 2.5 mg Linagliptin and 500 mg Metformin Hydrochloride twice daily.
  • For patients already on Metformin: Begin with 2.5 mg Linagliptin and the current dose of Metformin Hydrochloride.
• Linagliptin & Metformin Extended Release Tablets: Maximum recommended doses should not exceed 5 mg Linagliptin and 2000 mg Metformin Hydrochloride daily, taken once a day with food.
  • For patients new to Metformin: Start with 5 mg Linagliptin/1000 mg Metformin Hydrochloride once daily.
  • For current Metformin users: Begin with the corresponding dose of Metformin and 5 mg of Linagliptin once daily.

Always follow the prescribed dosage from a registered healthcare provider.

Interaction:

• Cationic Drugs: Cationic drugs eliminated through renal tubular secretion (e.g., amiloride, digoxin) may interact with Metformin, requiring dose adjustments.
• Carbonic Anhydrase Inhibitors: Medications like Topiramate can increase the risk of metabolic acidosis, particularly when combined with Glitin M.
• P-glycoprotein and CYP3A4 Inhibitors: Rifampin can reduce Linagliptin’s effectiveness by decreasing its blood concentration.
• Drugs Affecting Glycemic Control: Drugs such as diuretics, corticosteroids, and thyroid medications may affect blood sugar levels, requiring careful monitoring when taken with Glitin M.

Contraindications:

Glitin M should not be used in patients with renal impairment or those with a history of metabolic acidosis or hypersensitivity to Linagliptin or Metformin Hydrochloride. Its use is also contraindicated in acute diabetic ketoacidosis.

Side Effects:

The most common side effects include nasopharyngitis and diarrhea. The risk of hypoglycemia is higher when Glitin M is taken with sulfonylureas.

Pregnancy & Lactation:

There are no adequate studies for the use of Glitin M in pregnant women. It should only be used during pregnancy if clearly necessary. Use caution when administering to lactating mothers.

Precautions & Warnings:

• Lactic Acidosis: In rare cases, Metformin can cause lactic acidosis. Symptoms include abdominal discomfort, fast breathing, muscle pain, or weakness.
• Pancreatitis: Cases of pancreatitis have been reported, and if suspected, Glitin M should be discontinued immediately.
• Vitamin B12 Deficiency: Metformin use may lower Vitamin B12 levels, requiring annual monitoring of hematologic parameters.

Overdose Effects:

In case of overdose, standard supportive measures should be taken. While Linagliptin is not significantly dialyzable, Metformin can be removed through hemodialysis in case of overdose.

Therapeutic Class:

Combination Oral Hypoglycemic Agents

Storage Conditions:

Store in a cool, dry place below 30°C, away from light and moisture. Keep out of reach of children.