Losucon M 2/500

Indications:

Losucon M Tablet is indicated as an adjunct to diet and exercise in the management of type 2 diabetes mellitus in the following scenarios:

• When monotherapy with either glimepiride or metformin does not result in adequate glycemic control.
• As a replacement for combination therapy involving glimepiride and metformin.

Note: Always take this medication as per the advice of a registered healthcare provider.

Pharmacology:

Glimepiride:

• A sulfonylurea antidiabetic agent that lowers blood glucose levels by stimulating insulin release from functional pancreatic beta cells.
• It enhances the sensitivity of beta cells to glucose, improving insulin secretion.
• Additionally, glimepiride may have extrapancreatic effects like reducing hepatic glucose production and increasing peripheral tissue sensitivity to insulin.
• The hypoglycemic effect of a single dose persists for 24 hours in non-fasting diabetic patients.

Metformin Hydrochloride:

• A biguanide used for managing type 2 diabetes.
• It lowers both fasting and postprandial blood glucose by reducing hepatic glucose production, decreasing intestinal glucose absorption, and improving insulin sensitivity.
• Unlike sulfonylureas, metformin does not induce hypoglycemia.

Dosage:

• The dosage should be tailored to achieve the desired blood glucose levels. Regular blood and urine glucose monitoring is essential during treatment.
• If a dose is missed, it should not be compensated by taking a larger dose later. Adjustments should be made based on ongoing glucose control.
• As treatment progresses, glimepiride doses may be reduced due to improved insulin sensitivity.
• The maximum recommended dose is 8 mg of glimepiride and 2000 mg of metformin daily.
• If switching from combination therapy, the dosage should match the current individual doses of glimepiride and metformin.

Note: Always follow a registered healthcare provider’s guidance when using this medication.

Administration:

• The tablet should be swallowed whole, without crushing or chewing.
• Note: Follow the instructions of a registered healthcare provider for proper use.

Drug Interactions:

For Glimepiride:

• Potential interactions may occur with drugs like insulin, ACE inhibitors, anabolic steroids, certain antibiotics (e.g., chloramphenicol, tetracyclines), antifungal agents (e.g., fluconazole), and various others that could either potentiate or weaken the hypoglycemic effect.
• Alcohol intake may also alter the blood-glucose-lowering effect in unpredictable ways.
• Bile acid sequestrants (e.g., colesevelam) may reduce glimepiride absorption; it should be taken at least 4 hours before colesevelam.

For Metformin:

• Avoid alcohol consumption as it increases the risk of lactic acidosis.
• Iodinated contrast agents may interact with metformin, requiring its discontinuation before imaging procedures and resumption only after 48 hours, provided renal function is stable.
• Renal function should be closely monitored when using metformin alongside certain drugs (e.g., glucocorticoids, diuretics) that may adversely affect renal function.

Contraindications:

For Glimepiride:

• Hypersensitivity to glimepiride, metformin, sulfonylureas, or any excipients.
• Pregnancy and breastfeeding.
• Severe hepatic dysfunction or dialysis patients.

For Metformin:

• Hypersensitivity to metformin.
• Acute metabolic acidosis, diabetic ketoacidosis, severe renal failure, or conditions like dehydration and shock that could affect renal function.
• Alcohol intoxication or alcoholism.
• Hepatic insufficiency.

Side Effects:

For Glimepiride:

• Hypoglycemia (common) and occasionally prolonged hypoglycemia.
• Gastrointestinal issues (nausea, vomiting, abdominal pain).
• Possible liver function abnormalities (hepatitis, elevated enzymes).
• Hematological effects (e.g., thrombocytopenia, leucopenia).
• Alopecia and allergic reactions (itching, urticaria, rashes).

For Metformin:

• Gastrointestinal issues like nausea, vomiting, diarrhea, and abdominal pain are common at the start.
• Metallic taste is a common side effect.
• Lactic acidosis is a rare but severe condition.
• Vitamin B12 deficiency and associated neuropathy with long-term use.
• Possible liver function abnormalities.

Pregnancy & Lactation:

• Glimepiride: Not recommended during pregnancy due to potential harm to the fetus. Insulin should be used during pregnancy.
• Metformin: Should not be used during pregnancy; insulin is preferred to maintain normal blood glucose levels to reduce the risk of fetal malformations.
• Breastfeeding:
  • Glimepiride: Not recommended while breastfeeding. Switching to insulin is advised.
  • Metformin: The excretion of metformin in breast milk is unknown, so a decision must be made whether to discontinue nursing or metformin, depending on its importance to the mother.

Precautions & Warnings:

• Close monitoring is essential, especially in the initial stages of treatment.
• Risk of hypoglycemia when used with other glucose-lowering medications or in certain conditions.
• Renal function must be monitored due to potential risks associated with metformin use, particularly in patients with renal impairment.