Medicase - Ticozid Plus - Tablet - 2.5mg+500mg - Glipizide + Metformin Hydrochloride

Ticozid Plus2.5mg+500mg

Type:Tablet

Generic Name:Glipizide + Metformin Hydrochloride

Manufacturer:The White Horse Pharmaceuticals Ltd.

Price:৳4.00

Indication

Type 2 DM

Administration

Should be taken with food.

Adult Dose

Type 2 Diabetes Mellitus Initial treatment: start at 2.5 mg/250 mg (glipizide/metformin) PO qDay with food If fasting plasma glucose = 280-320 mg/dL: 2.5/500 mg PO q12hr May adjust daily dose in increments of 1 tab every 2 wk. Max: Glipizide 10 mg and metformin 2,000 mg daily. Type 2 DM Inadequately Controlled on Sulfonylurea &/or Metformin 2nd-line treatment: Start at 2.5/500 mg or 5/500 mg PO q12hr with food May adjust daily dose in increments of not more than 5 mg/500 mg. Max: Glipizide 20 mg and metformin 2,000 mg daily. Hepatic impairment: Contraindicated.

Renal Dose

Renal impairment: Serum creatinine (SCr) >1.5 mg/dL (males) or >1.4 mg/dL (females) Obtain eGFR before starting metformin eGFR <30 mL/min/1.73 m²: Contraindicated eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate treatment Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly) If eGFR falls below 45mL/min/1.73 m² while taking metformin, risks and benefits of continuing therapy should be evaluated If eGFR falls below 30 mL/min/1.73 m²: while taking metformin, discontinue the drug

Contraindication

Hypersensitivity. Type 2 diabetes mellitus; ketoacidosis; severe renal or hepatic insufficiency, diabetic coma, cardiac failure, recent MI, CHF. IDDM; severe infection; acute or chronic metabolic acidosis with or without coma; stress, trauma; severe impairment of thyroid function; dehydration, acute or chronic alcoholism. Pregnancy, lactation.

Mode of Action

Glipizide stimulates insulin release from pancreatic beta-cells and reduces gluconeogenesis in liver cells. It also increases insulin sensitivity at target sites. Metformin decreases hepatic gluconeogenesis, decreases intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilisation).

Precaution

Hypoglycaemia, stress, elderly. Thyroid impairment, monitor blood-glucose conc and renal function regularly. Lactation: enters breast milk; not recommended

Side Effect

Glipizide: GI upsets, diarrhoea, nausea; allergic skin reactions, leucopaenia, thrombocytopaenia, agranulocytosis, hyponatraemia; jaundice; haemolytic anaemia, pancytopaenia. Metformin: Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of Vitamin Potentially Fatal: Glipizide: Hypoglycaemia in presence of renal or hepatic damage and alcohol. Metformin: Lactic acidosis in presence of renal failure and alcoholism.

Interaction

Glipizide: Decreased effect with beta-blockers, cholestyramine, hydantoins, thiazide diuretics and urinary alkalinizers. Metformin: Additive effect with sulphonylureas. Antagonistic effects with diuretics, corticosteroids, phenothiazines, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, Ca channel blockers and isoniazid. Potentially Fatal: Glipizide: Increased glipizide levels and effects with fluconazole, gemfibrozil, ketoconazole, NSAIDs, pioglitazone and sulfonamides. Increased hypoglycaemic effects with H2 antagonists, anticoagulants, androgens, cimetidine, salicylates, tricyclic antidepressants, probenecid, MAOIs, methyldopa, digitalis glycosides and urinary acidifiers. Metformin: Lactic acidosis with alcohol and potentiation of hypoglycaemic effect. Cimetidine and furosemide may increase plasma-metformin levels. Drugs eliminated via renal tubular secretion may increase metformin levels.