Nido 1+ Specification
Requires Prescription (YES/NO)
Yes
Generics
Sitagliptin, Metformin HCl
How it works
Sitagliptin : It is a DPP-4 inhibitor, which exerts its actions in patients with type 2 diabetes by slowing the inactivation of incretin hormones, including glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis. When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by intracellular signaling pathways involving cyclic AMP. GLP-1 also lowers glucagon secretion from pancreatic alpha cells, leading to reduced hepatic glucose production. By increasing and prolonging active incretin levels, sitagliptin increases insulin release and decreases glucagon levels in the circulation in a glucose-dependent manner. Metformin HCl : Metformin HCl is a biguanide that improves glycemic control in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin HCl decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Nido 1+ Usage And Safety
Dosage
Sitagliptin, Metformin HCl
Side Effects
Sitagliptin with Metformin HCl : Diarrhea, upper respiratory tract infections and headache. Sitagliptin with Metformin HCl and Sulphonylurea : Hypoglycemia and headache. Sitagliptin with Metformin HCl and Insulin : Hypoglycemia. Additional adverse reactions of sitagliptin with or without metformin HCl and/or in combination with other antidiabetic medications include hypersensitivity reactions including anaphylaxis, angioedema, rash, urticaria, cutaneous vasculitis and exfoliative skin conditions including Stevens-Johnson syndrome, upper respiratory tract infection, hepatic enzyme elevations, acute pancreatitis, including fatal and non-fatal hemorrhagic and necrotizing pancreatitis, worsening renal function, including acute renal failure (sometimes requiring dialysis), severe and disabling arthralgia, bullous pemphigoid, constipation, vomiting, headache, arthralgia, myalgia, pain in extremity, back pain, pruritis, cholestatic, hepatocellular and mixed hepatocellular liver injury .
Drug Interactions
Carbonic Anhydrase Inhibitors : Concomitant use of carbonic anhydrase inhibitors may induce metabolic acidosis. Use these drugs with caution in patients treated with sitagliptin + metformin HCl, as the risk of lactic acidosis may increase and consider more frequent monitoring of these patients. Drugs that Reduce Metformin Clearance : Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors such as ranolazine, vandetanib, dolutegravir and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis. Consider the benefits and risks of concomitant use. Use of Metformin HCl with other drugs : Certain medicines tend to produce hyperglycemia and may lead to loss of glycemic control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs and isoniazid. When such drugs are administered to a patient receiving sitagliptin + metformin HCl, the patient should be closely observed to maintain adequate glycemic control.
Indication
Sitagliptin + Metformin HCl is indicated : As initial therapy in patients with type 2 diabetes mellitus to improve glycemic control when diet and exercise do not provide adequate glycemic control, when dual sitagliptin and metformin HCl therapy is appropriate (i.e. high initial HbA1c levels and poor prospects of response to monotherapy). As an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus inadequately controlled on sitagliptin or metformin HCl alone or in patients already being treated with the combination of sitagliptin and metformin HCl . In combination with a sulphonylurea as an adjunct to diet and exercise in patients with type 2 diabetes mellitus when combination therapy with metformin HCl and sulphonylurea does not provide adequate glycemic control . As an adjunct to diet and exercise to improve glycemic control in combination with insulin in patients with type 2 diabetes mellitus inadequately controlled on insulin and metformin HCl or in patients already being treated with the combination of sitagliptin, metformin HCl and insulin.
When not to Use
Sitagliptin + Metformin HCl is contraindicated in patients with : Known hypersensitivity to sitagliptin and metformin HCl or to any of excipient of the product . Renal disease or renal dysfunction, e.g. as suggested by serum creatinine levels ≥133 micromol/L [males] or ≥124 micromol/L [females], or abnormal creatinine clearance (<60 mL/min), which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction and septicaemia . Acute or chronic metabolic acidosis, including diabetic ketoacidosi, with or without coma .
Nido 1+ Warnings
Warning 1
Sitagliptin + metformin HCl should generally be avoided in patients with clinical or laboratory evidence of hepatic disease.
Warning 2
Before initiation of therapy with sitagliptin + metformin HCl and at least annually thereafter, renal function should be assessed. In patients in whom development of renal dysfunction is anticipated, particularly in elderly patients, renal function should be assessed more frequently and sitagliptin + metformin HCl discontinued if evidence of renal impairment is present.
Warning 3
Use of sitagliptin + metformin HCl should be temporarily discontinued while patients have restricted food and fluid intake. Withholding of food and fluids during surgical or other procedures may increase the risk for volume depletion, hypotension and renal impairment.
