Carlina-M
Generic Name
Linagliptin and Metformin Hydrochloride
Manufacturer
Hypothetical Pharma Co.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| carlina m 25 mg tablet | ৳ 13.00 | ৳ 78.00 |
Description
Overview of the medicine
Carlina-M is a combination medicine containing Linagliptin and Metformin, used to improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise.
Uses & Indications
Dosage
Adults
The usual starting dose is Linagliptin 2.5 mg / Metformin 500 mg orally twice daily with meals. The dose can be titrated up based on efficacy and tolerability, up to a maximum of Linagliptin 2.5 mg / Metformin 1000 mg twice daily.
Elderly
No specific dose adjustment for Linagliptin, but Metformin dose should be adjusted based on renal function. Close monitoring of renal function is advised.
Renal_impairment
Metformin is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m². For eGFR 30-45 mL/min/1.73 m², reduce Metformin dose. Linagliptin does not require dose adjustment in renal impairment, but the combination product requires careful consideration.
How to Take
Take Carlina-M orally twice daily with meals to reduce gastrointestinal side effects associated with Metformin. Do not crush or chew the tablets.
Mechanism of Action
Linagliptin inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), leading to increased and prolonged active incretin levels. Incretin hormones (GLP-1 and GIP) increase insulin synthesis and release from pancreatic beta cells and decrease glucagon secretion from pancreatic alpha cells. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Pharmacokinetics
Onset
Metformin: within hours of administration; Linagliptin: rapid onset of action, sustained over 24 hours.
Excretion
Linagliptin: mainly via bile/feces (~80%), renal (~5%). Metformin: excreted unchanged in the urine, primarily via renal tubular secretion.
Half life
Linagliptin: ~100 hours (terminal half-life); Metformin: plasma elimination half-life is approximately 4-9 hours.
Absorption
Linagliptin: ~30% oral bioavailability, peak plasma concentration at 1.5 hours. Metformin: absolute bioavailability of 50-60%, peak plasma concentration at 2-3 hours.
Metabolism
Linagliptin: primarily metabolized by CYP3A4, but with minimal metabolism. Metformin: not metabolized.
Side Effects
Contraindications
- •Hypersensitivity to linagliptin or metformin or any excipients.
- •Renal dysfunction (eGFR less than 30 mL/min/1.73 m²).
- •Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.
- •Acute conditions with the potential to alter renal function (e.g., severe dehydration, infection, shock).
- •Acute or chronic disease which may cause tissue hypoxia (e.g., cardiac failure, respiratory failure, recent myocardial infarction, shock).
- •Severe hepatic impairment.
- •Acute alcohol intoxication or alcoholism.
Drug Interactions
Alcohol
Increases the risk of lactic acidosis, especially in fasting, malnourished, or hepatically impaired patients.
Iodinated contrast agents
Temporarily discontinue Carlina-M at the time of or prior to iodinated contrast imaging procedures and for 48 hours afterward.
Insulin secretagogues (e.g., sulfonylureas) and Insulin
Increased risk of hypoglycemia, requiring dose adjustment of the sulfonylurea or insulin.
Corticosteroids, Diuretics (especially loop diuretics), Sympathomimetics, Thyroid products
May lead to a decrease in glycemic control due to their hyperglycemic effects.
Cationic drugs (e.g., amiloride, cimetidine, digoxin, procainamide, quinidine, ranitidine, triamterene, trimethoprim, vancomycin)
May increase Metformin levels by competing for renal tubular transport systems.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
In case of overdose, discontinue Carlina-M, initiate appropriate supportive care and symptomatic treatment. Hemodialysis is an effective method for removing Metformin from plasma; however, linagliptin is not significantly removed by hemodialysis or peritoneal dialysis.
Pregnancy & Lactation
Carlina-M is not recommended during pregnancy due to insufficient data on human pregnancy outcomes. It is unknown whether linagliptin or metformin are excreted in human milk. Therefore, it is not recommended for use during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 months from the date of manufacture when stored under recommended conditions.
Availability
Pharmacies, Hospitals
Approval Status
Approved by regulatory authorities (e.g., FDA, EMA, DGDA)
Patent Status
Patent protected (for original innovator), generics available
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Global Brand Names
International brand names for this medicine
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