Citazar-XR
Generic Name
Metformin Hydrochloride (Extended Release)
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| citazar xr 500 mg tablet | ৳ 30.00 | ৳ 300.00 |
Description
Overview of the medicine
Citazar-XR 500 mg Tablet is an extended-release oral antidiabetic medicine used to lower blood sugar levels in people with type 2 diabetes mellitus. It helps to improve glucose utilization and reduce glucose production in the liver.
Uses & Indications
Dosage
Adults
Initial dose 500 mg once daily with evening meal, gradually titrate to maximum 2000 mg once daily. Max 2500 mg/day in divided doses for some situations.
Elderly
Initial dose 500 mg once daily, titrate carefully based on renal function. Lower doses may be required due to decreased renal function.
Renal_impairment
eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate. If already on, reduce dose. eGFR <30 mL/min/1.73 m²: Contraindicated.
How to Take
Take orally once daily with the evening meal. Swallow whole; do not crush, chew, or break the tablet. The tablet shell may be visible in the stool.
Mechanism of Action
Metformin primarily reduces hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. It does not stimulate insulin secretion, thus reducing the risk of hypoglycemia.
Pharmacokinetics
Onset
Gradual, typically within hours for XR, full effect over several days/weeks.
Excretion
Excreted primarily unchanged in the urine.
Half life
Approximately 4-8 hours in plasma; up to 17.6 hours for XR.
Absorption
Slowly and incompletely absorbed from the gastrointestinal tract; bioavailability is about 50-60%. Food delays and slightly decreases absorption.
Metabolism
Not metabolized in the liver; excreted unchanged.
Side Effects
Contraindications
- Hypersensitivity to Metformin
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Acute or chronic metabolic acidosis (including diabetic ketoacidosis, with or without coma)
- Lactic acidosis history
- Severe hepatic impairment
- Severe heart failure
- Dehydration, acute myocardial infarction, septicaemia, other conditions associated with hypoxemia
Drug Interactions
Alcohol
Increases the risk of lactic acidosis, especially during fasting or malnutrition.
Iodinated contrast agents
Increased risk of lactic acidosis. Metformin should be withheld before and for 48 hours after contrast procedures.
Carbonic anhydrase inhibitors (e.g., topiramate, acetazolamide)
May increase risk of lactic acidosis.
Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, vancomycin)
May compete with metformin for renal tubular transport, increasing metformin concentration.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Overdose of metformin has led to lactic acidosis. Symptoms include abdominal pain, malaise, nausea, vomiting, lethargy, and hyperventilation. Management involves immediate discontinuation of metformin, supportive care, and hemodialysis for severe lactic acidosis.
Pregnancy & Lactation
Pregnancy Category B. Generally considered safe during pregnancy when clinically indicated, but insulin is often preferred for optimal glycemic control. Excreted in breast milk in small amounts; generally considered compatible with breastfeeding, but consult a doctor.
Side Effects
Contraindications
- Hypersensitivity to Metformin
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Acute or chronic metabolic acidosis (including diabetic ketoacidosis, with or without coma)
- Lactic acidosis history
- Severe hepatic impairment
- Severe heart failure
- Dehydration, acute myocardial infarction, septicaemia, other conditions associated with hypoxemia
Drug Interactions
Alcohol
Increases the risk of lactic acidosis, especially during fasting or malnutrition.
Iodinated contrast agents
Increased risk of lactic acidosis. Metformin should be withheld before and for 48 hours after contrast procedures.
Carbonic anhydrase inhibitors (e.g., topiramate, acetazolamide)
May increase risk of lactic acidosis.
Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, vancomycin)
May compete with metformin for renal tubular transport, increasing metformin concentration.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Overdose of metformin has led to lactic acidosis. Symptoms include abdominal pain, malaise, nausea, vomiting, lethargy, and hyperventilation. Management involves immediate discontinuation of metformin, supportive care, and hemodialysis for severe lactic acidosis.
Pregnancy & Lactation
Pregnancy Category B. Generally considered safe during pregnancy when clinically indicated, but insulin is often preferred for optimal glycemic control. Excreted in breast milk in small amounts; generally considered compatible with breastfeeding, but consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months
Availability
Pharmacies, hospitals
Approval Status
Approved by FDA and DGDA
Patent Status
Generic (Patent Expired)
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have established the efficacy and safety of metformin in type 2 diabetes management, including long-term cardiovascular outcome studies (e.g., UKPDS).
Lab Monitoring
- Renal function (eGFR) periodically (at least annually, more often in elderly or those with risk factors)
- HbA1c levels regularly
- Blood glucose levels (fasting and postprandial)
- Vitamin B12 levels (especially in long-term users or those with risk factors for deficiency)
Doctor Notes
- Educate patients on symptoms of lactic acidosis.
- Regularly monitor renal function and Vitamin B12 levels.
- Consider temporary discontinuation in cases of dehydration, surgery, or procedures involving iodinated contrast media.
Patient Guidelines
- Take your medicine regularly as prescribed by your doctor.
- Inform your doctor about all other medicines, supplements, and herbal products you are taking.
- Report any signs of lactic acidosis (e.g., unusual muscle pain, trouble breathing, unusual drowsiness, stomach discomfort) immediately.
- Do not stop taking this medicine without consulting your doctor.
- Maintain a balanced diet and regular exercise routine.
Missed Dose Advice
If a dose is missed, take it as soon as you remember with food, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
Metformin alone typically does not cause hypoglycemia, which could impair driving. However, if used in combination with other antidiabetic agents that can cause hypoglycemia, or if experiencing dizziness/vision changes, exercise caution.
Lifestyle Advice
- Follow a healthy diet plan recommended for diabetes management.
- Engage in regular physical activity.
- Avoid excessive alcohol consumption.
- Monitor your blood sugar levels as advised by your doctor.
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