Comet-XR
Generic Name
Metformin Hydrochloride Extended-Release
Manufacturer
Incepta Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| comet xr 500 mg tablet | ৳ 6.02 | ৳ 60.20 |
Description
Overview of the medicine
Comet-XR 500 mg Tablet is an extended-release oral antidiabetic medication used to control high blood sugar levels in patients with type 2 diabetes mellitus. It helps to restore the body's proper response to insulin by decreasing hepatic glucose production and improving insulin sensitivity.
Uses & Indications
Dosage
Adults
Initially 500 mg once daily with the evening meal. Dosage may be increased by 500 mg weekly up to a maximum of 2000 mg once daily or 1000 mg twice daily. Swallow whole, do not crush or chew.
Elderly
Close monitoring of renal function is recommended. Initial dosage should be conservative, starting with 500 mg once daily.
Renal_impairment
Contraindicated in severe renal impairment (eGFR <30 mL/min/1.73 m²). Dose adjustment required for moderate impairment (eGFR 30-60 mL/min/1.73 m²).
How to Take
Take orally, once daily with the evening meal. Swallow the tablet whole; do not crush, chew, or break it. Taking it with food helps reduce gastrointestinal side effects.
Mechanism of Action
Metformin decreases 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 and therefore does not cause hypoglycemia.
Pharmacokinetics
Onset
Gradual onset of glucose-lowering effect, usually within days.
Excretion
Primarily excreted unchanged in the urine via renal tubular secretion.
Half life
Approximately 6.2 hours for Metformin, but the extended-release formulation prolongs therapeutic levels.
Absorption
Slow and extended absorption over several hours from the gastrointestinal tract, leading to a flatter plasma concentration curve compared to immediate-release.
Metabolism
Not metabolized in the liver to a significant extent; excreted unchanged.
Side Effects
Contraindications
- Hypersensitivity to metformin or any components of the formulation
- Metabolic acidosis (including diabetic ketoacidosis, lactic acidosis)
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Acute or chronic disease that may cause tissue hypoxia (e.g., cardiac or respiratory failure, recent myocardial infarction)
- Hepatic impairment
- Dehydration, shock, severe infection
- Alcohol abuse
Drug Interactions
Alcohol
Increases the risk of lactic acidosis.
Cimetidine
May increase metformin plasma concentrations.
Iodinated contrast agents
Temporarily discontinue metformin at the time of or prior to imaging procedures and withhold for 48 hours afterward, and restart only after renal function has been re-evaluated and found to be normal.
Diuretics (especially loop diuretics)
May decrease renal clearance of metformin, increasing the risk of lactic acidosis.
Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, vancomycin) that are eliminated by renal tubular secretion
May increase metformin levels.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Overdose of metformin can lead to lactic acidosis, which is a medical emergency. Symptoms include malaise, myalgia, respiratory distress, somnolence, and abdominal pain. Treatment involves supportive measures, correction of acidosis, and hemodialysis for severe cases to remove metformin.
Pregnancy & Lactation
Pregnancy: Use during pregnancy should only be considered if clearly needed and the benefits outweigh the risks. Insulin is generally preferred for glycemic control in pregnant women with diabetes. Lactation: Metformin is excreted into breast milk. Benefits of breastfeeding should be weighed against potential risks to the infant.
Side Effects
Contraindications
- Hypersensitivity to metformin or any components of the formulation
- Metabolic acidosis (including diabetic ketoacidosis, lactic acidosis)
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Acute or chronic disease that may cause tissue hypoxia (e.g., cardiac or respiratory failure, recent myocardial infarction)
- Hepatic impairment
- Dehydration, shock, severe infection
- Alcohol abuse
Drug Interactions
Alcohol
Increases the risk of lactic acidosis.
Cimetidine
May increase metformin plasma concentrations.
Iodinated contrast agents
Temporarily discontinue metformin at the time of or prior to imaging procedures and withhold for 48 hours afterward, and restart only after renal function has been re-evaluated and found to be normal.
Diuretics (especially loop diuretics)
May decrease renal clearance of metformin, increasing the risk of lactic acidosis.
Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, vancomycin) that are eliminated by renal tubular secretion
May increase metformin levels.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Overdose of metformin can lead to lactic acidosis, which is a medical emergency. Symptoms include malaise, myalgia, respiratory distress, somnolence, and abdominal pain. Treatment involves supportive measures, correction of acidosis, and hemodialysis for severe cases to remove metformin.
Pregnancy & Lactation
Pregnancy: Use during pregnancy should only be considered if clearly needed and the benefits outweigh the risks. Insulin is generally preferred for glycemic control in pregnant women with diabetes. Lactation: Metformin is excreted into breast milk. Benefits of breastfeeding should be weighed against potential risks to the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date.
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory authorities (e.g., FDA, DGDA)
Patent Status
Generically available
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established metformin's efficacy and safety in managing type 2 diabetes, demonstrating reductions in microvascular and macrovascular complications. XR formulations aim to improve tolerability and patient adherence.
Lab Monitoring
- Renal function (eGFR) should be assessed before initiation and at least annually thereafter (more frequently in elderly or compromised patients).
- Vitamin B12 levels should be monitored periodically, especially in patients with risk factors for deficiency or those on long-term therapy.
- HbA1c levels to assess glycemic control.
Doctor Notes
- Emphasize the importance of diet and exercise alongside metformin therapy.
- Educate patients on symptoms of lactic acidosis and when to seek immediate medical attention.
- Regular monitoring of renal function and B12 levels is crucial, especially in high-risk groups.
Patient Guidelines
- Take with food to minimize stomach upset.
- Swallow the tablet whole; do not chew, crush, or break it.
- Inform your doctor if you experience symptoms of lactic acidosis.
- Avoid excessive alcohol consumption.
- Regularly monitor blood sugar levels as advised by your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose.
Driving Precautions
This medication does not typically cause hypoglycemia when used alone, so it usually does not impair the ability to drive or operate machinery. However, if used in combination with other antidiabetic drugs (e.g., sulfonylureas, insulin) that can cause hypoglycemia, caution is advised.
Lifestyle Advice
- Maintain a balanced diet rich in fruits, vegetables, and whole grains.
- Engage in regular physical activity for at least 30 minutes most days of the week.
- Maintain a healthy weight.
- Quit smoking if applicable.
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