Formet-L
Generic Name
Metformin Hydrochloride and Linagliptin
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| formet l 25 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Formet-L is a fixed-dose combination medication containing Metformin Hydrochloride and Linagliptin, used to improve glycemic control in adults with type 2 diabetes mellitus. The specific formulation 'formet-l-25-mg-tablet' may denote a unique regional variant or a strength where '25 mg' refers to a specific dosage component or identifier, as standard Linagliptin doses are typically 2.5 mg or 5 mg.
Uses & Indications
Dosage
Adults
The usual starting dose is Metformin 500 mg + Linagliptin 2.5 mg twice daily, with meals. Dosage may be titrated based on efficacy and tolerability, up to a maximum of Metformin 1000 mg + Linagliptin 5 mg twice daily.
Elderly
No specific dose adjustment for elderly patients based on age alone, but renal function should be assessed before initiation and monitored regularly.
Renal_impairment
Not recommended for patients with eGFR < 30 mL/min/1.73m². Dose adjustment required for eGFR 30-60 mL/min/1.73m²; Metformin dose should be reduced.
How to Take
Take orally, with meals, to reduce gastrointestinal side effects associated with Metformin.
Mechanism of Action
Metformin reduces hepatic glucose production, decreases intestinal glucose absorption, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Linagliptin, a DPP-4 inhibitor, increases the levels of active incretin hormones (GLP-1 and GIP), which enhance glucose-dependent insulin secretion from pancreatic beta cells and decrease glucagon secretion from pancreatic alpha cells.
Pharmacokinetics
Onset
Glycemic effects typically begin within days to weeks of consistent dosing.
Excretion
Metformin: Excreted unchanged in urine. Linagliptin: Primarily excreted via the enterohepatic system (approximately 80% through feces, 5% through urine).
Half life
Metformin: Elimination half-life is approximately 6.2 hours. Linagliptin: Terminal half-life is approximately 12 hours.
Absorption
Metformin: Absolute oral bioavailability of Metformin 500 mg tablet is approximately 50-60%. Linagliptin: Absolute oral bioavailability is approximately 30%. Peak plasma concentrations for both components are reached within a few hours.
Metabolism
Metformin: Not metabolized in the liver. Linagliptin: Undergoes minimal metabolism; the main pathway is hydrolysis of the amide bond.
Side Effects
Contraindications
- Severe renal impairment (eGFR < 30 mL/min/1.73m²)
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis
- Hypersensitivity to Metformin, Linagliptin, or any excipients
Drug Interactions
Alcohol
Increases the risk of lactic acidosis.
Iodinated contrast agents
Temporarily discontinue Metformin before or at the time of the procedure in patients with eGFR between 30 and 60 mL/min/1.73 m².
Cimetidine, Furosemide, Nifedipine
May increase Metformin levels.
Carbonic anhydrase inhibitors (e.g., topiramate)
May increase the risk of lactic acidosis.
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. Overdose of Linagliptin may lead to mild, transient gastrointestinal disturbances. Management of overdose is primarily symptomatic and supportive; hemodialysis may be useful for Metformin removal.
Pregnancy & Lactation
Should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known if Linagliptin is excreted in human milk; Metformin is excreted into human milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months
Availability
Available in pharmacies nationwide
Approval Status
Approved by DGDA (Bangladesh)
Patent Status
Generic available
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of Metformin and Linagliptin in improving glycemic control in type 2 diabetes patients, both as monotherapy and in combination.
Lab Monitoring
- Renal function (eGFR) before initiation and annually thereafter (more frequently in elderly or impaired patients)
- HbA1c (every 3-6 months)
- Fasting plasma glucose
- Vitamin B12 levels (periodically, especially with long-term Metformin use)
Doctor Notes
- Educate patients on symptoms of lactic acidosis and Vitamin B12 deficiency.
- Monitor renal function before initiating and regularly during treatment.
- Assess for pancreatitis symptoms and discontinue if suspected.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Take with food to minimize stomach upset.
- Maintain a healthy diet and regular exercise routine.
- Report any unusual symptoms, especially severe stomach pain, unexplained muscle pain, or difficulty breathing, to your doctor immediately.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
This medicine alone is unlikely to cause hypoglycemia and affect driving. However, if used in combination with insulin or sulfonylureas, or if you experience symptoms like dizziness or blurred vision, avoid driving or operating machinery.
Lifestyle Advice
- Regular physical activity is crucial for managing type 2 diabetes.
- Follow a balanced diet low in saturated fats and refined sugars.
- Monitor blood glucose levels regularly as advised by your healthcare provider.
- Avoid excessive alcohol consumption.
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