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ALIMENTARY TRACT AND METABOLISM › DRUGS USED IN DIABETES › BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS › Combinations of oral blood glucose lowering drugs
metformin and gemigliptin
A10BD18
Forms & Strengths
- Fixed-dose combination tablet: 500 mg metformin hydrochloride / 50 mg gemigliptin
- Fixed-dose combination tablet: 1000 mg metformin hydrochloride / 50 mg gemigliptin
Adult Dosing
- One tablet twice daily with meals
- Dose should be individualized based on current regimen, effectiveness, and tolerability
- Maximum daily dose: 2000 mg metformin / 100 mg gemigliptin
Pediatric Dosing
- Safety and effectiveness in pediatric patients below 18 years have not been established
Indications
- Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both metformin and gemigliptin is appropriate
Mechanism of Action
- Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization
- Gemigliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that inactivates incretin hormones GLP-1 and GIP, increasing insulin synthesis and release and decreasing glucagon secretion in a glucose-dependent manner
Contraindications
- Severe renal impairment (eGFR < 30 mL/min/1.73m2) or end-stage renal disease
- Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
- History of a serious hypersensitivity reaction to metformin or gemigliptin
- Acute conditions with potential to alter renal function such as dehydration, severe infection, or shock
Adverse Reactions
- Diarrhea
- Nausea
- Vomiting
- Flatulence
- Hypoglycemia (especially when used with insulin or secretagogues)
- Nasopharyngitis
- Upper respiratory tract infection
- Lactic acidosis (rare, associated with metformin)
Drug Interactions
- Cationic drugs eliminated by renal tubular secretion (e.g., cimetidine) may increase metformin accumulation
- Carbonic anhydrase inhibitors may increase risk of lactic acidosis
- Strong CYP3A4 inducers (e.g., rifampin) may decrease gemigliptin exposure
- Alcohol may potentiate the effect of metformin on lactate metabolism
Curated Content: Needs Vetting Before Put to Clinical Use