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Losartan 100 mg Tablets 100’s
800.00
Losartan 100 mg Tablets 100’s
Vitamin B Complex 100 Tablets per Box
1,050.00
Vitamin B Complex 100 Tablets per Box

Description

Indications/Uses
Type 2 diabetes mellitus.
Dosage/Direction for Use
Adult : PO Treatment: As conventional tab/solution: Initial: 500 or 850 mg bid or tid, gradually increase at intervals of at least 1 week according to response. Max: 3,000 mg/day in 3 divided doses. As extended-release tab: Initial: 500 mg/day with evening meal, increase dose in increments of 500 mg up to Max 2,000 mg/day according to response. Prophylaxis: As extended-release tab: Initial: 500 mg/day with evening meal, gradually increase dose at intervals of 10-15 days, according to response. Max: 2,000 mg/day with evening meal.
Dosage Details
Oral
Type 2 diabetes mellitus

Adult: Treatment: As conventional tab/solution: Initially, 500 or 850 mg bid or tid, gradually increase at intervals of at least 1 week according to response. Max: 3,000 mg daily in 3 divided doses. As extended-release tab: Initially, 500 mg daily with evening meal, increase dose in increments of 500 mg up to Max 2,000 mg daily according to response. Prophylaxis: As extended-release tab: Initially, 500 mg daily with evening meal, gradually increase dose at intervals of 10-15 days, according to response. Max: 2,000 mg daily with evening meal.
Child: ≥10 years As conventional tab/solution: Initially, 500 or 850 mg once daily, gradually increase dose at intervals of at least 1 week according to response. Max: 2,000 mg daily in 2 or 3 divided doses.
Elderly: Adjust dose based on renal function.
Renal Impairment
eGFR <30 mL/min: Contraindicated. eGFR 30-44 mL/min: Total Max daily dose: 1,000 mg. eGFR 45-59 mL/min: Total Max daily dose: 2,000 mg daily. eGFR 60-89 mL/min: Total Max daily dose: 3,000 mg. All doses to be taken in 2-3 divided doses.
Administration
Should be taken with food.
Contraindications
Acute or chronic metabolic acidosis with or without coma, acute conditions which may alter renal function (e.g. dehydration, severe infection, shock), acute or chronic disease-causing hypoxia (e.g. unstable cardiac or respiratory failure, recent MI, shock), acute alcohol intoxication or alcoholism. Severe renal (eGFR<30 mL/min) impairment. Intravascular administration of iodinated contrast agents.
Special Precautions
Patients with risk factors for lactic acidosis, stable heart failure, dehydration, prerenal azotemia. Mild to moderate renal impairment. Hepatic impairment. Children and elderly. Pregnancy and lactation. Not indicated for use in patient with type 1 diabetes mellitus or with diabetic ketoacidosis.
Adverse Reactions
Significant: Vitamin B12 deficiency.
Cardiac disorders: Chest discomfort, palpitations, dyspnoea.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, flatulence, heartburn/dyspepsia, abdominal distention, abnormal stools, constipation.
General disorders and admin site conditions: Asthenia, flu-like symptoms, malaise.
Hepatobiliary disorders: Cholestatic, hepatocellular, mixed hepatocellular liver injury.
Musculoskeletal and connective tissue disorders: Myalgia, chills.
Nervous system disorders: Taste disturbance, headache.
Psychiatric disorders: Increased somnolence.
Respiratory, thoracic and mediastinal disorders: Upper respiratory tract infection.
Skin and subcutaneous tissue disorders: Nail disease, rash.
Vascular disorders: Flushing.
Potentially Fatal:
 Lactic acidosis.
Pregnancy Category (US FDA)
PO: B
MonitoringParameters
Monitor glucose and ketones (urine and blood), fasting blood sugar, haemoglobin A1c at least twice yearly in stable glycaemic control; quarterly if not meeting therapy goals. Monitor renal function prior to initiation of therapy and annually thereafter; haematologic parameters at baseline and annually thereafter; vitamin B12 serum concentration every 2-3 years (prolonged use). Monitor for signs and symptoms of lactic acidosis.
Overdosage
Symptoms: Hypoglycaemia, lactic acidosis manifested as acidotic dyspnoea, abdominal pain, muscle cramps, hypothermia followed by coma. Management: Perform haemodialysis to remove lactate and metformin in the blood.
Drug Interactions
Increased risk of hypoglycaemia with insulin and insulin secretagogues (e.g. sulfonylurea). Increased risk of lactic acidosis with carbonic anhydrase inhibitors (e.g. acetazolamide, dichlorphenamide), NSAIDs, and antihypertensive agents (e.g. ACE inhibitors). Increased plasma concentration and reduced clearance with OCT2 inhibitors (e.g. cimetidine, dolutegravir, ranolazine, trimethoprim, vandetanib, isavuconazole).
Potentially Fatal: Contrast-induced nephropathy and increased risk of lactic acidosis with iodinated contrast agents.
Food Interaction
Food decreases extent and slightly delays absorption. Increased risk of lactic acidosis with alcohol.
Action
Description: Metformin is a biguanide antihyperglycaemic agent which improves glucose tolerance by lowering both basal and postprandial plasma glucose. It decreases hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis, delays intestinal glucose absorption, and improves insulin sensitivity by enhancing peripheral glucose uptake and utilisation.