Dibizide

Dibizide is a hypoglycemic tablet used in case of non-insulin-dependent diabetes mellitus.

Indications Dibizide

It is used for non-insulin-dependent diabetes mellitus that is not compensated by physical activity and dietary regimen (also prescribed to people with lipid metabolism disorders and obesity).

Release form

The medicinal substance is released in tablet form, in the amount of 10 pieces inside the cell plates. There are 6 such plates in a pack.

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Pharmacodynamics

Glipizide reduces elevated blood sugar levels (food response) by stimulating insulin secretion through ß-cells of the islet tissue in the pancreas. The extrapancreatic effect consists of a decrease in gluconeogenesis and an increase in the sensitivity of muscle and liver cells to insulin. It has fibrinolytic properties.

Metformin is a hypoglycemic agent that increases the sensitivity of peripheral and liver tissues to insulin. At the same time, it has a positive effect on plasma lipid indices and potentiates the fibrinolytic effect. When using metformin, patients do not gain weight.

Pharmacokinetics

The pharmacokinetic characteristics of the drug are developed due to the activity of its elements (metformin with glipizide).

Glipizide is fully and rapidly absorbed when taken orally. Absorption in the absence of food in the stomach is no more than 60-120 hours. Food may slow down absorption.

The substance, synthesized by 98% with blood plasma protein, undergoes rapid distribution. Glipizide and its metabolic products are not detected in the brain and cerebrospinal fluid.

Glipizide maintains linear pharmacokinetic parameters at doses of 5-60 mg. Excretion occurs via hepatic conversion; less than 10% of the administered dose is excreted unchanged in feces and urine. Metabolic products are also excreted in urine (80%) and feces (10%). The half-life is 2-4 hours.

The bioavailability of the metformin element when taken orally is 50-60%; it is absorbed in the gastrointestinal tract after 6 hours, after which it is distributed at high speed throughout the tissues. Renal excretion of metformin has 2 stages. 95% of the absorbed element is excreted in the 1st stage with a half-life of 6 hours. The remainder is excreted in the 2nd stage with a half-life of 20 hours. Metformin is not synthesized in plasma with protein. It is excreted unchanged in urine (40-60%) and feces (30%).

Dosing and administration

Adult doses are selected individually for patients; the initial dose is usually 0.5-1 tablet per day. It should be increased gradually, if necessary - up to 1-2 pieces 1-2 times per day. The maximum daily dose is 4 tablets. The dose is taken before meals.

After 10-15 days of therapy, the dosage should be adjusted, taking into account the results of serum sugar measurements.

Slowly increasing the dosage helps reduce the likelihood of negative digestive symptoms.

When switching to therapy using Dibizide, you must first stop using other hypoglycemic drugs.

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Use Dibizide during pregnancy

Dibizid is prohibited for use during pregnancy or breastfeeding.

Contraindications

Main contraindications:

• presence of severe hypersensitivity to therapeutic agents or sulfonylurea derivatives;
• insulin-dependent diabetes mellitus, DKA, comatose state or diabetic coma;
• liver dysfunction, adrenal cortex insufficiency and renal dysfunction (creatinine clearance values <60 ml/minute);
• thrombocytopenia, leukopenia or granulocytopenia;
• surgical procedures (including complex ones);
• allergy to sulfonamides;
• shock or dehydration;
• performing X-ray or radioisotope examinations, when a contrast component containing iodine is injected into the vessels;
• conditions that may cause lactic acidosis;
• presence of lactic acidosis at the moment or in the anamnesis;
• acute infections, as well as chronic diseases, in which hypoxia may occur;
• respiratory or cardiac failure, acute myocardial infarction;
• acute cerebral blood flow disorder;
• feverish condition and chronic alcoholism;
• conditions associated with hypoxia (infections affecting the kidneys, sepsis, as well as bronchopulmonary diseases);
• acute APN;
• on a low-calorie diet (less than 1000 calories per day);
• use in people over 60 years of age who engage in heavy physical labor - due to the increased likelihood of lactic acidosis.

Side effects Dibizide

Adverse symptoms caused by glipizide include:

• disorders associated with the sensory organs and the nervous system: dizziness, headaches and a feeling of drowsiness;
• disorders of hemostasis and hematopoiesis processes, as well as the functioning of the cardiovascular system: agranulocytosis, palpitations, thrombocytopenia, leukopenia or pancytopenia, and in addition, hemolytic or aplastic anemia;
• metabolic problems: porphyria, diabetes insipidus and hyponatremia;
• damage to the gastrointestinal tract: diarrhea, constipation, vomiting or cholestatic hepatitis (the sclera and epidermis acquire a yellow tint, the urine darkens and feces become discolored, pain occurs in the right hypochondrium);
• Epidermal symptoms: urticaria, eczema, maculopapular rashes, itching, common rash and photosensitivity;
• other manifestations: increased levels of alkaline phosphatase, LDH or indirect bilirubin.

Side effects caused by the use of metformin hydrochloride:

• gastrointestinal disorders: dyspeptic symptoms (nausea, diarrhea, loss of appetite and metallic taste), vomiting, taste disorders and bloating;
• endocrine dysfunction: hypoglycemia (mainly due to the use of inadequate therapeutic doses);
• problems associated with metabolism: hyponatremia or lactic acidosis are observed occasionally;
• damage to the hematopoietic system: megaloblastic anemia may develop;
• manifestations affecting digestive activity: hepatitis and liver dysfunction.

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Overdose

Poisoning with the drug can provoke hypoglycemia. If intoxication occurs, gastric lavage should be performed immediately, followed by intravenous administration of a 10% or 40% glucose solution, constantly monitoring plasma sugar levels.

After using metformin in a dose of 85 mg, hypoglycemia did not occur, but it caused lactic acidosis. In this case, it is necessary to cancel the therapy, and send the victim for urgent hospitalization, after which, having previously clarified the lactate indicators, determine the exact diagnosis. The most effective method of excretion of lactate and medication from the body is hemodialysis. In addition, symptomatic measures are carried out.

Interactions with other drugs

Glipizide.

Medicines that can displace the substance from the centers of synthesis with plasma protein are able to potentiate its antidiabetic effect. Among such substances are salicylates, warfarin, and sulfonamides.

In addition, NSAIDs, β-blockers and MAOIs have a potentiating effect on glipizide.

The properties of glipizide are also enhanced by the consumption of alcoholic beverages.

Metformin.

Combined use with cimetidine caused an increase in the plasma index of metformin in 7 volunteers participating in the studies. The level of clearance of the substance in the kidneys also decreased; competition for proximal excretion of the drug through the tubules was noted. To reduce the likelihood of lactic acidosis in people combining metformin and cimetidine, the drug should be used in half doses.

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Storage conditions

Dibizid must be stored in a dry place, out of the reach of small children. Temperature values are a maximum of 25°C.

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Shelf life

Dibizide can be used within a 36-month period from the date of manufacture of the pharmaceutical product.

Application for children

There is no information regarding the medicinal efficacy and safety of the drug in pediatrics, which is why it is not used in children.

Analogues

The drug's analogues include such drugs as Glibofor, Amaril M, Duglimax, as well as Glucovance with Glibomet and Dianorm-M.