Langerin

Langerin is an oral antidiabetic medication.

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Indications Langerina

Shown for:

• type 2 diabetes mellitus (not dependent on insulin levels), if dietary treatment has not yielded results, especially in people suffering from obesity;
• monotherapy or combination therapy with other oral antidiabetic drugs or with insulin used in adults;
• monotherapy or in combination with insulin, used for children aged 10 years and over.

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Release form

Available in tablets of 10 pieces on 1 blister. Inside the pack there are 3, 6 or 9 blister plates with tablets.

Langerin 1000. 1 tablet of Langerin 1000 contains 1000 mg of metformin hydrochloride, which is equal to 780 mg of metformin.

Langerin 500. Inside the Langerin 500 tablet there is 500 mg of metformin hydrochloride. This indicator is equal to the level of 390 mg of metformin.

Langerin 850. One Langerin 850 tablet contains 850 mg of metformin hydrochloride, which is 662.9 mg of the substance metformin.

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Pharmacodynamics

Metformin helps reduce hyperglycemia, but does not provoke hypoglycemia. It differs from sulfonylurea in that it does not cause insulin secretion, and does not provoke a hypoglycemic effect in healthy people. It reduces both the initial sugar level in the plasma and its level after eating.

The substance acts in 3 ways:

• helps to reduce the production of glucose in the liver, slowing down the processes of glycogenolysis, as well as gluconeogenesis;
• promotes improved uptake and removal of peripheral glucose within the muscles, increasing the body's sensitivity to insulin;
• inhibits intestinal absorption of glucose.

Metformin induces glycogen binding inside cells by acting on glycogen synthase. Along with this, it also increases the size of any type of membrane glucose transporter (GLUT) capacity.

Regardless of its effect on sugar levels, metformin has a positive effect on lipid metabolism – it lowers total cholesterol levels, as well as the level of triglycerides and low-density lipoproteins.

Increases sensitivity to insulin at peripheral endings, as well as cellular removal of glucose. Slows down the process of hepatic gluconeogenesis. Inhibits the absorption of carbohydrates inside the intestine.

Pharmacokinetics

Metformin after its use is almost completely absorbed in the gastrointestinal tract, while about 20-30% of the substance is excreted with feces. The period of reaching the peak indicator is 2.5 hours, the level of bioavailability reaches about 50-60%. If the drug is taken with food, the absorption of the active substance slows down and weakens.

It is synthesized very weakly with plasma protein. A small part of metformin passes into erythrocytes. The peak value in the blood is lower than the same value in the plasma, and both values are reached at the same time. Erythrocytes are most likely a secondary route of drug distribution. The average value of the distribution volume is usually within 63-276 l.

Metformin is excreted in urine, the substance is excreted unchanged. The drug does not have any decay products.

The intrarenal clearance rate of metformin is >400 ml/min, which suggests that its excretion is carried out by glomerular filtration and tubular secretion. The half-life of the substance reaches approximately 6.5 hours. In case of renal dysfunction, the clearance rate decreases in accordance with creatinine clearance. Because of this, the half-life is prolonged and the plasma level of metformin increases.

Dosing and administration

For adults, monotherapy or a course in combination with other oral antidiabetic drugs is carried out with an initial dose of 500-850 mg twice/three times a day with or immediately after meals.

After 10-15 days, the dosage size should be adjusted, taking into account the blood sugar level. At the same time, a slow increase in dosage can reduce the frequency of negative reactions from the gastrointestinal tract.

It is allowed to consume no more than 3000 mg per day, dividing this dose into 3 doses.

When switching from another oral antidiabetic drug to Langerin, the previous medication should be discontinued and a course of therapy with the above dosage of metformin should be started immediately.

In combination with insulin: to more effectively control glycemia, it is allowed to combine insulin with metformin. In this case, the initial dosage of Langerin will be 500 or 850 mg per day (in 2-3 doses), and the insulin dose is adjusted taking into account sugar levels.

Children over 10 years of age in case of monotherapy or in combination with insulin: at the beginning, the dose is 500 or 850 mg once a day with or after food. After 10-15 days, the dose is adjusted taking into account sugar levels. To reduce the frequency of negative effects on the gastrointestinal tract, it is recommended to increase the dose slowly.

It is allowed to take no more than 2000 mg per day, which is divided into 2-3 doses.

The duration of the course is determined in accordance with the severity of the pathology.

Use Langerina during pregnancy

During pregnancy planning, and also if pregnancy occurs while using the drug, it is necessary to stop using it and consult a doctor who will prescribe appropriate insulin treatment.

There is no information about metformin getting into breast milk, therefore, the use of the drug during lactation is prohibited. If Langerin is still necessary, it is necessary to stop breastfeeding for the duration of the treatment course.

Contraindications

Among the contraindications of the drug:

• the presence of intolerance to metformin or other components of the drug;
• state of coma, diabetic ketoacidosis, and also diabetic coma;
• renal dysfunction (creatinine clearance <60 ml/minute);
• acute conditions that develop with the risk of renal dysfunction, severe stages of infectious pathologies, shock, dehydration, as well as the use of the drug during radioisotope or X-ray testing, in which the patient is administered a contrast component containing iodine;
• acute or chronic forms of pathologies capable of causing hypoxia (including respiratory or cardiac failure, shock, and acute myocardial infarction);
• major surgeries;
• liver dysfunction, alcoholism, and acute alcohol poisoning;
• a state of fever or hypoxia (infectious processes in the kidneys, diseases of the bronchi and lungs, as well as sepsis);
• presence of lactic acidosis (also in the anamnesis);
• children under 10 years of age;
• being on a low-calorie diet (consuming less than 1000 calories per day).

It should also not be prescribed to people over 60 years of age who are engaged in heavy physical labor, because this increases the risk of lactic acidosis.

Side effects Langerina

As a result of using the medicine, the following side effects may occur:

• nervous system organs: often there is a disturbance of taste sensations;
• Digestive system organs: gastrointestinal disorders often occur (vomiting, abdominal pain, diarrhea, nausea, loss of appetite, bloating and metallic taste in the mouth). Such reactions usually appear at an early stage of drug use and usually disappear on their own a little later. The risk of such disorders can be prevented by taking the medicine 2-3 times a day with food or immediately after it. The method of gradually increasing the dosage can also prevent the development of gastrointestinal problems;
• hematopoietic system: megaloblastic form of anemia is observed occasionally;
• subcutaneous tissue and skin: itching, allergic reactions, as well as urticaria and erythema occasionally occur;
• alimentary and metabolic disorders: lactic acidosis develops occasionally. In case of prolonged use of metformin, the absorption of cyanocobalamin is weakened and its level in plasma decreases. This factor should be taken into account when treating people with megaloblastic anemia;
• liver: occasional deviations from normal liver function values may be observed, and hepatitis may develop; these manifestations resolve with discontinuation of metformin.

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Overdose

In the case of metformin use in the amount of 85 g, hypoglycemia did not develop, although lactic acidosis began.

If such a disorder occurs, it is necessary to immediately stop using the drug, immediately hospitalize the patient, and then, having determined the lactate level, clarify the diagnosis. The most effective method of excretion of metformin with lactate is the hemodialysis procedure. In addition, therapy aimed at eliminating the signs of the disorder is required.

Interactions with other drugs

Alcoholic beverages are not recommended for use in combination. The risk of developing lactic acidosis is especially high during acute alcohol poisoning, which is combined with liver failure, starvation or malnutrition. During treatment with Langerin, it is necessary to abstain from alcoholic beverages and medications that contain alcohol.

Contrast agents containing iodine - if combined with them, the likelihood of liver failure may increase, as a result of which metformin will begin to accumulate and the risk of lactic acidosis will increase.

Metformin should be discontinued 48 hours before the examination, then not resumed for at least 48 hours after the procedure, and only restarted after renal function has been assessed.

Combination with danazol should be avoided to prevent hyperglycemic effects from the latter. If it is impossible to stop using danazol, metformin dosages should be adjusted during and after treatment, also monitoring glycemic levels.

Diuretics, GCS with local and systemic action, and β-2-sympathomimetics have a hyperglycemic effect. Patients should be warned about this and glycemia should be assessed as often as possible, especially at the initial stage of using these drugs. During the combined course, as well as after its completion, it is necessary to adjust the dose of Langerin, taking into account glucose levels.

ACE inhibitors are able to reduce the glycemia index. If necessary, it is necessary to adjust the dosage of the antidiabetic drug in case of combination with this drug or when it is canceled.

High doses of chlorpromazine (100 mg per day) increase the sugar level, weakening insulin release. In cases of using neuroleptics, and also after discontinuing these drugs, it is necessary to adjust the dosage of Langerin, monitoring the glycemia level.

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Storage conditions

The medicine does not require any special storage conditions. It should be kept out of the reach of small children.

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Shelf life

Langerin is permitted to be used for 5 years from the date of release of the drug.

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