Langerin

Langerin is an antidiabetic drug for oral use.

Indications of the langerina

Indicated when:

• type 2 diabetes mellitus (independent of the level of insulin), if treatment with diets did not work, especially for people suffering from obesity;
• monotherapy or combined treatment in combination with other antidiabetic drugs for ingestion or with adult insulin;
• monotherapy or in combination with insulin, used for children from 10 years of age.

Release form

Produced in tablets of 10 pieces on the 1st blister. Inside the pack contains 3, 6 or 9 blister plates with tablets.

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

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

Langerin 850. The Langerin 850 tablet contains 850 mg of metformin hydrochloride, which is 662.9 mg of metformin.

Pharmacodynamics

Metformin helps reduce hyperglycemia, but does not provoke hypoglycemia. It differs from sulfonylurea in that it does not cause insulin secretion, and also does not provoke hypoglycemic action in healthy people. Reduces both the initial index of sugar inside the plasma, and its level after eating food.

The action of the substance occurs in 3 ways:

• contributes to a decrease in the production of glucose within the liver, slowing down glycogenolysis, as well as gluconeogenesis;
• improves the capture with the removal of peripheral glucose within the muscles, increasing the sensitivity of the body relative to insulin;
• inhibits intestinal absorption of glucose.

Metformin provokes the binding of glycogen inside cells, affecting glycogen synthetase. Together with this, it also increases the size of any type of capacity of membrane glucose transporters (GLUT).

Regardless of the effect on sugar, metformin has a positive effect on lipid metabolism - lowers the total level of cholesterol, and in addition triglycerides and low-density lipoproteins.

Increases sensitivity relative to insulin in peripheral endings, as well as cellular removal of glucose. Slows the process of hepatic gluconeogenesis. It inhibits the absorption of carbohydrates inside the intestine.

Pharmacokinetics

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

With the plasma protein is synthesized very weakly. A small part of metformin passes inside the erythrocytes. The peak value inside the blood is lower than the same value inside the plasma, reaching both values occurs at the same time. Erythrocytes, most likely, are a secondary way of distribution of drugs. The average value of the distribution volume is usually in the range 63-276 liters.

Excretion of metformin is carried out with urine, the substance is excreted unchanged. The drug does not show any decay products.

The index of clearance of metformin inside the kidney is> 400 ml / minute, which allows us to conclude that its excretion is carried out by filtering the glomeruli and secreting the tubules. The half-life of the substance reaches about 6.5 hours. In the case of a disorder in the work of the kidneys, the clearance level is lowered in accordance with the creatinine clearance. Because of this, the half-life is prolonged and the plasma index of metformin is increased.

Use of the langerina during pregnancy

During the period of pregnancy planning, and in addition, when pregnancy occurs during the use of drugs - it is required to cancel its use and consult a doctor who will prescribe the appropriate treatment with insulin.

There is no information about the ingestion of metformin into breast milk, as a result of which it is forbidden to use the medicine during lactation. If Langerin is still needed, it is required to cancel breastfeeding for the period of the treatment course.

Contraindications

Among the contraindications of drugs:

• the presence of intolerance to metformin or other elements of the drug;
• the state of coma, the diabetic form of ketoacidosis, and also the diabetic coma;
• renal function impairment (KC score <60 mL / minute);
• acute conditions that develop with the risk of renal function disorders, severe stages of infectious pathologies, shock, dehydration, and the use of medication during radioisotope or X-ray testing in which a contrast agent containing iodine is administered to the patient;
• acute or chronic forms of pathologies that can cause hypoxia (among them, insufficiency of respiratory or cardiac function, shock state and acute form of myocardial infarction);
• serious surgical operations;
• a disorder in the work of the liver, alcoholism, as well as an acute form of alcohol poisoning;
• state of fever or hypoxia (infectious processes in the kidneys, bronchial and lung diseases, as well as sepsis);
• the presence of lactic acidosis (also in history);
• children age less than 10 years;
• stay on a hypocaloric diet (eating less than 1000 calories per day).

Also, people from 60 years of age who are engaged in heavy physical labor should not be appointed, because this increases the risk of lactic acidosis.

Side effects of the langerina

As a result of using the medication, these side effects may appear:

• organs of the National Assembly: often there is a disorder of taste sensations;
• organs of the digestive system: often there are disorders of the digestive tract (vomiting, abdominal pain, diarrhea, nausea, loss of appetite, bloating and smack of metal in the mouth). Such reactions usually appear at an early stage of drug use and mostly self-run a little later. Warn the risk of such violations can be, using the drug 2-3 times a day with food or immediately after it. The method of gradually increasing the dosage is also able to prevent the development of problems with the gastrointestinal tract;
• hemopoietic system: a megaloblastic form of anemia is observed singly;
• subcutaneous tissue and skin: occasionally there are itching, allergic manifestations, as well as urticaria and erythema;
• alimentary, as well as metabolic disorders: lactoacidosis develops sporadically. In the case of prolonged use of metformin, the absorption of cyanocobalamin is weakened and its index within the plasma decreases. It is necessary to take this factor into account in the treatment of people with a megaloblastic form of anemia;
• liver: single can be observed deviations from the normal value of liver function, as well as develop hepatitis; these manifestations occurred with the abolition of metformin.

Dosing and administration

For adults, monotherapy or a course in combination with other oral antidiabetics drugs is given with an initial dose of 500-850 mg twice / thrice a day with or immediately after meals.

After 10-15 days, the size of the dosage should be adjusted, taking into account the sugar in the blood. In this case, a slow increase in dosage can reduce the frequency of adverse reactions from the gastrointestinal tract.

For a day it is allowed to consume no more than 3000 mg, dividing this dose into 3 receptions.

When switching from another antidiabetic drug with oral administration to Langerin, it is necessary to stop using the previous medication and immediately begin a course of therapy with the above dosage of metformin.

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 (2-3 times), and the amount of insulin dose is adjusted taking into account the sugar values.

Children older than 10 years in the case of monotherapy or with a combination with insulin: at the beginning the dose is 500 or 850 mg once a day with or after eating. After 10-15 days there is a dose adjustment taking into account the sugar values. To reduce the incidence of adverse effects on the part of the digestive tract, it is recommended to slowly increase the dose.

A day is allowed to take no more than 2000 mg, which are divided into 2-3 uses.

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

Overdose

In the case of the use of metformin in the amount of 85 g, there was no development of hypoglycemia, although lactatacidosis was started.

If such a violation occurs, it is necessary to immediately abolish the use of drugs, immediately hospitalize the patient, and then, after clarifying the level of lactate, to clarify the diagnosis. The most effective method of excretion of metformin with lactate is the procedure of hemodialysis. In addition, therapy is required to eliminate signs of impairment.

Interactions with other drugs

A non-recommended combination is alcohol. In particular, the risk of developing lactic acidosis is high during acute alcohol poisoning, which is combined with liver failure, starvation or malnutrition. In the period of treatment, Langerin is required to abandon alcoholic beverages and medicines that contain alcohol.

Contrast medications containing iodine - in case of combination with them, the probability of developing liver failure is likely to increase, which will result in the accumulation of metformin and increase the risk of lactic acidosis.

The use of metformin should be discontinued 48 hours before the examination, and then not renewed for at least 48 hours after the end of the procedure, and begin only after the renal function has been evaluated.

It is necessary to avoid the combination with danazolum in order to prevent the hyperglycemic effect from using the latter. If you refuse to use danazol impossible, you need to adjust the dosages of metformin during the treatment and at the end of it, and also monitor the glycemic parameters.

Hyperglycemic effect has diuretics, SCS with local and systemic effects, as well as β-2-sympathomimetics. It is necessary to warn patients about it, and to evaluate the glycemia as often as possible, especially at the initial stage of using these medicines. During the period of the combined course, and also at its completion, it is necessary to adjust the dose size of Langerin, taking into account the glucose values.

ACE inhibitors can reduce the glycemic index. If necessary, it is necessary to adjust the dosage size of the antidiabetic drug in case of combination with this drug or when it is abolished.

High doses of chlorpromazine (100 mg per day) increase the sugar index, weakening the insulin release. In cases of using neuroleptics, and in addition, after the abolition of these drugs, you need to adjust the dosage of Langerin, controlling the glycemic index.

Storage conditions

The medicine does not need special storage conditions. It should not be accessible to young children.

Shelf life

Langerin is allowed to be used within 5 years from the date of release of the drug.