What is Zipmet pill for?

Zipmet is a brand name of one of the products of Obeid Pharmaceutical Company, which is made from the combination of Metformin and Sitagliptin. Zipmet is mainly used to control blood sugar in adults with type 2 diabetes. Outside of Iran, this drug is known under the brand name Janumet or Janumet-Rx. Zipmet belongs to the drug class of antidiabetics, biguanide/dipeptyl peptidase-IV inhibitors.

Zipmet dosage forms

Zipmet is generally produced and supplied in two pharmaceutical forms and with limited doses. One form of this drug is in the form of regular tablets, and the other form is continuous release or long-acting. Sustained-release drugs refer to those drugs that, due to the special compounds used in their production, the release of their active ingredients occurs at a low speed, and therefore their duration of effect is longer, and as a result, the number of times the drug is used is less, or in other words, The intervals between taking the medicine are longer. The following table provides the pharmaceutical information of Zipmet.

Uses of Zipmet

Zipmet is a prescription drug (non-prescription) that is used to lower blood sugar in adult patients with type 2 diabetes along with a specific exercise program and specific diet.

Pharmacological effects and mechanism of action of Zipmet

The pharmacological effects and mechanism of action are as follows:

The mechanism of action

· Sitagliptin:

It is an inhibitor of dipeptidyl peptidase 4 (DPP-4) in such a way that by deactivating the DPP-4 enzyme, it increases and prolongs the activity of the incretin hormone. Incretins increase insulin secretion and synthesis from pancreatic beta cells and decrease glucagon secretion from alpha pancreatic cells.

· Metformin:

alienate; By reducing endogenous hepatic glucose production, reducing intestinal absorption of glucose, and finally by increasing peripheral absorption and use of glucose, it leads to improved insulin sensitivity. Biguanide improves glucose tolerance and reduces basal and postprandial plasma glucose.

attraction

Mean AUC: 8.52 μM/h (single oral dose of 100 mg)

Maximum plasma concentration: The maximum drug concentration in plasma is equal to 950 nanomolar (a single oral dose of 100 mg).

Maximum plasma time: Sitagliptin reaches the maximum concentration of the drug in plasma between 1 and 4 hours.

Bioavailability: The bioavailability or absorbable percentage of the drug is approximately 87%.

Bioavailability: approximately 50-60%.

Stability: Metformin can remain stable for 24 to 48 hours under different environmental conditions and maintain its medicinal properties.

Food decreases and slightly delays the absorption of metformin (approximately 40% lower mean peak plasma concentration, 25% lower AUC, and 35 min delay in peak plasma time after an 850 mg dose with food, compared with fasting ).

Dosage of Zimpet

Zipmet doses vary for each patient, but in general should not exceed 100 mg sitagliptin/2000 mg metformin. Usually, the recommended starting dose is 50 mg sitagliptin/500 mg metformin. Patients should take Zipmet twice daily with food, and dose increases should be gradual to minimize gastrointestinal side effects of metformin.

If the patient is currently taking metformin, the doctor should continue his treatment with the same drug and the same dose plus 50 mg of sitagliptin. If the patient was already taking 850 mg of metformin, he should continue his treatment as follows: 50 mg of sitagliptin / 1000 mg of metformin.

Time to take Zipmet tablets

A very important point regarding the mechanism of action of Zipment is that this pill must be taken with a meal. The number of doses of this medicine is usually twice a day. The general recommendation is not to split these pills.

Precautions

Those who use Zipmet are advised to observe the following precautions:

• Take seriously the diet combined with the exercises prescribed by the doctor.
• Measure your blood sugar regularly and inform your doctor about its changes.
• Do not increase or decrease the amount of medicine arbitrarily.
• In case of stress, fever, surgery or injury, consult your doctor to measure blood sugar.
• Have fasting blood sugar, hemoglobin A1C, and kidney function tests while taking this medication.
• See your doctor regularly

2) Metformin may cause a rare but very serious complication called lactic acidosis that can lead to death. Therefore, if you notice the following side effects, stop taking the medicine and contact your doctor immediately:

• Feeling weak and extremely tired – unusual muscle pain – difficulty in breathing
• Stomach or intestinal problems with nausea and vomiting or diarrhea
• Feeling cold, especially in the arm and leg – a feeling of confusion or numbness
• Slow or abnormal heartbeat

3) The possibility of lactic acidosis increases under the following conditions:

• Kidney diseases
• Liver diseases
• Congestive heart failure that requires medical treatment
• Consuming large amounts of alcohol
• Dehydration (loss of large amounts of body fluids) caused by fever, vomiting, or diarrhea. Dehydration can also be caused by excessive sweating during physical activity and exercise and not consuming enough fluids.
• X-ray imaging with or without contrast material
• surgery
• heart attack
• Severe infection

Contraindications for the use of Zipmet

Zipmet should be avoided in the following cases:

• Severe allergic reaction (for example, anaphylaxis, angioedema, etc.) to the sitagliptin/metformin combination or to any of the sitagliptin or metformin drugs.
• Severe renal failure
• Acute/chronic metabolic acidosis, including diabetic ketoacidosis

Zipmet side effects

The use of this drug, like any other drug, may be accompanied by unwanted side effects. If you experience any of the following after taking Zipmet, stop using the drug and discuss the matter with your doctor.

• Abdominal pain (probability rate: 2%)
• Diarrhea (probability: 4%)
• Hypoglycemia (probability rate: 2.1%)
• Nausea (probability rate: 1.3%)
• Vomiting (probability rate: 1.1%)

In the following cases, the probability is not known:

• Scalp peeling disorder
• Lactic acidosis (rare)

The complications mentioned above were observed in some patients during clinical trials. Listed below are other possible side effects based on post-marketing reviews and pharmacy reports:

• Hypersensitivity reactions include anaphylaxis, angioedema, rash, urticaria, cutaneous vasculitis, and exfoliative skin conditions including Stevens-Johnson syndrome.
• Upper respiratory tract infection
• Increased liver enzymes
• Acute pancreatitis including fatal and non-fatal hemorrhagic and necrotizing pancreatitis
• Digestive system: constipation, vomiting
• Neurological: headache
• Rhabdomyolysis
• Worsening of kidney function, including acute kidney failure (sometimes requiring dialysis)
• Myalgia, pain in limbs and back pain
• Severe debilitating arthralgia
• itching
• Bullous pemphigoid
• Mouth ulcers; stomatitis
• Interstitial tubular nephritis

Zipmet drug interactions

We have divided the drug interactions of this product into three parts.

A) drug interaction:

Zipmet or any of the compounds used in it have the following drug interactions. If you are taking any of these drugs, be sure to inform your doctor before prescribing Zipmet.

• digoxin
• Carbonic anhydrase inhibitors such as topiramate, zonisamide, acetazolamide, or dichlorphenamide may increase the risk of lactic acidosis.
• Insulin may increase the risk of low blood sugar
• Some drugs (eg, thiazides, corticosteroids) tend to cause hyperglycemia and may lead to loss of glycemic control.

b) disease interference:

Zipmet interacts with 6 types of diseases listed below. If you suffer from any of these diseases, be sure to inform your doctor before taking Zipmet.

• Pancreatitis
• Lactic acidosis
• Cardiovascular problems
• Kidney dysfunction
• hypoglycemia
• B12 deficiency

c) Food interference:

Regarding food and alcohol, we have the following topics

1. Alcohol

Avoid alcohol in general: Alcohol can enhance the effect of metformin on lactate metabolism and increase the risk of lactic acidosis. In addition, alcohol may cause hypoglycemia or hyperglycemia in diabetic patients. Although hypoglycemia may rarely occur during metformin therapy, the risk of this complication increases with alcohol consumption. Even small amounts can significantly lower blood sugar, especially when alcohol is consumed on an empty stomach or after exercise.

This mechanism involves the inhibition of gluconeogenesis as well as the counterregulatory response to hypoglycemia. Hypoglycemic episodes may last 8 to 12 hours after ethanol ingestion. On the other hand, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption does not usually affect blood glucose levels in patients with controlled diabetes.

2. Food

Food may have different effects on the absorption of metformin in any of the drugs with immediate-release or extended-release formulations. When an 850 mg dose of immediate-release metformin is administered with food, the mean peak plasma concentration and systemic exposure are reduced by 40% and 25%, respectively. In addition, the time to reach the maximum plasma concentration reaches 35 minutes compared to administration in fasting conditions. In contrast, administration of extended-release metformin with food (fat or nonfat) increases systemic exposure by 50% without affecting peak plasma concentration or time to peak plasma concentration. In any case, metformin should be taken with meals and the necessary precautions and side effects should be carefully monitored. This information may not be true for formulations containing metformin with other oral antidiabetic agents.

Use of Zipmet during pregnancy and breastfeeding

Pregnancy and breastfeeding each have their own issues

A) Pregnancy

Published studies of Zipmet use during pregnancy have not reported a clear association with the drug and major birth defects or risks of miscarriage. According to clinical studies, if diabetes is not controlled during pregnancy, the risk of developing diabetic ketoacidosis, preeclampsia, spontaneous abortion, premature birth, stillbirth, and birth complications increases. Uncontrolled diabetes also increases the risk of major birth defects. It also increases stillbirths and complications related to macrosomia.

b) breastfeeding

Regarding the use of this drug during breastfeeding, there is no information about the penetration of the drug into the milk or its effect on the infant, but these effects have been seen in experiments on animals. According to the available data, sitagliptin is excreted in the milk of rats, and therefore the same is likely to be the case in humans. Regarding metformin, limited published studies report the presence of the drug in human milk. However, there have been no reports of adverse effects in infants exposed to metformin. In addition, information about the effects of the drug on the amount and quality of milk production is not available.

Zipmet storage conditions

Store at a temperature below 30 degrees.

Zipmet compounds

Sitagliptin and metformin

A final word about Zipmet tablets

Zipmet, as stated in this article from the online pharmacy magazine Positive Green, is a drug used to lower blood sugar in adult patients with type 2 diabetes. This drug is one of the most sensitive drugs that should be used with utmost seriousness both in the type of use (in terms of time, method, dose, etc.) and in the diet and exercise program recommended by the doctor.

Like any other drug, Zipmet may have side effects. Since some side effects including lactic acidosis (the presence of lactic acid in the blood) can be very dangerous and even fatal, therefore, it is very necessary for patients to pay close attention to medical recommendations and strictly observe the relevant points, continuously monitor Monitor your blood sugar level and keep in constant contact with your doctor, and share any new cases or possible complications with your doctor.

Site source: Medscape