Metformin is a well-liked prescription drug that’s used as a first-line therapy for kind 2 diabetes. It’s additionally an energetic ingredient in lots of two- and three-ingredient mixture medicine for diabetes.
Mixture medicine for folks with kind 2 diabetes typically pair metformin with one other drug that has a unique motion within the physique, thereby permitting for a number of strategies of reducing blood glucose ranges.
This text will examine using metformin mixture medicine for kind 2 diabetes and can reply some frequent questions you might need about mixture medicine.
What are mixture medicine?
Mixture medicine, which mix two drugs right into a single capsule, are extra complicated than two separate drugs, every with one remedy.
These medicine mix no less than two totally different energetic substances into one prescription, with every drugs in a particular, predetermined ratio. Every of the 2 (or extra) medicine has a singular mechanism of motion, that means it has its personal set of results on the physique.
Mixture medicine could also be authorised for a number of causes, together with that there could also be a synergistic impact — that means that the impact of the 2 medicine when mixed is best than it will be if the 2 medicine had been taken individually.
Mixture medicine also can simplify remedy administration by decreasing the variety of drugs an individual must take, making it simpler to maintain observe of their routine.
Mixture medicine, formally recognized by the U.S. Meals and Drug Administration (FDA) as “fixed-dose mixture medicine” (or FDCs), first started coming to market in important numbers within the Eighties in america and actually accelerated in reputation via the mid-Nineties.
What’s the greatest mixture with metformin?
Simply by itself, metformin is available in many manufacturers and is taken day by day as an oral capsule, usually a couple of times every day.
Metformin helps to handle blood sugar ranges by lowering the quantity of glucose the liver produces, reducing the quantity of glucose absorbed from the gastrointestinal tract, and decreasing insulin resistance (a situation by which the physique doesn’t use insulin effectively). It may possibly even assist with weight reduction.
Study extra in: Metformin and Weight Loss: Can a Capsule Assist You Lose Weight?
Nevertheless, metformin just isn’t at all times efficient sufficient by itself. In these circumstances, a healthcare supplier might advocate including a second remedy to the therapy routine.
That is typically within the type of a fixed-dose mixture drug (a single capsule containing two or extra drugs at particular doses).
Docs contemplate many elements when figuring out which metformin mixture drug will greatest assist an individual handle their kind 2 diabetes. It might be essential to attempt a couple of mixture drug earlier than discovering the one which greatest meets your blood sugar and different well being targets whereas minimizing unintended effects.
Medicines that mix metformin with SGLT-2 inhibitors (a category of kind 2 diabetes medicine first authorised in 2013) are each generally prescribed and are backed by strong proof.
These mixture medicine, which embrace pairings with empagliflozin (model names Synjardy and Synjardy XR), dapagliflozin (Xigduo XR), and ertugliflozin (Segluromet), work by serving to the kidneys to excrete extra glucose via the urine, which reduces total blood glucose ranges.
Metformin and SGLT2 mixture medicine have been proven to supply a bigger HbA1c discount than simply metformin alone, and analysis in folks with diabetes has additionally indicated a number of the medicines on this class of mixture medicine cut back the danger of coronary heart assault and different critical coronary heart circumstances when in comparison with taking metformin by itself.
Different less-common mixture medicine which have been proven to be extremely efficient in lowering HbA1c ranges are “triple mixture therapies” that embrace metformin plus a DPP-4 inhibitor and a sulfonylurea (two extra lessons of kind 2 diabetes remedy).
Small-scale trials with this triple mixture drug yielded important HbA1c enhancements. Subsequent triple-combination trials utilizing different energetic substances have proven broader effectiveness for bigger teams of individuals with kind 2 diabetes.
In large-scale trials, triple mixture medicine comparable to Trijardy (which mixes empagliflozin, linagliptin, and metformin) have been proven to enhance HbA1c ranges by greater than 1.1% in comparison with taking metformin alone.
You will need to observe that whereas triple mixture medicine (or another sort of mixture drug) may be an efficient means to assist handle blood sugar ranges, they aren’t proper for everybody.
A health care provider or different medical supplier will consider if these medicine are acceptable for you and if the advantages outweigh any of the potential unintended effects.
Which antidiabetic medicine may be taken together with metformin?
There’s a distinction between what medicine may be taken on the similar time as metformin and what medicine may be taken as a mixture drug with metformin.
Metformin is mostly well-tolerated and may be taken with quite a few different medicine if prescribed by your physician. It’s at all times a good suggestion to inform your medical care group what prescribed drugs you’re taking to ensure there aren’t any surprising interactions.
Although loads of different medicine may be taken concurrently metformin, there are solely a handful of metformin mixture medicine which have been authorised.
Metformin mixture medicine checklist
FDA-approved metformin mixture medicine presently obtainable in america embrace:
- ActoPlus Met (metformin and pioglitazone)
- ActoPlus Met XR* (metformin XR and pioglitazone)
- Avandamet (metformin and rosiglitazone)
- Glucovance (metformin and glyburide)
- Invokamet (metformin and canagliflozin)
- Invokamet XR (metformin XR and canagliflozin)
- Janumet (metformin and sitagliptin)
- Janumet XR (metformin XR and sitagliptin)
- Jentadueto (metformin and linagliptin)
- Jentadueto XR (metformin XR and linagliptin)
- Kazano (metformin and alogliptin)
- Kombiglyze XR (metformin XR and saxagliptin)
- Metformin and glipizide (generic variations solely)
- Qternment XR (metformin, saxagliptin, and dapagliflozin)
- Segluromet (metformin and ertugliflozin)
- Synjardy (metformin and empagliflozin)
- Synjardy XR (metformin XR and empagliflozin)
- Xigduo XR (metformin XR and dapagliflozin)
- Trijardy XR (metformin XR, empagliflozin, and linagliptin)
*All the medicine listed above with “XR” embrace an extended-release formulation of metformin, which many individuals discover helps them keep away from gastrointestinal unintended effects and sensitivity that’s frequent with standard-release metformin.
What are the principle advantages of metformin mixture medicine?
Utilizing a metformin combo drug as an alternative of a number of medicines individually can have a wide range of advantages, together with:
- Improved effectiveness of the drugs
- A lower in unintended effects
- Fewer drugs to maintain observe of and a extra manageable therapy routine
- Decrease prescription prices
What’s subsequent if metformin isn’t sufficient to handle kind 2 diabetes?
It may be discouraging in case your blood sugar ranges stay elevated even after taking metformin and making dietary and life-style modifications.
Many individuals with kind 2 diabetes marvel what choices they’ve left if their blood sugar is out of vary even whereas taking metformin, or if it appears like metformin is dropping its effectiveness over time.
Study extra in: Indicators Metformin Is Working (Or Isn’t Working)
As mentioned above, oftentimes a physician will prescribe a metformin mixture drug to enhance blood sugar management.
As a result of these medicine have totally different energetic substances and totally different mechanisms of motion, they typically have “synergistic” results, bringing down your blood sugar greater than taking every drug individually would.
Mixture medicine are additionally thought-about to be the perfect subsequent step after metformin remedy as a result of their unintended effects are effectively understood and are usually much less critical than with different medicine.
A health care provider might also contemplate starting insulin remedy together with metformin.
Insulin is a hormone produced within the pancreas that helps transfer glucose from the blood into the physique’s cells for use for power.
Artificial insulin is normally taken as an injection to complement the physique’s personal insulin (if any continues to be being produced). Insulin is available in many formulations, which broadly embrace rapid-acting (bolus) insulin and long-acting (basal) insulin.
In kind 2 diabetes, insulin remedy tends to assist decrease blood sugar ranges extra rapidly than different drugs, but it surely requires cautious administration and may include important unintended effects, like critical low blood sugar (hypoglycemia), for those who take an excessive amount of insulin without delay.
In case your common blood sugar ranges (as measured by an HbA1c take a look at or long-term use of a steady glucose monitor [CGM]) don’t come down, and for those who’re already taking the utmost really helpful dose of metformin or a mixture drug, then your physician might contemplate insulin remedy.
If metformin alone simply isn’t sufficient to handle your blood sugar, it’s essential to speak with a physician about different choices. Everybody’s wants, response to prescribed drugs, and total medical historical past are totally different, so discussing the professionals and cons of several types of therapy along with your physician is a good place to start out.
Study extra: The Finest Options to Metformin for Sort 2 Diabetes Administration.
Regularly requested questions
What’s the distinction between taking two drugs and taking a mixture drug?
Mixture medicine are available in a single capsule and are prescribed underneath a single prescription. They’ve been examined collectively, and the doses of the 2 (or extra) energetic substances have been calibrated to work collectively.
What’s the distinction between a mixture drug and a mixture remedy?
A mix drug combines two or extra energetic substances right into a single capsule or dose. Mixture remedy makes use of two or extra totally different medicine to deal with a situation and it may possibly additionally contain taking a number of drugs in several methods (e.g., taking a day by day metformin capsule, plus injectable semaglutide [Ozempic] or insulin).
Mixture remedy also can contain using medical gadgets, comparable to insulin pumps.
What drawbacks are there to metformin mixture medicine?
As a result of mixture medicine have mounted ratios of their energetic substances, it might be tougher to regulate the dosages than for those who had been taking metformin and the opposite drug as two separate drugs.
Moreover, as a result of every energetic ingredient additionally has its personal potential unintended effects, rising the variety of energetic substances in a prescription drug typically can enhance the variety of undesirable unintended effects.
See extra in: Metformin Facet Results (Frequent and Severe).
What’s the most secure remedy for kind 2 diabetes?
Pharmacists and medical doctors usually advise that metformin is among the most secure and most studied medicine for managing blood sugar in folks with kind 2 diabetes.
(Nevertheless, it is very important observe that metformin just isn’t appropriate for everybody. As an illustration, its use just isn’t really helpful in folks with sure circumstances, comparable to extreme kidney impairment, metabolic acidosis, or those that have had a hypersensitivity response to it.)
Learn extra in: Is Metformin Protected?
Many metformin mixture medicine even have wonderful security profiles.
Nonetheless, it’s at all times essential to debate therapy choices along with your physician to get individualized steering.
Last ideas
Managing kind 2 diabetes successfully requires a custom-made strategy, contemplating the distinctive well being wants and responses of every individual. Metformin, as a cornerstone of diabetes therapy, provides important advantages, notably when mixed with different drugs.
These mixture therapies provide a extra full and efficient strategy to managing blood glucose, typically main to raised outcomes than utilizing metformin alone.
Nevertheless, it’s essential to do not forget that each therapy plan ought to be as distinctive as the person it serves. What works successfully for one individual might not be your best option for one more.
And whereas metformin mixture medicine have strong proof for controlling blood glucose ranges and promising outcomes concerning cardiovascular advantages, they don’t seem to be with out their potential drawbacks. The issue of constructing dosage changes and the potential unintended effects have to be rigorously weighed in opposition to the advantages.
As with all medical therapy, ongoing dialogue with healthcare professionals and a dedication to private well being targets are key to discovering the best technique for managing kind 2 diabetes.
Advised subsequent article: Every part You Have to Know About Metformin.
