Diabetology is an actively developing area of medicine. In recent years, many fundamentally new drugs have been developed that facilitate the management of type 2 diabetes. The scientific breakthrough of the last decade is called incretin mimetics that reduce glycated hemoglobin by 1%. At the same time, the diabetic body weight also gradually decreases, and the incretin series does not cause serious consequences of the type of hypoglycemia.
All of these characteristics (neutrality in body weight, the absence of serious adverse effects, high efficiency plus an affordable price) also apply to the traditional antidiabetic drug metformin, which has been in the forefront for the treatment of type 2 diabetes for half a century.
Combined American drug Kombogliz prolong has combined the advantages of metformin and incretin mimetics, and the prolonged form provides ease of use and additional security.
Pharmacological features of the drug
Comboglise prolong is a fixed combination of saxagliptin and metformin, which provides medical and diabetic patients with new opportunities to control the glycemic profile.
Saksagliptin is a representative of incretin drugs. Incretin produces intestines when carbohydrates enter it. There are 2 types of natural hormones: GLP-1 (glucagon-like peptide) and HIP (glucose-dependent insulinotropic polypeptide).
Penetrating into the bloodstream, they 70% stimulate the production of endogenous insulin by the B-cells responsible for this process.
In parallel, incretins inhibit glucagon synthesis and inhibit the release of the contents of the stomach, creating an additional effect of saturation.
It has been established that in diabetics with type 2 disease, the production of endogenous incretin is deficient due to the fact that hormones are easily destroyed by the enzyme DPP-4 (dipeptidyl peptidase). Incretomimetics inhibit the activity of DPP-4, while maintaining the performance of endogenous incretin. Artificial analogues of GLP-1 lack sensitivity to this aggressive enzyme.
Saksagliptin not only prolongs the life of the incretin, but also contributes to the growth of their number within the physiological norm (maximum - 2 times). Acceptance of an incretin mimetic reduces the rates of both lean and postprandial glycemia. These features of the drug allow to exclude hypoglycemic states.
The antihyperglycemic drug metformin, the only representative of the biguanide group, does not affect b-cells, therefore, insulin secretion does not stimulate and the pancreas does not overload.
He controls the basal fluctuation of glycemia by inhibiting the release of glycogen in the liver by 30%. Metformin blocks the absorption of glucose molecules in the intestine, increases the sensitivity of cell receptors to their own insulin. Accelerating the transport of glucose to the muscles, it increases energy consumption for the needs of the body and reduces the rate of transformation of non-processed sugar into fat.
In metformin with a modified release, there is an additional advantage - a minimum of side effects from the gastrointestinal tract, weight stabilization. Absorbing gastric juice, the shell quickly resolves, the capsule swells and becomes covered with gel. Thanks to this gel matrix, the drug is released evenly throughout the day, providing conditions for maximum absorption.
The combination of incretin mimetic with metformin is recognized by physicians as optimal at any stages of the control of type 2 diabetes. In addition to the convenience of receiving and loyalty of patients to such a treatment regimen, the main criterion is high efficiency and proven safety. For diabetics with obesity, this is the best choice, as the medicine does not contribute to weight gain, development of cardiovascular insufficiency, pancreatitis, oncology.
Release form and composition of Kombiglyze prolong
Antidiabetic medicine American pharmaceutical company Bristol-Myers Squibb releases in the form of tablets in a colored shell with modified capabilities.
Each capsule contains 500 or 1000 mg of the active ingredients of Metformin preparations and 2.5 or 5 mg - Saxagliptin. In addition to the basic ingredients, the composition is supplemented with fillers: magnesium stearate, sodium carmellose, hypromellose. The color of the shell can be yellow, pink or beige, depending on the dosage. Capsules are packaged in blister cells made of aluminum foil. A cardboard box may contain 4-8 such plates.
Release the drug by prescription. At ComboGlise Prolong the price depends on the dosage: 1000 mg + 5 mg (28 tab.) - up to 3250 rubles; 1000 mg + 2.5 mg (56 tab. Per pack) - up to 3130 rubles.
The shelf life of the drug - no more than 3 years. Expired medication must be disposed of. Special conditions for storage of the drug does not require.
Comboglise prolong: instructions for use
The doctor selects the dosage schedule and dosage individually, taking into account the indicators of the glucometer, the general state of health, the age of the diabetic, the individual reaction to the pills. In general, the instruction gives such recommendations.
Prolonged medication usually take 1 p. / Day. at the same time.
Drink a pill in the morning or in the evening, without grinding. For drugs with a modified release, the integrity of the shell plays a special role.
The dosage is individual, as a starting monotherapy it can be 1 tablet (500 mg of metformin + 2.5 mg of saxagliptin), if it is not possible to achieve full glycemic control, the dose is increased to 2 tablets (1000 mg of metformin +5 mg of saxagliptin).
With the simultaneous use of medicines for the treatment of associated diseases, it is necessary to take into account the results of their interaction. In particular, when parallel intake of inhibitors of isoenzymes CYP3A4 / 5 (Indinavira, Ketoconazole, Nefazodone, Itraconazole, Atazanavir), the dosage of saxagliptin is prescribed as minimum - 2.5 mg.
In drugs based on metformin with a prolonged effect of undesirable consequences in the form of dyspeptic disorders, it is much less than that of analogues with a quick release. To make the body adapt to new conditions absolutely painless for the digestive tract, dose titration should be carried out gradually, every 2 weeks.
Any lifestyle changes should be taken into account when correcting the norm of the drug, so it is important to report them to the doctor in a timely manner.
Analogs of Kombiglyce Prolong
For Kombogliza Prolong analogue with the same set of active ingredients can be Kombogliz XR, which is produced in Italy and the UK. Price analog - from 1650 rubles. (28 tablets of 1000 mg of metformin and 2.5 mg of saxagliptin).
Similar therapeutic effect have combined drugs Avandamet, Janumet, Glimekomb, Galvusmet and Bagomet plus.
Medications are prescribed on the basis of a single active ingredient such as Gliformin Prolong, Glucophage, Metadien, Sofamet, Diaformin Hod, Onglizy, Matospanin, Metfohammy, Siofor.
Who shows the medicine
Comboglise prolong is prescribed for type 2 diabetes to normalize glycemic control as an addition to a low carbohydrate diet and adequate physical exertion, if lifestyle modification did not produce the desired results and the combination of saxagliptin with metformin is suitable for the patient.
Absolute and relative contraindications
Even the drug with a high degree of safety, which is Kombogliz prolong, is not prescribed for individual intolerance and hypersensitivity to the ingredients of the formula.
- The medicine is not indicated for pregnant and lactating mothers (they are temporarily transferred to insulin), because of the lack of a sufficient evidence base of effectiveness, it is not prescribed to children.
- The drug is not suitable for diabetics with type 1 disease.
- In case of renal dysfunctions, as well as conditions provoking them, the medicine is also not prescribed.
- Do not use the drug for the treatment of patients with pathologies that cause oxygen starvation of tissues.
- With ketoacidosis (diabetic form) with or without a coma, the medication is temporarily not taken.
- Canceled pills at the time of operations, with severe injuries, extensive burns. An x-ray examination with iodine-containing markers in a diabetic can affect the kidneys, so it is also transferred to insulin. In total, insulin therapy is shown for 48 hours before and 48 hours after the procedure, in particular - it all depends on the condition of the kidneys and the general well-being of the patient.
- Liver pathologies, lactic acidosis and alcohol dependence are also on the list of contraindications. You can not prescribe the drug to patients with genetic intolerance to galactose.
Particular attention should be paid to diabetics of mature age, especially when malnutrition, pancreatitis, and inadequate physical activities that can provoke hypoglycemia.
Potential adverse effects and overdose
Saksagliptin with varying degrees of probability is able to cause states:
- Abdominal pains;
- Urinary tract infections;
- Disorders of bowel movements;
- Edema on the face;
Laboratory studies revealed a deterioration in the absorption of vitamin B12 with prolonged use of the drug, as well as a decrease in the number of lymphocytes. Cases of overdose are rare, often occur with long-term use of saxagliptin. The drug does not cause intoxication, hemodialysis is effective with an excess of the drug. Simultaneously, symptomatic treatment is performed.
An overdose of metformin is more common, the most dangerous complication is lactic acidosis.. Recognize the state can be on such grounds:
- Shortness of breath;
- Abdominal pains;
- Low blood pressure;
- Muscle spasms;
- Heart rhythm disorder.
In a difficult situation, disturbances of consciousness develop, fainting, precoma and coma. The victim needs urgent hospitalization; he may die without adequate medical care. Excess metformin is also removed by hemodialysis, it is important to note that creatinine clearance reaches 170 ml / min.
The more accurately a diabetic fulfills all the recommendations of a doctor, the lower the risk of serious complications. In the case of a prolonged combination, it is not difficult to comply with the medication schedule.
Options for interaction with other medicines
When developing a regimen of treatment with Kombogliz, it is important to warn the endocrinologist about all the drugs that a diabetic takes for the treatment of associated diseases. Some of them are capable of enhancing the hypoglycemic potential of Combioglise, others inhibit its functions.
For a general view, you can navigate the table.
Increased hyperglycemic effect
|Rifampicin, Pioglitazone, magnesium and aluminum hydroxides / simethicone||GKS, diuretics, nicotinic acid|
thyroid hormones, Isoniazid, sympathomimetics, phenothiazines, estrogens, phenytoin, calcium channel blockers
Provoke hypoglycemic states
|Amprenavir, Diltiazem, Erythromycin, Fluconazole, Aprepitant, Verapamil, grapefruit juice, Ketoconazole, sulfonylurea drugs, Glibenclamide, Ketoconazole, CYP3A 4/5 isoenzymes, Famotidine||Cationic agents, Furosemide, ethanol-based drugs, Nifedipine|
Amprenavir, Diltiazem, Erythromycin, Fluconazole, Aprepitant, Verapamil, grapefruit juice, Ketoconazole, sulfonylurea drugs, Glibenclamide, Ketoconazole, CYP3A 4/5 isoenzymes, Famotidine
Cationic agents, Furosemide, ethanol-based drugs, Nifedipine
It is obvious that experiments with self-diagnosis and self-treatment with Komboglizom prolong can have serious consequences for health.
Kombogliz prolong: reviews of diabetics
Doctors who observe the efficacy of treatment with Kombogliz prolong medication, note its uniqueness, diabetics also have no doubt about its capabilities.
Full diabetes management involves an integrated approach: low-carb split meals, daily monitoring of the meter, adequate physical exercise, and medication support. Only in such a combination can we count on the 100% effect of Kombogliz prolong.
In the video, Professor Endocrinologist A.S. Ametov talks about modern principles of management of type 2 diabetes.