Comet 500500mg

Introduction

Comet 500 is a medicine used to treat type 2 diabetes mellitus. It helps control blood sugar levels and thus prevent serious complications of diabetes. It is also used to treat menstruation related disorder known as Polycystic ovary syndrome (PCOS) in women. Comet 500 is best taken with food to avoid nausea and abdominal pain. You should take it regularly, at the same time each day, to get the most benefit. You should not stop taking this medicine unless your doctor recommends it. Your lifestyle plays a big part in controlling diabetes. Therefore, it is important to stay on the diet and exercise program recommended by your doctor while taking this medicine. The most common side effects of this medicine include nausea, vomiting, taste change, diarrhea, abdominal pain and loss of appetite. Some people may develop hypoglycemia (low blood sugar level) when this medicine is taken along with other antidiabetic medicines, alcohol or upon skipping a meal. Monitor your blood sugar levels regularly while taking it. Before taking this medicine, inform your doctor if you have any kidney, liver or heart problems. Pregnant or breastfeeding women should also consult their doctor before taking it. Your doctor will check your kidney function tests before starting treatment with it. Avoid excessive alcohol intake while taking it as this may increase the risk of developing some side effects.

Uses of Comet 500

• Type 2 diabetes mellitus

Side effects of Comet 500

• Nausea
• Vomiting
• Taste change
• Diarrhea
• Abdominal pain
• Loss of appetite

How to use Comet 500

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Comet 500 is to be taken with food.

How Comet 500 works

Comet 500 is an anti-diabetic medication (biguanide). It works by lowering glucose production in the liver, delaying the absorption of sugar (glucose) from the intestines and increasing the body’s sensitivity to insulin.

What if you forget to take Comet 500?

If you miss a dose of Comet 500, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Indication

Type 2 DM, Polycystic ovarian syndrome,

Administration

Should be taken with food.

Adult Dose

Oral Type 2 diabetes mellitus Adult: Conventional preparation: Initially, 500 mg bid or tid, or 850 mg 1-2 times daily, may increase gradually to 2000 mg daily at intervals of at least 1 wk. Maximum daily dose of 2550 mg per day. Modified-release preparation: Initially, 500 mg once daily, may increase in increments of 500 mg at intervals of at least 1 wk to max 2000 mg once daily at night. If glycaemic control is not sufficient, dose may be divided to give 1000 mg bid. Not to exceed 2000 mg/day Polycystic ovary syndrome Initial: 500 mg/day in the morning for 1 wk, then 500 mg twice daily for 1 wk, then 1.5-1.7 g/day in 2-3 divided doses. Elderly: Initial and maintenance dosing should be conservative. Hepatic impairment: Avoid use; risk of lactic acidosis

Child Dose

Oral Type 2 diabetes mellitus Child: >10 yr Initially, 500 mg 1-2 times daily or 850 mg once daily, may increase gradually to max 2000 mg daily in 2 or 3 divided doses at intervals of at least 1 wk.

Renal Dose

Renal impairment Obtain eGFR before starting metformin eGFR <30 mL/min/1.73 m²: Contraindicated eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate treatment Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly) If eGFR falls below 45mL/min/1.73 m² while taking metformin, risks and benefits of continuing therapy should be evaluated If eGFR falls below 30 mL/min/1.73 m²: while taking metformin, discontinue the drug

Contraindication

Acute or chronic metabolic acidosis with or without coma (including diabetic ketoacidosis). Renal failure, severe renal or hepatic impairment, acute conditions which may affect renal function e.g. dehydration, severe infection or shock. Cardiac failure, CHF, IDDM, severe impairment of thyroid function; acute or chronic alcoholism. Acute or chronic diseases which may cause tissue hypoxia e.g. cardiac or respiratory failure, recent MI or shock. Pregnancy, lactation.

Mode of Action

Metformin is a biguanide w/ antihyperglycaemic effects, lowering both basal and postprandial plasma glucose. It decreases hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis; delays intestinal absorption of glucose; and enhances insulin sensitivity by increasing peripheral glucose uptake and utilisation.

Precaution

Caution when used in patients with CHF especially in those with unstable or acute heart failure. Risk of lactic acid accumulation increases with the degree of renal impairment. May need to discontinue treatment in patients with stress-related states e.g. fever, trauma, infection or surgery. Metformin should be temporarily discontinued for 48 hr in patients undergoing radiologic studies involving intravascular admin of iodinated contrast materials. Elderly. Monitor renal function regularly. Because of possibility of hypoglycemia in combination therapy with a sulphonylurea or insulin, diabetic control should be monitored by blood sugar readings. Lactation: Enters breast milk; not recommended

Side Effect

Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of vit B12. Chest discomfort, flushing, palpitation, chills, headache, lightheadedness, indigestion, abdominal discomfort. Potentially Fatal: Lactic acidosis in presence of renal failure and alcoholism. Patients may experience a metallic taste and there may be weight loss, which in some diabetics could be an advantage.

Interaction

Additive effect w/ sulfonylureas. Thiazide diuretics, corticosteroids, phenothiazines, OC, sympathomimetics, niacin, Ca channel blockers and isoniazid may exacerbate loss of glycaemic control. ACE inhibitors may reduce fasting blood glucose concentrations. May increase serum level w/ cimetidine. Potentially Fatal: Concurrent use w/ iodinated contrast agents may increase the risk of metformin-induced lactic acidosis.