Siglimet XR 50/500 500 mg + 50 mg Er Tablet

Siglimet XR 50/500 500 mg + 50 mg er tablet is a combination diabetes medicine from Square Pharmaceuticals PLC, Pabna. Each dose provides two proven blood-sugar-lowering medicines — sitagliptin, a DPP-4 inhibitor, and metformin hydrochloride, a biguanide — in a single er tablet, which makes daily treatment simpler for adults with type 2 diabetes.

The two ingredients work in complementary ways. Sitagliptin protects the body's natural incretin hormones, helping the pancreas release more insulin after meals and reducing sugar production by the liver. Metformin lowers the amount of glucose the liver makes, slows sugar absorption from the gut and helps the body's cells respond better to insulin. Together they control blood sugar more effectively than either medicine alone, without promoting weight gain.

Siglimet XR 50/500 is prescribed for adults with type 2 diabetes mellitus, along with diet and exercise, when:

• Blood sugar is not adequately controlled with metformin alone at the highest tolerated dose
• The patient is already taking sitagliptin and metformin as separate tablets and a single combined er tablet is more convenient
• It is used together with a sulfonylurea or insulin under medical supervision, when extra control is needed

Siglimet XR 50/500 is not used for type 1 diabetes or diabetic ketoacidosis. Whether this combination suits you depends on your kidney function, other illnesses and current medicines — your doctor will decide.

Siglimet XR 50/500 is usually taken twice daily with meals — taking it with food greatly reduces the stomach upset caused by metformin. The strength is chosen by your doctor based on your current metformin dose, blood sugar levels and kidney function, so never select or change the strength yourself.

• Swallow the er tablet whole with a glass of water; do not crush or chew it.
• If you miss a dose, take it with your next meal when you remember; if it is almost time for the next dose, skip the missed one.
• Never take a double dose, and never stop the medicine on your own.

Common side effects, mostly from the metformin part, include nausea, vomiting, diarrhoea, stomach pain, gas, loss of appetite and a metallic taste. These usually appear at the start and settle within days to weeks, especially when the medicine is taken with meals. Other possible effects:

• Low blood sugar when combined with a sulfonylurea or insulin
• Vitamin B12 deficiency with long-term use — periodic blood tests may be advised
• Headache, dizziness, skin rash or itching

Rare but serious: pancreatitis (severe persistent stomach pain) and lactic acidosis — unusual muscle pain, difficulty breathing, severe weakness, stomach pain with vomiting, feeling unusually cold or drowsy. Lactic acidosis is a medical emergency; go to hospital immediately.

Your kidney function should be tested before starting Siglimet XR 50/500 and regularly afterwards, because metformin builds up when the kidneys are weak. Also important:

• During severe vomiting, diarrhoea, high fever or any illness causing dehydration, contact your doctor — the medicine may need a temporary pause.
• Tell every doctor you take Siglimet XR 50/500 before any X-ray or CT scan using contrast dye, or major surgery; metformin is usually paused around these procedures.
• Avoid heavy alcohol use, which raises the risk of lactic acidosis and low blood sugar.
• Keep glucose or sweets handy if you also take insulin or a sulfonylurea.

Do not stop Siglimet XR 50/500 on your own, even when you feel well.

Tell your doctor and pharmacist about all medicines you use, including herbal and over-the-counter products. Key interactions of Siglimet XR 50/500:

• Alcohol — increases the risk of lactic acidosis; avoid binge drinking.
• Iodinated contrast dye used in some scans — the medicine is usually paused before and after the scan.
• Medicines that can strain the kidneys — NSAID painkillers (e.g. diclofenac, ibuprofen), some blood pressure medicines (ACE inhibitors, ARBs) and diuretics — may need extra monitoring.
• Insulin and sulfonylureas increase the risk of low blood sugar; doses may be adjusted.
• Cimetidine and some other drugs can raise metformin levels, and sitagliptin can slightly raise digoxin levels.

Do not take Siglimet XR 50/500 if you have:

• Allergy to sitagliptin, metformin or any ingredient, or a previous serious reaction to a DPP-4 inhibitor
• Severely reduced kidney function or are on dialysis
• Metabolic acidosis, including diabetic ketoacidosis
• Severe dehydration, severe infection or shock
• Conditions that lower oxygen supply to tissues, such as recent heart attack, uncontrolled heart failure or severe breathing problems
• Severe liver disease or alcohol dependence

Siglimet XR 50/500 is not for type 1 diabetes. If any of these apply to you, your doctor will choose a different treatment.

Siglimet XR 50/500 is generally not recommended during pregnancy. Most pregnant women with diabetes are switched to insulin, which controls blood sugar precisely and has the best safety record for the baby. If you become pregnant or plan a pregnancy while taking Siglimet XR 50/500, inform your doctor promptly — do not stop the medicine suddenly on your own, as high blood sugar also harms the baby.

Metformin passes into breast milk in small amounts, and there is little data for sitagliptin. Whether you can breastfeed while using this combination should be decided by your doctor after weighing the benefits and risks.

Store Siglimet XR 50/500 below 30°C in a cool, dry place, protected from direct sunlight and moisture. Keep the er tablet in its original blister or container until use — do not store loose tablets in pockets, purses or pill boxes for long periods, and avoid the bathroom or kitchen where humidity is high.

• Keep all medicines out of the reach and sight of children.
• Do not use after the expiry date printed on the pack.
• Return unused or expired medicine to a pharmacy where possible instead of throwing it in household waste.