SUGUAN ® - Phenformin + Glibenclamide

SUGUAN ® a drug based on phenformin hydrochloride and glibenclamide

THERAPEUTIC GROUP: Oral hypoglycemic agents - combined therapy


Indications SUGUAN ® - Phenformin + Glibenclamide

SUGUAN ® is used in type 2 diabetic patients to improve glycemic control in case of primary or secondary resistance to sulfonylureas.

Mechanism of action SUGUAN ® - Phenformin + Glibenclamide

SUGUAN ® owes its therapeutic efficacy to the presence of complementary active ingredients such as phenformin and glibenclamide.
The synergistic action of these two compounds allows on the one hand to improve insulin secretion by pancreatic beta cells, facilitating the depolarization of the plasma membrane and the entry of calcium ions useful for releasing the hormone into the circulation (effect of sulfonylureas-glibenclamide ) and on the other hand to improve the uptake of glucose by peripheral tissues by increasing the exposure of GLUT4, and at the same time reducing the activation of those biochemical processes, such as gluconeogenesis and glycogenolysis, capable of increasing blood concentrations glucose (effect of biguanides - phenformin).
The efficacy of the therapy is also supported by the ease of taking the drug, which predisposes the patient to follow medical recommendations.
In fact, both active ingredients can be easily administered orally.

Studies carried out and clinical efficacy

1. SECONDARY FAILURE OF THERAPY WITH ORAL HYPOGLYCEMISING

J Assoc Physicians India. 2002 May; 50: 641-6.

Response of regimens of insulin therapy in type 2 diabetes mellitus subjects with secondary failure.

Zargar AH, Masoodi SR, Laway BA, Wani AI, Bashir MI.


Even when the combined therapy between glibenclamide and phenformin does not produce the expected results, the glycemic control in the second type diabetic patient is entrusted to the administration of insulin alone, which seems to be able to guarantee good glycemic control even in the long term.


2. EFFECTIVENESS OF COMBINED THERAPY


Acta Diabetol Lat. 1990 Jan-Mar; 27: 11-22.

Comparative study of the therapeutic effects of glibenclamide or the fixed combination of glibenclamide-phenformin with those of gliclazide or chlorpropamide.

Raptis AE, Tountas N, Yalouris AG, Hadjidakis D, Zaharis A, Miras K, Raptis SA.


The combined therapy between sulfonylureas and biguanides, ie glibenclamide and phenformin, has proved particularly effective, in this study conducted on about 500 patients with type II diabetes, in ensuring good glycemic control, without the onset of serious side effects.


3. OVERDOSE

Vet Hum Toxicol. 1991 Jun; 33: 256-8.

Acute oral hypoglycemic ingestions.

Erickson T, Arora A, Lebby TI, Lipscomb JW, Leikin JB.


The overdose of oral hypoglycemic agents has proved to be very frequent, especially in the adolescent period, with consequent hypoglycemia, sometimes with a dangerous course. Fortunately, despite the serious symptoms, the number of deaths from hypoglycemic overdose remains insignificant.

Method of use and dosage

SUGUAN ® 25 mg tablets of phenoform and 2.5 mg of glibenclamide:
SUGUAN ® therapy should begin with ½ tablet per day, to be subsequently increased following poor glycemic control.
It is therefore important that the doctor carefully evaluates the patient's glycemic profile and also based on this, establishes the best dosage within the 3 daily tablets.

SUGUAN ® warnings - Phenformin + Glibenclamide

The entire treatment period with SUGUAN ® must be accompanied by a balanced diet and a healthy lifestyle marked by periodic monitoring of liver, kidney, heart and metabolic function, to avoid the onset of serious side effects and at the same time guarantee maximum therapeutic efficacy.
The success of the therapy also derives from the correct management of the doctor-patient relationship which must clarify the disease, the management of the disease and those warning signs, which may precede the appearance of serious side effects such as hypoglycemic crises and lactic acidosis.
Before surgery, in the course of infectious diseases and febrile states, trauma or serious pathologies, it would be advisable to shift the hypoglycemic therapy towards insulin, in order to maintain good glycemic control.
SUGUAN ® contains lactose, therefore it could be associated with the appearance of unpleasant side effects in patients with lactase deficiency, lactose intolerance or galactose / glucose malabsorption.

PREGNANCY AND BREASTFEEDING

Gestational diabetes is a fairly frequent condition in pregnancy, which can have serious repercussions on the health of the fetus, and therefore must be treated in the best way.
In this regard, therefore, it is preferred in these cases to intervene with well-characterized drugs such as insulin, and with the best safety profile, without compromising the development of the fetus.

Interactions

The interactions described for SUGUAN ® are evidently associated with the presence of glibenclamide and phenformin.
Consequently, the intake of dicumarol and derivatives, MAO inhibitors, phenylbutazone and derivatives, chloramphenicol, probenecid, cyclophosphamide, salicylates, adrenals, corticosteroids, oral contraceptives and thiazide diuretics could alter the normal pharmacokinetic properties of glibenclamide, while alcohol, glucorticoids , diuretics and ACE inhibitors could alter the therapeutic capabilities of phenformin.
It is also important to remember that the administration of iodinated contrast media could reduce renal function, resulting in an accumulation of phenformin potentially toxic to the patient's health.

Contraindications SUGUAN ® - Phenformin + Glibenclamide

SUGUAN ® contraindicated in case of impaired liver and kidney function, fasting, diabetic keto acidosis, diabetic pre coma, alcoholism, cardiovascular diseases, dystrophic diseases, acute bleeding and gangrene.
SUGUAN ® is contraindicated in case of hypersensitivity to the active ingredients or excipients, and during the period of pregnancy and lactation.

Undesirable Effects - Side Effects

Several clinical trials and careful post-marketing monitoring seem to agree on the good tolerability of SUGUAN ® therapy.
In fact, the most common side effects include gastrointestinal reactions such as nausea, vomiting, diarrhea, dermatological reactions due to hypersensitivity to the active ingredient and headache.
Clinically relevant adverse reactions such as hypoglycemia or lactic acidosis, have been observed only in a few cases, in predisposed patients or following excessive doses of the drug or inadequate diets.

Note

SUGUAN ® sold only under medical prescription.


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