Lim Tablet

Introduction

Lim Tablet 2.5 mg+500 mg is a combination medication used to treat type 2 diabetes. The medication is a combination of the oral medications linagliptin and metformin hydrochloride. Linagliptin belongs to a class of medicines known as dipeptidyl peptidase-4 (DPP-4) inhibitors, and helps lower blood sugar levels by increasing insulin release from the pancreas and decreasing glucose production in the liver. Metformin hydrochloride belongs to a class of medicines known as biguanides, and helps lower blood sugar levels by decreasing absorption of glucose from the intestine, and decreasing glucose production in the liver.

Uses for

Lim Tablet 2.5 mg+500 mg is used to treat type 2 diabetes in adult patients aged 18 years and older who are inadequately controlled by diet and exercise alone. It is also used to improve glycemic control in adult patients with type 2 diabetes who are using a combination of linagliptin and metformin hydrochloride as separate tablets, and who have not achieved sufficient glycemic control on this combination therapy.

Brand Name	Lim
Type	Tablet
Weight	2.5 mg+500 mg
Generic	Linagliptin + Metformin Hydrochloride
Manufacturer	Benham Pharmaceuticals Ltd.
Available in	English বাংলা

Mechanism of Action

Linagliptin belongs to a class of medicines known as dipeptidyl peptidase-4 (DPP-4) inhibitors. It increases insulin release from the pancreas and decreases glucose production in the liver, which helps lower blood sugar levels. Metformin hydrochloride belongs to a class of medicines known as biguanides. It decreases absorption of glucose from the intestine, and also decreases glucose production in the liver, which helps lower blood sugar levels. The combination of linagliptin + metformin hydrochloride helps to improve glycemic control in patients with type 2 diabetes by lowering fasting and post-meal plasma glucose levels.

How Long Does it Take to Work?

Lim Tablet 2.5 mg+500 mg begins to take effect within 1–2 weeks of starting therapy, and the maximum therapeutic effect occurs after 8–10 weeks.

Absorption

Linagliptin is rapidly absorbed after oral administration, with peak plasma concentrations being reached in 1–3 hours. Metformin hydrochloride is absorbed slowly and the systemic bioavailability is low. Peak plasma concentrations are achieved 4–8 hours after administration.

Route of Elimination

Linagliptin is eliminated primarily through renal excretion, while metformin hydrochloride is eliminated largely through hepatic metabolism.

Dosage

Linagliptin & Metformin immediate release tablet: The dosage of Linagliptin & Metformin should be individualized on the basis of both effectiveness and tolerability. Maximum recommended dose of 2.5 mg Linagliptin and 1000 mg Metformin Hydrochloride twice daily with meals. Dose escalation should be gradual to reduce the gastrointestinal (GI) side effects associated with Metformin Hydrochloride use.

Recommended starting dose: In patients currently not treated with Metformin Hydrochloride, initiate treatment with 2.5 mg Linagliptin and 500 mg Metformin Hydrochloride twice daily.

In patients already treated with Metformin Hydrochloride, start with 2.5 mg Linagliptin and the current dose of Metformin Hydrochloride twice daily.

Patients already treated with Linagliptin and Metformin Hydrochloride, individual components may be switched to this combination containing the same doses of each component.

Linagliptin & Metformin extend release tablet: The dosage of this combination should be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended total daily dose of Linagliptin 5 mg and Metformin Hydrochloride 2000 mg. this combination should be given once daily with a meal.

Recommended starting dose: In patients currently not treated with metformin, initiate this combination treatment with 5 mg Linagliptin/1000 mg Metformin Hydrochloride extended-release once daily with a meal.

In patients already treated with Metformin, start this combination with 5 mg of Linagliptin total daily dose and a similar total daily dose of Metformin once daily with a meal.

In patients already treated with Linagliptin & Metformin immediate release tablet, switch to extend release tablet containing 5 mg of Linagliptin total daily dose and a similar total daily dose of Metformin once daily with a meal.

5 mg Linagliptin & 1000 mg Metformin Hydrochloride extended-release tablet should be taken as a single tablet once daily. Patients using 2.5 mg Linagliptin & 1000 mg Metformin extended release tablets should take two tablets together once daily. The recommended adult dosage is 1 tablet taken orally once a day, with or without food. If a dose is missed, the patient should take the next dose as soon as possible, unless it is almost time for the next dose. The patient should not double the dose.

Administration

Lim Tablet 2.5 mg+500 mg should be taken orally, with or without food.

Side Effects

Patients taking linagliptin + metformin hydrochloride may experience common side effects such as headache, nausea, vomiting, abdominal pain, dizziness, and weakness. In rare cases, patients may experience serious side effects including lactic acidosis, pancreatitis, and allergic reactions.

Toxicity

Linagliptin has low potential for toxicity due to its rapid elimination from the body. Overdose of linagliptin may lead to increased levels of biomarkers of inflammation and renal impairment. Metformin hydrochloride has a medium potential for toxicity due to its slow elimination from the body. Overdose of metformin hydrochloride may lead to lactic acidosis.

Precautions

Patients should inform their healthcare provider if they have any of the following conditions before beginning therapy with linagliptin + metformin hydrochloride: kidney or liver disease; heart disease; breathing problems; low blood sugar; diabetes-related eye problems; history of pancreatitis; alcohol abuse; or if they are pregnant or nursing.

Interactions

Lim Tablet 2.5 mg+500 mg may interact with certain medications, including non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, and drugs used that contain alcohol. Patients should inform their healthcare provider of all their current medications before beginning therapy with linagliptin + metformin hydrochloride.

Disease Interactions

Lim Tablet 2.5 mg+500 mg should not be used in patients with type 1 diabetes, and should be used with caution in patients with kidney or liver disease, heart disease, or breathing problems.

Drug Interactions

Food Interactions

Lim Tablet 2.5 mg+500 mg should be taken with food or without food.

Pregnancy Use

Lim Tablet 2.5 mg+500 mg is not recommended for use in pregnant women.

Lactation Use

Lim Tablet 2.5 mg+500 mg is not recommended for use in nursing mothers.

Acute Overdose

There is no specific antidotal therapy for an overdose with linagliptin + metformin hydrochloride. If an overdose is suspected, the patient should seek medical treatment immediately.

Contraindications

Lim Tablet 2.5 mg+500 mg is contraindicated in patients with type 1 diabetes and when hypersensitivity to linagliptin or metformin hydrochloride is present.

Use Directions

Lim Tablet 2.5 mg+500 mg should be taken once a day, with or without food. If a dose is missed, the patient should take the next dose as soon as possible, unless it is almost time for the next dose. The patient should not double the dose.

Storage Conditions

Lim Tablet 2.5 mg+500 mg should be stored at 20–25°C in original container.

Volume of Distribution

The volume of distribution of linagliptin is approximately 13 liters, and the volume of distribution of metformin hydrochloride is approximately 63 liters.