Istamet D Ir 5/50/1000

Dapagliflozin 5 mg + Sitagliptin 50 mg + Metformin Hydrochloride 1000 mg (Immediate-release) per tablet

Type 2 diabetes mellitus: to improve glycaemic control as an adjunct to diet and exercise when treatment with these medicines is appropriate.

Metformin decreases hepatic glucose production and improves insulin sensitivity. Sitagliptin (a DPP-4 inhibitor) increases incretin levels, enhancing glucose-dependent insulin release and reducing glucagon. Dapagliflozin (an SGLT2 inhibitor) increases urinary glucose excretion by blocking glucose reabsorption in the kidney.

Oral tablet (IR). Take as prescribed by your doctor, usually with meals to reduce stomach upset. Swallow whole with water; do not crush/chew. Maintain adequate hydration; follow diet/exercise advice and monitor blood glucose.

Nausea,diarrhoea,abdominal pain,loss of appetite,headache,upper respiratory tract infection,nasopharyngitis,urinary tract infection,genital fungal infection,increased urination,dizziness

Prescription-only antidiabetic. Risk of lactic acidosis with metformin (higher in kidney/liver impairment, dehydration, heavy alcohol use, severe infection, hypoxia); stop and seek care if unexplained tiredness, muscle pain, fast breathing, abdominal pain occur. Dapagliflozin may cause dehydration/low blood pressure, genital infections, UTI, ketoacidosis (can occur with normal sugars), and rare Fournier’s gangrene—seek urgent help for severe nausea/vomiting, abdominal pain, rapid breathing, genital/perineal pain/swelling/fever. Sitagliptin: rare pancreatitis and hypersensitivity. Monitor kidney function; dose/therapy adjustments may be needed in renal impairment. Temporarily withhold around major surgery/acute illness and before iodinated contrast as advised by doctor. Not for type 1 diabetes or diabetic ketoacidosis.

Insulin/sulfonylureas (increased hypoglycaemia risk),diuretics and antihypertensives (increased dehydration/hypotension),alcohol (increases lactic acidosis risk),iodinated contrast media (risk of lactic acidosis—temporary stoppage of metformin),cimetidine (may increase metformin levels),digoxin (sitagliptin may increase digoxin levels),carbonic anhydrase inhibitors e.g. topiramate/acetazolamide (increased acidosis risk),NSAIDs/ACE inhibitors/ARBs (may affect kidney function—monitor),other SGLT2 inhibitors or DPP-4 inhibitors (duplicate therapy)

Store below 25°C in a cool, dry place. Protect from moisture and direct light. Keep out of reach of children.

Istamet D IR 5/50/1000 Tablet,Glyxambi-M 5/50/1000 Tablet (where available),Kombiglyze XR + Dapagliflozin equivalent combinations (brand varies),Janumet 50/1000 + dapagliflozin add-on (separate products),Sitagliptin + metformin + dapagliflozin combination tablets (brand varies)