Patient leaflet - Sitagliptin and Metformin Hydrochloride 50 mg/1000 mg film-coated tablets
1. What Sitagliptin and metformin hydrochloride Ascend is and what it is used for
Sitagliptin and metformin hydrochloride Ascend contains two different medicines called sitagliptin and metformin.
sitagliptin belongs to a class of medicines
called DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors)
metformin belongs to a class of medicines
called biguanides.
They work together to control blood sugar levels in adult patients with a form of diabetes called 'type 2 diabetes mellitus'. This medicine helps to increase the levels of insulin produced after a meal and lowers the amount of sugar made by your body.
Along with diet and exercise, this medicine helps lower your blood sugar. This medicine can be used alone or with certain other medicines for diabetes (insulin, sulphonylureas, or glitazones).
What is type 2 diabetes?
Type 2 diabetes is a condition in which your body does not make enough insulin, and the insulin that your body produces does not work as well as it should. Your body can also make too much sugar.
When this happens, sugar (glucose) builds up in the blood. This can lead to serious medical problems like heart disease, kidney disease, blindness, and amputation.
2. What you need to know before you take Sitagliptin and metformin hydrochloride Ascend
Do not take Sitagliptin and metformin hydrochloride Ascend:
if you are allergic to sitagliptin or metformin
or any of the other ingredients of this medicine (listed in section 6).
if you have severely reduced kidney
function
if you have uncontrolled diabetes, with e.g.
severe hyperglycaemia (high blood glucose), nausea, vomiting, diarrhoea, rapid weight loss, lactic acidosis (see “Risk of lactic acidosis” below) or ketoacidosis. Ketoacidosis is a condition in which substances called 'ketone bodies’ 40 accumulate in the blood and which can
lead to diabetic pre-coma. Symptoms include stomach pain, fast and deep breathing, sleepiness or your breath developing an unusual fruity smell.
if you have a severe infection or are
dehydrated
if you are going to have an X-ray where you
will be injected with a dye. You will need to stop taking Sitagliptin and metformin hydrochloride Ascend at the time of the X-ray and for 2 or more days after as directed by your doctor, depending on how your kidneys are working
if you have recently had a heart attack or
have severe circulatory problems, such as 'shock' or breathing difficulties
- if you have liver problems
if you drink alcohol to excess (either every
day or only from time to time)
- if you are breast-feeding
Do not take Sitagliptin and metformin hydrochloride Ascend if any of the above apply to you and talk with your doctor about other ways of managing your diabetes. If you are not sure, talk to your doctor, pharmacist or nurse before taking Sitagliptin and metformin hydrochloride Ascend.
Warnings and precautions
Cases of inflammation of the pancreas (pancreatitis) have been reported in patients receiving Sitagliptin and metformin
hydrochloride Ascend (see section 4).
If you encounter blistering of the skin it may be a sign for a condition called bullous pemphigoid. Your doctor may ask you to stop Sitagliptin and metformin hydrochloride Ascend.
Risk of lactic acidosis
Sitagliptin and metformin hydrochloride Ascend may cause a very rare, but very serious side effect called lactic acidosis, particularly if your kidneys are not working properly. The risk of developing lactic acidosis is also increased with uncontrolled diabetes, serious infections, prolonged fasting or alcohol intake, dehydration (see further information below), liver problems and any medical conditions in which a part of the body has a reduced supply of oxygen (such as acute severe heart disease).
If any of the above apply to you, talk to your doctor for further instructions.
Stop taking Sitagliptin and metformin hydrochloride Ascend for a short time if you have a condition that may be associated with dehydration (significant loss of body fluids) such as severe vomiting, diarrhoea, fever, exposure to heat or if you drink less fluid than normal. Talk to your doctor for further instructions.
Stop taking Sitagliptin and metformin hydrochloride Ascend and contact a doctor or the nearest hospital immediately if you experience some of the symptoms of lactic acidosis, as this condition may lead to coma. Symptoms of lactic acidosis include:
- vomiting
- stomach ache (abdominal pain)
- muscle cramps
a general feeling of not being well with
severe tiredness
- difficulty in breathing
- reduced body temperature and heart beat.
Lactic acidosis is a medical emergency and must be treated in a hospital.
Talk to your doctor or pharmacist before taking Sitagliptin and metformin hydrochloride Ascend:
if you have or have had a disease of the
pancreas (such as pancreatitis)
if you have or have had gallstones, alcohol
dependence or very high levels of triglycerides (a form of fat) in your blood. These medical conditions can increase your chance of getting pancreatitis (see section 4)
if you have type 1 diabetes. This is
sometimes called insulin-dependent diabetes
if you have or have had an allergic reaction
to sitagliptin, metformin, or Sitagliptin and metformin hydrochloride Ascend (see section 4)
if you are taking a sulphonylurea or insulin,
diabetes medicines, together with Sitagliptin and metformin hydrochloride Ascend , as you may experience low blood sugar levels (hypoglycaemia). Your doctor may reduce the dose of your sulphonylurea or insulin
If you need to have major surgery you must stop taking Sitagliptin and metformin hydrochloride Ascend during and for some time after the procedure. Your doctor will decide when you must stop and when to restart your treatment with Sitagliptin and metformin hydrochloride Ascend.
If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Sitagliptin and metformin hydrochloride Ascend.
During treatment with Sitagliptin and metformin hydrochloride Ascend, your doctor will check your kidney function at least once a year or more frequently if you are elderly and/or if you have worsening kidney function.
Children and adolescents
Children and adolescents below 18 years should not use this medicine. It is not effective in children and adolescents between the ages of 10 and 17 years. It is not known if this medicine is safe and effective when used in children younger than 10 years.
Other medicines and Sitagliptin and metformin hydrochloride Ascend
If you need to have an injection of a contrast medium that contains iodine into your bloodstream, for example, in the context of an X-ray or scan, you must stop taking Sitagliptin and metformin hydrochloride Ascend before or at the time of the injection. Your doctor will decide when you must stop and when to restart your treatment with Sitagliptin and metformin hydrochloride Ascend.
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. You may need more frequent blood glucose and kidney function tests, or your doctor may need to adjust the dose of Sitagliptin and metformin hydrochloride Ascend. It is especially important to mention the following:
medicines (taken by mouth, inhalation, or
injection) used to treat diseases that involve inflammation, like asthma and arthritis (corticosteroids)
medicines which increase urine production
(diuretics)
medicines used to treat pain and
inflammation (NSAID and COX-2-inhibitors, such as ibuprofen and celecoxib)
certain medicines for the treatment of high
blood pressure (ACE inhibitors and angiotensin II receptor antagonists)
specific medicines for the treatment of
bronchial asthma (β-sympathomimetics)
iodinated contrast agents or alcohol-
containing medicines
certain medicines used to treat stomach
problems such as cimetidine
- ranolazine, a medicine used to treat angina
dolutegravir, a medicine used to treat HIV
infection
vandetanib, a medicine used to treat a
specific type of thyroid cancer (medullary thyroid cancer)
digoxin (to treat irregular heart beat and
other heart problems). The level of digoxin in your blood may need to be checked if taking with Sitagliptin and metformin hydrochloride Ascend.
Sitagliptin and metformin hydrochloride Ascend with alcohol
Avoid excessive alcohol intake while taking Sitagliptin and metformin hydrochloride Ascend since this may increase the risk of lactic acidosis (see section “Warnings and precautions”).
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. You should not take this medicine during pregnancy and Do not take this medicine if you are breast-feeding. See section 2, Do not take Sitagliptin and metformin hydrochloride Ascend.
Driving and using machines
This medicine has no or negligible influence on the ability to drive and use machines. However, dizziness and drowsiness have been reported with sitagliptin, which may affect your ability to drive or use machines.
Taking this medicine in combination with medicines called sulphonylureas or with insulin
can cause hypoglycaemia, which may affect your ability to drive and use machines or work without safe foothold.
Sitagliptin and metformin hydrochloride Ascend contains sodium
This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say it is essentially 'sodium-free'.
3. How to take Sitagliptin and metformin hydrochloride Ascend
Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.
Take one tablet:
- twice daily by mouth
with meals to lower your chance of an
upset stomach.
Your doctor may need to increase your
dose to control your blood sugar.
If you have reduced kidney function, your
doctor may prescribe a lower dose.
You should continue the diet recommended by your doctor during treatment with this medicine and take care that your carbohydrate intake is equally distributed over the day.
This medicine alone is unlikely to cause abnormally low blood sugar (hypoglycaemia). When this medicine is used with a
sulphonylurea medicine or with insulin, low blood sugar can occur and your doctor may reduce the dose of your sulphonylurea or insulin.
If you take more Sitagliptin and metformin hydrochloride Ascend than you should
If you take more than the prescribed dose of this medicine, contact your doctor immediately. Go to the hospital if you have symptoms of lactic acidosis such as feeling cold or uncomfortable, severe nausea or vomiting, stomach ache, unexplained weight loss, muscular cramps, or rapid breathing (see section “Warnings and precautions”).
If you forget to take Sitagliptin and metformin hydrochloride Ascend
If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do not take a double dose of this medicine.
If you stop taking Sitagliptin and metformin hydrochloride Ascend
Continue to take this medicine as long as your doctor prescribes it so you can continue to help control
your blood sugar. You should not stop taking this medicine without talking to your doctor first. If you
stop taking Sitagliptin and metformin hydrochloride Ascend , your blood sugar may rise again.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
STOP taking Sitagliptin and metformin hydrochloride Ascend and contact a doctor immediately if you notice any of the following serious side effects:
Severe and persistent pain in the abdomen
(stomach area) which might reach through to your back with or without nausea and vomiting, as these could be signs of an inflamed pancreas (pancreatitis).
Sitagliptin and metformin hydrochloride Ascend may cause a very rare (may affect up to 1 in 10,000 people), but very serious side effect called lactic acidosis (see section “Warnings and precautions”). If this happens, you must stop taking Sitagliptin and metformin hydrochloride Ascend and contact a doctor or the nearest hospital immediately, as lactic acidosis may lead to coma.
If you have a serious allergic reaction (frequency not known), including rash, hives, blisters on the skin/peeling skin and swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing, stop taking this medicine and call your doctor right away. Your doctor may prescribe a medicine to treat your allergic reaction and a different medicine for your diabetes.
Some patients taking metformin have experienced the following side effects after starting sitagliptin:
Common (may affect up to 1 in 10 people): low blood sugar, nausea, flatulence, vomiting Uncommon (may affect up to 1 in 100 people): stomach ache, diarrhoea, constipation, drowsiness
Some patients have experienced diarrhoea, nausea, flatulence, constipation, stomach ache or vomiting when starting the combination of sitagliptin and metformin together (frequency is common).
Some patients have experienced the following side effects while taking this medicine with a sulphonylurea such as glimepiride:
Very common (may affect more than 1 in 10 people): low blood sugar
Common: constipation
Some patients have experienced the following side effects while taking this medicine in combination with pioglitazone:
Common: swelling of the hands or legs
Some patients have experienced the following side effects while taking this medicine in combination with insulin:
Very common: low blood sugar
Uncommon: dry mouth, headache
Some patients have experienced the following side effects during clinical studies while taking sitagliptin alone (one of the medicines in Sitagliptin and metformin hydrochloride Ascend) or during post-approval use of Sitagliptin and metformin hydrochloride Ascend or sitagliptin alone or with other diabetes medicines:
Common: low blood sugar, headache, upper respiratory infection, stuffy or runny nose and sore throat, osteoarthritis, arm or leg pain Uncommon: dizziness, constipation, itching Rare: reduced number of platelets
Frequency not known: kidney problems (sometimes requiring dialysis), vomiting, joint pain, muscle pain, back pain, interstitial lung
disease, bullous pemphigoid (a type of skin blister)
Some patients have experienced the following side effects while taking metformin alone: Very common: nausea, vomiting, diarrhoea, stomach ache and loss of appetite. These symptoms may happen when you start taking metformin and usually go away
Common:
- decreased or low vitamin B12 levels in the blood (symptoms may include extreme tiredness (fatigue), a sore and red tongue (glossitis), pins and needles (paraesthesia) or pale or yellow skin). Your doctor may arrange some tests to find out the cause of your symptoms because some of these may also be caused by diabetes or due to other unrelated health problems.
- a metallic taste
Very rare: hepatitis (a problem with your liver), hives, redness of the
skin (rash) or itching
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at:
www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects, you can help provide more information on the safety of this medicine.
5. How to store Sitagliptin and metformin hydrochloride Ascend
Keep this medicine out of the sight and reach of children.
Do not store above 25°C.
Do not take the tablets after the expiry date which is stated on the blister and carton after EXP. The expiry date refers to the last day of that month.
If the tablet becomes discolored or shows any signs of deterioration, seek the advice of your pharmacist.
Remember if your doctor tells you to stop taking this medicine, return any unused medicine to your pharmacist for safe disposal. Only keep this medicine if your doctor tells you to.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Contents of the pack and other information
What Sitagliptin and metformin hydrochloride Ascend contains
- The active substance are sitagliptin and metformin.
Each film-coated tablet contains sitagliptin
(as phosphate anhydrous) equivalent to 50 mg of sitagliptin and 850 mg of metformin hydrochloride.
Each film-coated tablet contains sitagliptin
(as phosphate anhydrous) equivalent to 50 mg of sitagliptin and 1000 mg of metformin hydrochloride.
- The other ingredients are:
- Tablet core: povidone, croscarmellose sodium, cellulose microcrystalline & sodium stearyl fumarate.
Film-coating: Poly(vinyl acetate), macrogol
3350, talc, titanium dioxide, red iron oxide, yellow iron oxide, iron oxide red & ferrosoferric oxide.
What Sitagliptin and metformin hydrochloride Ascend looks like and contents of the pack
Sitagliptin and metformin hydrochloride Ascend 50 mg/850 mg film-coated tablets: Light pink, oval shaped, film coated tablets, debossed with “M/S” on one side and “8/5” on other side.
Sitagliptin and metformin hydrochloride Ascend 50 mg/1000 mg film-coated tablets: Red, oval shaped, film coated tablets, debossed with “M/S” on one side and “10/5” on other side.
Sitagliptin and metformin hydrochloride Ascend is available in:
PVC/PE/PVDC Blister Pack in cartons of
10's, 14, 28, 56, 60, 112, 168, 180, 196 film-coated tablets
Multi-packs containing 196 (2 packs of 98)
and 168 (2 packs of 84) film-coated tablets. Pack of 50 x 1 film-coated tablets in perforated unit dose blisters.
Not all pack sizes may be marketed.
Marketing Authorisation Holder
Ascend Laboratories (UK) Limited
Elsley Court 20-22
Great Titchfield Street
London, W1W 8BE
United Kingdom
Manufacturer
Ascend Laboratories (UK) Limited
4th floor, Cavendish House,
369 Burnt Oak Broadway,
Edgware, HA85AW
United Kingdom