Voglibose + Repaglinide

Voglibose+ Repaglinide is an Anti-diabetic Agent belonging to the pharmacological class of Alpha-Glucosidase inhibitors and Meglitinides Derivatives.

Voglibose + Repaglinide has been approved to treat type 2 diabetes in adults when diet and exercise alone do not provide adequate glycemic control.

The gastrointestinal system absorbs voglibose + repaglinide. Alpha-glucosidase in the intestine is inhibited by Voglibose, which delays the breakdown of carbohydrates. The pancreas releases insulin when Repaglinide is administered. The liver is responsible for both types of metabolism. Renal and biliary pathways facilitate elimination.

The common side effects of Voglibose + Repaglinide are flatulence, diarrhoea, stomach pain, hypoglycemia (low blood sugar level), and skin rash.

Voglibose + Repaglinide is available as a tablet for convenient administration.

Voglibose + Repaglinide is available in India, the United States, Canada, the United Kingdom, Japan, France and Australia.

Voglibose+ Repaglinide is an Anti-diabetic Agent belonging to the pharmacological class of Alpha-Glucosidase inhibitors and Meglitinides Derivatives.

Voglibose: A synthetic substance called Voglibose, an alpha-glucosidase inhibitor, has strong and long-lasting therapeutic effects against diseases of the sensory, motor, and autonomic nerve systems brought on by diabetes mellitus. Alpha-glucosidase inhibitors are oral anti-diabetic medications used to treat type 2 diabetes mellitus. They function by stopping the breakdown of complex carbohydrates, such as starch. Usually, simple sugars, or monosaccharides, are formed from complex carbohydrates and can be absorbed by the colon. As a result, alpha-glucosidase inhibitors lessen complex carbohydrates' effect on blood glucose.

Repaglinide: Repaglinide activity depends on the presence of active cells and glucose. Repaglinide does not affect insulin release without glucose, unlike sulfonylurea insulin secretagogues. Instead, it amplifies the effects of extracellular glucose on ATP-sensitive potassium channels while having minimal impact on insulin levels during the day and nighttime. As a result, Repaglinide is more effective in lowering postprandial blood glucose levels than fasting blood glucose levels and needs to be taken for a more extended period (about one month) before fasting blood glucose levels begin to decline. Repaglinide has the most excellent insulinotropic effects at intermediate glucose concentrations (3 to 10 mmol/L), but it does not boost insulin release that has already been triggered by high glucose concentrations (more than 15 mmol/L).

Synergistic Benefits: When combined, Voglibose and Repaglinide provide synergistic effects that enable patients with type 2 diabetes mellitus to achieve better overall glycemic control and more effective postprandial glucose management. Repaglinide helps to immediately manage blood sugar levels after a meal by stimulating the pancreas to release insulin. Voglibose delays the absorption and digestion of carbohydrates by inhibiting intestinal alpha-glucosidase.

Data Onset of action of Voglibose+ Repaglinide typically occurs within 30 minutes after administration.

The data duration of action of Voglibose+ Repaglinide effects is relatively short.

The Data of Tmax and Cmax of Voglibose+ Repaglinide has yet to be established.

Voglibose+ Repaglinide is available in oral tablets.

Tablets: To be swallowed whole with water/liquid. Do not chew, crush or break it.

As the physician recommends, take the medication orally three times daily before meals or generally with a meal.

Voglibose + Repaglinide is used for the treatment, control, prevention, & improvement of type 2 Diabetes Mellitus in patients to help control blood sugar levels.

Voglibose: Voglibose is an alpha-glucosidase inhibitor used for lowering postprandial blood glucose levels in people with diabetes mellitus.

Repaglinide: It increases the amount of insulin the body produces (in the pancreas), helping treat type 2 diabetes mellitus. Insulin lowers blood glucose levels and prevents them from rising after meals.

Voglibose + Repaglinide helps in the management of type 2 diabetes in adults. Repaglinide stimulates the pancreas to release insulin, regulating blood glucose levels. Meanwhile, Voglibose inhibits the intestinal enzyme (alpha-glucosidase), delaying carbohydrate digestion and absorption in the intestine. Together, they prevent excessive post-meal blood sugar elevation, effectively controlling glucose levels in the bloodstream.

Orally: Voglibose+ Repaglinide is available as a tablet that can be taken orally. It is advised to progressively raise the Repaglinide dose at the beginning of treatment to reduce gastrointestinal adverse effects. Take the drug before food or up to 30 minutes after meals. Avoid breaking, crushing, dissolving, or chewing extended-release pills; swallow them whole. The tablet strength determines the precise dosage. Do not double the next dose if missed; take it as soon as possible.

The dosage and duration of treatment should be as per the treating physician's clinical judgment.

Voglibose+ Repaglinide has various strengths, such as 0.2 mg+ 0.5 mg, 0.3 mg + 0.5 mg, 0.2mg+1mg, 0.3+ 1 mg or 0.3mg+2mg.

Voglibose+ Repaglinide is available in the form of Oral tablets.

Starting dose: The recommended starting dose is three tablets of Voglibose+Repaglinide given orally before each large meal (breakfast, lunch, and dinner).

Titration and Maintenance: Depending on the patient's glycemic reaction, dosage modifications may be necessary. The dosage adjustment is required to maintain an ideal blood glucose control.

Maximum Dosage: Three Voglibose+Repaglinide tablets are typically the maximum daily dose recommended.

Voglibose+ Repaglinide should be used in treating type 2 diabetes mellitus, along with appropriate dietary restrictions.

Voglibose+ Repaglinide is usually taken with meals to reduce the risk of gastrointestinal side effects. It is essential to take Voglibose+Repaglinide just before meals. Skipping a meal or eating inadequate carbohydrates may increase the risk of hypoglycemia.

Limit alcohol intake while using Voglibose+Repaglinide, as alcohol can potentiate the risk of hypoglycemia.

While taking this combination, it is advised to stay hydrated, consume a rich-balanced diet low in saturated fats and cholesterol—and drink plenty of vegetables, whole grains, fruits, and lean proteins in meals.

The dietary restriction should be individualized as per patient requirements.

Voglibose+ Repaglinide may be contraindicated in the following conditions:-

Before taking Voglibose+ Repaglinide, evaluate your current health status, allergies, supplements, herbal remedies, and pre-existing diseases with a physician. Voglibose + Repaglinide sensitivity may be increased by a few conditions. These include notifying the physician if the individual is about to undergo major surgery, has recently recovered from a severe illness, is experiencing fever, trauma, or infection, has a history of laparotomy or ileus, or has a chronic intestinal disease that hinders absorption and digestion.

People who need to operate heavy machinery, have a history of myocardial infarction or have impaired kidney function should exercise extra caution. Individuals who are weak, malnourished, or elderly necessitate special care.

The adverse reactions related to Voglibose+ Repaglinide can be categorized as:-

Common Adverse Effects: Hypoglycemia, upper respiratory infection.

Less Common Adverse Effects: Increased liver enzymes, abdominal pain, nausea and loss of appetite.

Rare Adverse Effects: Allergic reactions like itching and swelling, thrombocytopenia (low platelet count) and blood disorders.

The clinically relevant drug interactions of Voglibose and Repaglinide are briefly summarized here:

Drug Interactions: Voglibose + Repaglinide interacts with pain relievers (like aspirin), anti-diabetic medications (including metformin, insulin, sitagliptin, and empagliflozin), and beta-blocker drugs (like metoprolol). Before the physician recommends this drug, inform them about all ongoing medical conditions and treatments. Before prescribing this medication, your doctor may consider these and check for drug interactions.

Drug-Food Interactions: Drinking too much alcohol can raise your risk of developing the potentially fatal illness lactic acidosis. Thus, abstain from drinking alcohol while using Voglibose + Repaglinide,

Drug-Disease Interactions: People with Type I diabetes, cardiovascular disease, hypoglycemia, liver illness, and renal impairment should use caution.

Voglibose+ Repaglinide should be prudent in the following group of special populations.

Voglibose: Pregnancy Category C: Use caution if the benefits outweigh the risks.

There are currently no relevant epidemiological data available. Because there are no reported adverse effects of the medication on pregnancy, fetal or embryonic development, parturition, or postnatal development, it should only be administered to pregnant or potentially pregnant women when the potential benefits outweigh the risks.

Repaglinide: Pregnancy Category C: Use caution if the benefits outweigh the risks.

A medication-associated risk of significant birth abnormalities, miscarriage, or unfavourable maternal or fetal outcomes has not been found in the limited information from case reports and case series that are currently available.

Voglibose: Lactating rats excrete metformin into their milk. Since there is a lack of comparable data for humans, the benefits of continuing the compound in the mother should be considered when deciding whether to stop nursing or stop taking metformin.

Repaglinide: No information is available on Repaglinide's presence in human milk, its effects on nursing infants, or its impact on milk production. Repaglinide is not advised for usage while nursing due to the risk of hypoglycemia in breastfed infants.

As per FDA, safety and effectiveness in the pediatric population have yet to be established.

Kidney Impairment (Mild to Severe): Not recommended; Regular assessment of renal function is necessary.

Hepatic impairment (Mild to Severe): Do not administer.

The physician should be vigilant about the knowledge pertaining to the identification and treatment of overdosage of Voglibose+ Repaglinide.

Overconsumption of Voglibose + Repaglinide could lead to severe hypoglycemia (very low blood sugar)

There is no specific antidote for Voglibose + Repaglinide overdose, emphasizing the need for immediate medical attention. Suspected overdose warrants discontinuation of the medications. For conscious patients, oral glucose or sugar-containing products are administered. In severe cases with unconsciousness, intravenous administration of glucose or glucagon may be required.

Supportive care addresses symptoms through fluids, electrolyte correction, and antiemetics for nausea and vomiting. Severe hypoglycemia necessitates close monitoring until stabilization.

Timely intervention and medical supervision are imperative to manage Voglibose+ Repaglinide overdose effectively and mitigate potential complications.

Voglibose: Alpha-glucosidase inhibitors are saccharides that function as competitive inhibitors of the alpha-glucosidase enzymes in the small intestine's brush border, which are necessary for digesting carbohydrates. In the small intestine, oligosaccharides, trisaccharides, and disaccharides are hydrolyzed to glucose and other monosaccharides by the membrane-bound intestinal alpha-glucosidases. Acarbose inhibits membrane-bound alpha-glucosidases and also suppresses pancreatic alpha-amylase. In the small intestine lumen, complex starches are hydrolyzed to oligosaccharides by pancreatic alpha-amylase. Compromising these enzyme systems slows down the rate at which complex carbohydrates are metabolized. Because the carbs are not converted into glucose molecules, less glucose is absorbed. The short-term impact of these medication regimens on diabetes patients is a decline in blood glucose levels; the long-term effect is a slight decrease in haemoglobin A1c levels.

Repaglinide: Repaglinide activity depends on the presence of active cells and glucose. Repaglinide does not affect insulin release without glucose, unlike sulfonylurea insulin secretagogues. Instead, it amplifies the effects of extracellular glucose on ATP-sensitive potassium channels while having minimal impact on insulin levels during the day and nighttime. As a result, Repaglinide is more effective in lowering postprandial blood glucose levels than fasting blood glucose levels and needs to be taken for a more extended period (about one month) before fasting blood glucose levels begin to decline. Repaglinide has the most excellent insulinotropic effects at intermediate glucose concentrations (3 to 10 mmol/L), but it does not boost insulin release that has already been triggered by high glucose concentrations (more than 15 mmol/L).

Voglibose: <2% (as active drug) and approx 35% (as metabolites) are absorbed from the gastrointestinal tract.

Repaglinide: Following oral administration, it is rapidly and entirely absorbed. Peak plasma concentrations are observed within an hour (between 0.5 and 1.4 hours). There is around 56% absolute bioavailability. The biological action peaks in 3-3.5 hours and higher plasma insulin levels last 4-6 hours. The area under the curve (AUC) for Repaglinide is 18.0 to 18.7 (ng/mL/h) when a single 2 mg dosage is administered to healthy subjects.

Voglibose: Time to peak plasma concentration: Approx 1 hour (active drug).

Repaglinide: After intravenous (IV) dosing, the volume of distribution at steady state (Vss) and whole-body clearance (CL) in healthy participants were 31 L and 38 L/h, respectively—more than 98% of the proteins bound to human serum albumin.

Voglibose: Exclusively metabolized in the gastrointestinal tract mainly by intestinal bacteria and digestive enzymes into at least 13 metabolites, including sulfate, methyl, and glucuronide conjugates as the primary metabolites.

Repaglinide: Cytochrome P450 3A4 and 2C9 rapidly metabolize Repaglinide by oxidizing and dealkylating it to produce the primary dicarboxylic acid derivative (M2). The aromatic amine derivative (M1) is produced by further oxidation. Repaglinide's carboxylic acid group can be glucuronidated to produce an acyl glucuronide (M7). Other unidentified metabolites have also been found. There is no apparent hypoglycemia action in repaglinide metabolites.

Voglibose: Via urine (approx 34% as inactive metabolites; <2% as unchanged drug and active metabolites); faeces (approx 51% as unabsorbed drug). Elimination half-life: Approx 2 hours.

Repaglinide: Within 96 hours of administering a single oral dosage of 14C-repaglinide, 90% of the radiolabel was found in the faeces and 8% in the urine. Only 0.1% of the dosage is excreted as the parent chemical in the urine. 60% of the dosage delivered comprised the primary metabolite (M2). In faeces, less than 2% of the parent drug was found.