SITAZUCA MH 50 MG/850 MG

Indications

• Type 2 diabetes mellitus
• Gestational diabetes
• Management of pre-existing diabetes in pregnant women

Dosage

Children: For children aged 10 years and older, the usual starting dose is 500 mg taken with food, with gradual increases based on clinical response. Refer to the BNF for Children for specific dosing recommendations.

Adults: The initial dose is usually 500 mg to 1,000 mg taken orally with food, and the dosage may be gradually increased based on glycemic control and tolerance, with a maximum daily dose typically not exceeding 2,000 mg.

Mechanism of action

Metformin decreases hepatic glucose production and increases peripheral glucose utilization. It does not stimulate insulin release from the pancreas, making it antihyperglycemic rather than hypoglycemic. The drug also interacts with SIRT1, a protein involved in bile acid metabolism, contributing to its effects on glucose homeostasis.

Pharmacodynamics

Metformin improves glycemic control in patients with type 2 diabetes by reducing fasting and postprandial plasma glucose levels. It acts by decreasing intestinal absorption of glucose, increasing insulin sensitivity, and enhancing peripheral glucose uptake and utilization, without causing hypoglycemia.

Pharmacokinetics

Metformin is absorbed from the gastrointestinal tract and is excreted unchanged in the urine. It has a half-life of about 6 hours and does not undergo significant metabolism. The drug's pharmacokinetics can be affected by renal function, and caution is advised in patients with renal impairment.

Contra-indications

• Severe renal impairment (creatinine clearance less than 25 mL/minute)
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis
• Hypersensitivity to metformin or any of its components

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Lactic acidosis (rare)
• Hepatic disorders (rare)
• Oedema (rare)
• Acute generalised exanthematous pustulosis (very rare)
• Thrombocytopenia (very rare)

Interactions

• Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists may require monitoring and adjustments
• Antacids containing magnesium and aluminium salts may reduce the absorption of metformin
• Concomitant use with other antihyperglycemic agents requires careful monitoring for hypoglycemia

Precautions

• Caution in patients with hepatic impairment
• Monitor liver function regularly during treatment
• Patients should be advised to discontinue use in the event of significant illness, especially dehydration or infections

Pregnancy

Avoid use during pregnancy. Women planning to become pregnant should discontinue metformin and consult a healthcare provider for safer alternatives.

Breast-feeding

Avoid use during breastfeeding. Metformin is excreted in breast milk, and its effects on a nursing infant are unknown.

Storage

Store in a cool, dry place, below 25°C. Protect from light.

Formulations

• Metformin hydrochloride 500 mg tablets
• Metformin hydrochloride 850 mg tablets
• Metformin hydrochloride 1000 mg tablets

Indications

• Dehydration
• Fluid replacement
• Support for metabolic reactions
• Regulation of body temperature

Dosage

Children: Fluid requirements for children depend on age, weight, and activity level. It is crucial to monitor hydration status and adjust intake accordingly, referring to specific guidelines in the BNF for Children.

Adults: Dosage varies based on individual needs, activity level, and environmental conditions. General guidelines suggest approximately 2 to 3 liters per day for adults, considering factors like exercise and climate.

Mechanism of action

Water acts as a solvent in biological systems, enabling the dissolution and transport of nutrients and waste products. It also plays a vital role in metabolic reactions, including hydrolysis and dehydration synthesis, which are essential for cellular function.

Pharmacodynamics

Water maintains cellular integrity and supports physiological functions, including osmotic balance, acid-base equilibrium, and thermoregulation. Its role in enzymatic reactions and as a medium for biochemical processes is crucial for organismal health.

Pharmacokinetics

Water is absorbed efficiently in the gastrointestinal tract and distributed throughout the body via the bloodstream. It is excreted primarily through urine, sweat, and respiration. The body regulates water balance through mechanisms involving the kidneys, hormones, and thirst responses.

Pregnancy

Considered safe for use.

Breast-feeding

Considered safe for use.

Storage

Store in a cool, dry place away from sunlight.

Formulations

• Liquid
• Pure Water

Indications

• Constipation
• Dietary fiber supplementation
• Irritable bowel syndrome
• Diverticular disease
• Weight management

Dosage

Children: Refer to appropriate guidelines for specific dosage; generally taken with adequate fluid intake.

Adults: Refer to appropriate guidelines for specific dosage; generally taken with adequate fluid intake.

Mechanism of action

Cellulose acts primarily as a bulk-forming laxative. It absorbs water in the intestines, which increases stool bulk and stimulates peristalsis, thus facilitating bowel movements. Additionally, cellulose is not digestible by human enzymes, leading to fermentation by gut bacteria, which may enhance gut health and alter gut microbiota composition.

Pharmacodynamics

Cellulose increases stool weight and frequency of bowel movements. It works by retaining water in the intestines, leading to softer stools and improved passage through the gastrointestinal tract. The bulking effect of cellulose can help alleviate constipation and promote overall digestive health. It may also play a role in cholesterol reduction and glycemic control through its effects on digestion and absorption of nutrients.

Pharmacokinetics

Cellulose is not absorbed into the bloodstream due to its indigestible nature. Instead, it passes through the gastrointestinal tract, where it adds bulk to the stool. Its fermentation by colonic bacteria produces short-chain fatty acids, which may have beneficial effects on colon health. The onset of action for cellulose as a laxative can vary but is generally within 24 to 72 hours after ingestion.

Adverse effects

• Bloating
• Flatulence
• Diarrhea
• Abdominal discomfort

Precautions

• Use with caution in patients with a history of gastrointestinal disorders.
• Monitor for potential allergic reactions in sensitive individuals.

Pregnancy

Cellulose is generally considered safe during pregnancy as it is a non-toxic, indigestible fiber.

Breast-feeding

Cellulose is also considered safe during breastfeeding; it is excreted in breast milk in negligible amounts.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Powder
• Capsules
• Tablets
• Granules

Indications

• Hypovolemic shock
• Severe burns
• Postoperative fluid replacement
• Sepsis
• Trauma management

Dosage

Children: Refer to established guidelines for specific dosing, as it varies based on the type of colloidal solution used and the clinical condition being treated.

Adults: Refer to established guidelines for specific dosing, as it varies based on the type of colloidal solution used and the clinical condition being treated.

Mechanism of action

Colloidal solutions work by maintaining oncotic pressure in the blood, thus helping to retain fluid within the vascular system. This is primarily due to the large molecular weight of the colloidal particles, which cannot easily pass through capillary walls. The presence of colloids in the blood helps to draw water into the circulation, increasing blood volume and improving tissue perfusion.

Pharmacodynamics

The pharmacodynamics of colloidal solutions are centered on their ability to exert osmotic pressure, which helps maintain blood volume and pressure. This effect is particularly important in conditions such as hypovolemia and shock, where fluid replacement is necessary to restore hemodynamic stability. The efficacy of colloidal solutions can vary depending on the type of colloid used, as well as the underlying clinical condition being treated.

Pharmacokinetics

Colloidal solutions are typically administered intravenously and their pharmacokinetics can vary based on the specific formulation. Generally, colloids are distributed throughout the vascular compartment and have a longer duration of action compared to crystalloids, as they remain in circulation longer. The elimination of colloids is primarily through the reticuloendothelial system, where they are metabolized or eliminated by the liver and spleen. Factors such as particle size and composition can influence their distribution and clearance.

Adverse effects

• Allergic reactions
• Injection site reactions
• Nausea
• Vomiting
• Headache
• Fever

Precautions

• Use with caution in patients with known allergies to any component of the formulation
• Monitor for signs of hypersensitivity during administration
• Consider volume overload in patients with cardiac or renal impairment

Pregnancy

The safety of colloidal solutions during pregnancy has not been established. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether colloidal solutions are excreted in human milk. Caution should be exercised when administering to breastfeeding mothers.

Storage

Store at room temperature, protect from light, and do not freeze. Keep out of reach of children.

Formulations

• Colloidal silver
• Colloidal gold
• Colloidal iron
• Other metal colloids

Indications

• Used as a disintegrant in tablet formulations
• Improves dissolution of active pharmaceutical ingredients
• Facilitates the breakdown of solid dosage forms

Dosage

Children: Refer to specific product information for dosing guidelines, as croscarmelose is used as an excipient and not dosed independently.

Adults: Refer to specific product information for dosing guidelines, as croscarmelose is used as an excipient and not dosed independently.

Mechanism of action

Croscarmelose functions by rapidly absorbing water and swelling upon hydration. This swelling action creates pressure within the tablet, leading to disintegration into smaller particles. The increased surface area of the drug particles enhances dissolution and absorption in the gastrointestinal tract, ultimately improving the pharmacokinetic profile of the active ingredients.

Pharmacodynamics

As a disintegrant, croscarmelose does not exert a pharmacological effect on its own but plays a critical role in the formulation of oral solid dosage forms. Its pharmacodynamic properties are primarily related to its ability to facilitate the release of active ingredients from their dosage forms, thereby influencing the onset and duration of action of the administered medication.

Pharmacokinetics

Croscarmelose is not absorbed systemically when ingested, as it functions primarily within the gastrointestinal tract. It is excreted unchanged in the feces following its role in aiding the dissolution and disintegration of solid dosage forms. Its safety profile is well-established, and it is considered non-toxic, with minimal adverse effects when used in recommended amounts.

Pregnancy

Croscarmelose is generally considered safe for use during pregnancy as it is an inert substance and does not have systemic effects.

Breast-feeding

Croscarmelose is not absorbed systemically and is considered safe for use during breastfeeding.

Storage

Store in a cool, dry place, away from direct sunlight and moisture.

Formulations

• Tablet
• Capsule
• Powder

Indications

• Monitoring respiratory function
• Assessment of metabolic status
• Management of respiratory acidosis
• Management of respiratory alkalosis

Dosage

Children: Dosing for interventions related to carbon dioxide levels in pediatric patients should be guided by clinical protocols and the BNF for Children.

Adults: Dosing for interventions related to carbon dioxide levels is typically based on clinical assessment and individual patient needs. Refer to clinical guidelines for specific scenarios.

Mechanism of action

Carbon dioxide acts primarily as a signaling molecule in the body, influencing respiratory drive and blood pH. It is produced during cellular respiration and is a critical component of the bicarbonate buffering system, which helps maintain acid-base homeostasis. Elevated levels of CO2 in the blood stimulate ventilation in the lungs, increasing the rate of gas exchange and facilitating the removal of excess CO2.

Pharmacodynamics

The pharmacodynamic effects of dioxides, particularly carbon dioxide, are closely related to its concentration in the blood. As CO2 levels increase, it leads to respiratory acidosis, which can stimulate the respiratory centers in the brain to increase ventilation. Conversely, low levels of CO2 can cause respiratory alkalosis, potentially leading to decreased respiratory drive. CO2 also plays a role in vasodilation and can affect blood flow and pressure through its influence on smooth muscle tone.

Pharmacokinetics

Carbon dioxide is produced endogenously during metabolic processes and is transported in the bloodstream primarily in three forms: dissolved in plasma, as bicarbonate ions (HCO3-), and bound to hemoglobin. The half-life of CO2 in the bloodstream is very short due to its rapid exchange with alveolar gas in the lungs. The elimination of CO2 occurs through exhalation, making it a dynamic component of respiratory physiology.

Pregnancy

Data on the effects of dioxide during pregnancy are limited. Caution is advised due to potential risks associated with exposure.

Breast-feeding

Limited data are available regarding the excretion of dioxide in human milk. Caution is recommended.

Storage

Store in a cool, dry place, away from direct sunlight and moisture.

Indications

• Dry eye syndrome
• Ocular surface disorders
• Eye irritation
• Contact lens discomfort

Dosage

Children: Refer to specific product instructions for paediatric dosage, as recommendations can vary widely based on age and clinical condition.

Adults: Refer to specific product instructions for adult dosage, which may vary based on formulation and severity of symptoms.

Mechanism of action

Insta works primarily by lubricating the ocular surface, which helps to alleviate dryness and discomfort. The active ingredients often mimic natural tears, providing moisture and aiding in the maintenance of the tear film, thereby improving eye comfort and visual clarity.

Pharmacodynamics

The pharmacodynamics of Insta involve the interaction of its components with the ocular surface, enhancing tear film stability and reducing the symptoms of dryness. The formulation may also reduce inflammation and irritation by providing a protective barrier over the eye.

Pharmacokinetics

The pharmacokinetics of Insta can vary depending on its specific formulation. Generally, the components are designed for local action, with minimal systemic absorption. The onset of action is typically rapid, with effects lasting for a variable duration depending on the specific formulation and the severity of symptoms.

Pregnancy

Consult a healthcare provider before use, as safety in pregnancy has not been established.

Breast-feeding

Consult a healthcare provider before use, as it is unknown if it is excreted in human milk.

Storage

Store in a cool, dry place away from direct sunlight.

Indications

• Cleansing agent in topical formulations
• Emulsifying agent in cosmetic products
• Foaming agent in shampoos and body washes

Dosage

Children: Refer to specific product formulations for appropriate concentrations and application methods.

Adults: Refer to specific product formulations for appropriate concentrations and application methods.

Mechanism of action

Lauryl sulfate functions as an anionic surfactant. It reduces the surface tension between different substances, allowing for better spreading and wetting. In the context of cleansing, it facilitates the removal of dirt and oils from the skin and hair by emulsifying these substances, thus making them easier to rinse away with water.

Pharmacodynamics

As a surfactant, lauryl sulfate displays properties that can disrupt cellular membranes and alter permeability. This mechanism is beneficial in enhancing the penetration of other therapeutic agents in topical formulations. However, its irritant potential on skin and mucous membranes should be noted, as it can lead to dryness and irritation with prolonged exposure.

Pharmacokinetics

Lauryl sulfate is primarily applied topically and is not intended for systemic absorption. When used in formulations, it acts locally at the site of application. Its absorption through the skin is minimal, and any systemic exposure is limited. Metabolism and excretion pathways are not well-defined for topical applications, as it is largely washed away after use.

Pregnancy

Safety during pregnancy has not been established. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Unknown whether lauryl is excreted in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Type 2 diabetes mellitus
• Polycystic ovary syndrome (PCOS)

Dosage

Children: The

Adults: The usual starting dose of metformin for adults is 500 mg taken orally twice a day or 850 mg once daily, with gradual increases based on tolerance and blood glucose levels. The maximum recommended daily dose is 2000-3000 mg, depending on the formulation used.

Mechanism of action

Metformin decreases blood glucose levels by decreasing hepatic glucose production (gluconeogenesis), decreasing intestinal absorption of glucose, and increasing insulin sensitivity, which enhances peripheral glucose uptake and utilization. It is known to inhibit mitochondrial complex I activity, leading to increased AMP:ATP ratios that activate AMP-activated protein kinase (AMPK), a key regulator of glucose metabolism. This activation results in reduced hepatic glucose output and improved cellular glucose uptake.

Pharmacodynamics

Metformin exerts its effects primarily by enhancing insulin sensitivity and reducing glucose production by the liver. Unlike sulfonylureas, which increase insulin secretion, metformin does not cause hyperinsulinemia. Its ability to lower fasting plasma glucose and glycosylated hemoglobin (HbA1c) levels makes it a cornerstone in the management of type 2 diabetes. Clinical studies have shown significant reductions in fasting plasma glucose and HbA1c levels in patients treated with metformin.

Pharmacokinetics

Metformin is absorbed from the gastrointestinal tract, with peak plasma concentrations typically occurring 2-3 hours after ingestion. It has a bioavailability of approximately 50-60% when administered orally. The drug is primarily eliminated unchanged by the kidneys, and its clearance is proportional to renal function. The half-life of metformin is about 6.5 hours. Accumulation may occur in cases of renal impairment, necessitating caution in patients with reduced renal function.

Adverse effects

• Gastrointestinal disturbances (nausea, vomiting, diarrhea)
• Lactic acidosis
• Vitamin B12 deficiency

Interactions

• dolutegravir+metformin: Moderate (increases exposure)
• cimetidine+metformin: Moderate (increases exposure)
• risdiplam+metformin: Moderate (increases concentration)
• vandetanib+metformin: Moderate (increases exposure)
• bictegravir+metformin: Unknown (increases exposure)
• guanfacine+metformin: Unknown (increases concentration)
• mexiletine+metformin: Unknown (affects exposure)
• pitolisant+metformin: Unknown (increases exposure)
• ribociclib+metformin: Unknown (increases exposure)

Precautions

• Renal impairment
• Dehydration
• Excessive alcohol intake

Pregnancy

Metformin is classified as a Category B medication. It is often used during pregnancy for managing gestational diabetes but should be administered under medical supervision.

Breast-feeding

Metformin is excreted in breast milk, but is generally considered safe for use during breastfeeding. Consult with a healthcare provider for specific guidance.

Storage

Store in a cool, dry place, away from direct light. Keep out of reach of children.

Formulations

• Tablets
• Extended-release tablets
• Oral solution

Indications

• Used as an excipient in tablet formulations
• Used as a bulking agent in capsule formulations
• Used in food products as a thickener or stabilizer

Dosage

Children: Refer to specific product guidelines as dosage will depend on the formulation and the active ingredients.

Adults: Refer to specific product guidelines as dosage will depend on the formulation and the active ingredients.

Mechanism of action

Microcrystalline cellulose acts as a non-digestible filler that enhances the flow properties of powders during the manufacturing of tablets and capsules. It does not have a direct pharmacological action on the body but ensures that the active ingredients are effectively delivered to the patient.

Pharmacodynamics

As a non-active ingredient, microcrystalline cellulose does not exert pharmacodynamic effects typical of active pharmaceutical ingredients. Its primary role is to provide a stable and consistent matrix for the drug, facilitating the release of the active compound once ingested.

Pharmacokinetics

Microcrystalline cellulose is not absorbed in the gastrointestinal tract; it passes through the digestive system largely unchanged. It adds bulk to the stool, which may aid in promoting regular bowel movements. The substance is excreted in feces, where it contributes to dietary fiber intake.

Pregnancy

Data regarding the use of microcrystalline cellulose during pregnancy is limited. It is advisable to consult with healthcare professionals before use.

Breast-feeding

Microcrystalline cellulose is considered safe during breastfeeding, as it is not absorbed systemically.

Storage

Store in a cool, dry place away from direct sunlight and moisture.

Indications

• Eczema
• Atopic dermatitis
• Contact dermatitis
• Psoriasis
• Dry skin
• Skin irritation

Dosage

Children: For children, apply as directed by a healthcare provider, typically 1-3 times daily, depending on the severity of the condition and age of the child.

Adults: Apply generously to the affected area as needed, usually 1-3 times daily or as directed by a healthcare provider.

Mechanism of action

Moistshield works by forming a protective layer over the skin, preventing transepidermal water loss and maintaining hydration. It may also contain emollients that soften the skin and occlusive agents that trap moisture, thereby aiding in the restoration of the skin barrier. The specific ingredients can enhance skin repair and reduce inflammation.

Pharmacodynamics

The pharmacodynamic properties of Moistshield are primarily related to its ability to hydrate the skin and restore the skin barrier function. Emollients and occlusive agents in the formulation help to alleviate dryness and irritation, promoting overall skin health. The effectiveness can vary depending on the specific formulation and concentration of active ingredients.

Pharmacokinetics

Moistshield is applied topically, and its pharmacokinetics involve minimal systemic absorption. The active ingredients primarily act locally at the site of application. The onset of action is typically rapid, providing immediate relief from dryness and irritation. The duration of effect can depend on the formulation and frequency of application.

Pregnancy

Consult a healthcare provider before use during pregnancy.

Breast-feeding

Consult a healthcare provider before use while breastfeeding.

Storage

Store in a cool, dry place away from direct sunlight.

Mechanism of action

The exact mechanism of action for Pink is not detailed in the provided information. However, compounds with similar structures often function as antagonists or inhibitors at certain receptors or enzymes, which modulates physiological processes.

Pharmacodynamics

Pharmacodynamics details for Pink are not specified. Typically, the pharmacodynamics of similar compounds involve interactions with neurotransmitter systems, influencing both central and peripheral nervous system functions. This can lead to varying therapeutic effects depending on the target receptors.

Pharmacokinetics

The pharmacokinetics of Pink, including absorption, distribution, metabolism, and excretion, are not explicitly stated. However, compounds of this nature generally exhibit moderate to high oral bioavailability, with metabolism primarily occurring in the liver, followed by renal excretion of metabolites.

Indications

• Topical antiseptic for skin disinfection
• Surgical scrubs and hand sanitizers
• Wound care management
• Pharmaceutical excipient in solid and liquid formulations

Dosage

Children: Refer to specific product guidelines for pediatric dosing recommendations, as doses can vary based on formulation and intended use.

Adults: Refer to specific product guidelines for dosing recommendations, as doses can vary based on the formulation and intended use.

Mechanism of action

Povidone acts by forming a complex with iodine when used as an antiseptic, which releases iodine slowly to exert its antimicrobial effect. The iodine disrupts microbial cell walls and interferes with protein synthesis, leading to cell death. Additionally, as a polymer, povidone can enhance drug solubility and stability by forming a hydrophilic matrix.

Pharmacodynamics

Povidone has a broad spectrum of antimicrobial activity against bacteria, viruses, and fungi. Its antiseptic properties are primarily due to the release of iodine, which is effective in reducing microbial load and preventing infection. The polymer's ability to bind to various substances allows it to be utilized in formulations that require improved stability and solubility.

Pharmacokinetics

Povidone is not absorbed systemically when applied topically, as it remains localized at the site of application. Its pharmacokinetics are largely dependent on the formulation and route of administration, with the polymer being metabolized by hydrolysis and excreted in urine as low-molecular-weight compounds. The release and activity of iodine are influenced by the concentration of povidone and the presence of organic matter.

Adverse effects

• Local irritation
• Allergic reactions
• Skin rashes
• Hypersensitivity reactions

Precautions

• Use with caution in patients with known allergies to iodine or povidone-iodine
• Avoid use in deep puncture wounds or serious burns

Pregnancy

Povidone is generally considered safe for use during pregnancy, but it is advisable to consult a healthcare professional before use.

Breast-feeding

Povidone is considered safe during breastfeeding, but it is recommended to consult a healthcare professional.

Storage

Store at room temperature, away from moisture and heat. Keep the container tightly closed.

Formulations

• Topical solution
• Ointment
• Surgical scrub
• Gauze impregnated with povidone-iodine

Dosage

Children: Refer to specific drug formulations and product labels as purified substances can vary widely in their use and dosing.

Adults: Refer to specific drug formulations and product labels as purified substances can vary widely in their use and dosing.

Mechanism of action

The mechanism of action for purified compounds varies widely depending on the specific substance. Generally, purified drugs exert their effects by interacting with specific biological targets, such as receptors, enzymes, or ion channels, leading to a desired therapeutic effect. This interaction can involve binding to receptors to activate or inhibit signaling pathways, modulating enzymatic activity, or altering physiological processes.

Pharmacodynamics

Pharmacodynamics describes the effects of a drug on the body and the relationship between drug concentration and effect. For purified drugs, this can involve dose-response relationships and the time course of their action. The purified form often enhances potency and reduces variability in response among patients, which can lead to more predictable therapeutic outcomes. The overall effect is determined by the drug's affinity for its target, the efficacy of the drug-receptor interaction, and the downstream signaling pathways activated as a result of this interaction.

Pharmacokinetics

Pharmacokinetics involves the absorption, distribution, metabolism, and excretion (ADME) of a drug. For purified substances, absorption can be more efficient due to the absence of impurities that may affect solubility or stability. Distribution may also be enhanced, leading to higher bioavailability. Metabolism can be influenced by the structure of the purified compound, as it may be metabolized more readily by liver enzymes. Excretion typically occurs through the kidneys or liver, depending on the molecular characteristics of the purified drug.

Pregnancy

Consult with a healthcare professional, as the safety of purified forms of medications during pregnancy may vary depending on the specific substance.

Breast-feeding

Consult with a healthcare professional, as the safety of purified forms of medications during breastfeeding may vary depending on the specific substance.

Storage

Store in a cool, dry place, away from light and moisture, and keep out of reach of children.

Indications

• Wound management
• Silicone implants
• Dermal fillers
• Medical lubricants
• Scar treatment

Dosage

Children: Refer to specific product guidelines for paediatric dosages, as silicone applications vary widely.

Adults: Refer to specific product guidelines for adult dosages, as silicone applications vary widely.

Mechanism of action

Silicones exhibit their effects primarily through their physical properties rather than a specific biochemical mechanism. They form a protective barrier that is hydrophobic, preventing moisture and microbial penetration, which aids in wound healing and reduces the risk of infection. Their flexibility and inertness also allow them to integrate well with biological tissues.

Pharmacodynamics

Silicones are generally inert and do not interact significantly with biological systems. They provide mechanical support, lubricate surfaces, and facilitate healing without eliciting a strong immune response. Their low toxicity and biocompatibility contribute to their favorable pharmacodynamic profile in medical applications.

Pharmacokinetics

Silicones are not absorbed by the body when used in medical applications. They remain at the site of application and do not undergo significant metabolism. Their elimination is largely through physical means, including degradation over time or removal during surgical procedures. The pharmacokinetic properties can vary depending on the specific silicone formulation and application.

Pregnancy

Silicone is generally considered safe for use during pregnancy as it is inert and non-toxic. However, specific products should be evaluated for safety.

Breast-feeding

Silicone is also considered safe during breastfeeding as it does not transfer into milk; however, care should be taken with specific formulations.

Storage

Store in a cool, dry place away from direct sunlight.

Indications

• Type 2 diabetes mellitus as monotherapy (if metformin is inappropriate)
• Type 2 diabetes mellitus in combination with other antidiabetic drugs (including insulin) when metformin alone or in combination fails to achieve adequate glycemic control

Dosage

Adults: 100 mg once daily, or 50 mg twice daily when used in combination with a sulfonylurea or insulin. Dose adjustments may be required based on renal function.

Mechanism of action

Sitagliptin inhibits the enzyme dipeptidyl peptidase-4 (DPP-4), which is responsible for the degradation of incretin hormones. This inhibition results in prolonged active incretin levels, which enhances insulin secretion from pancreatic beta cells and decreases glucagon secretion from alpha cells in the pancreas, leading to lowered blood glucose levels.

Pharmacodynamics

Sitagliptin's pharmacodynamic effects include improved glycemic control, characterized by reduced fasting and postprandial blood glucose levels. The drug is effective in lowering HbA1c levels and is associated with a low risk of hypoglycemia. It has a beneficial effect on weight management, as it typically does not promote weight gain.

Pharmacokinetics

Sitagliptin is absorbed rapidly after oral administration, with peak plasma concentrations occurring within 1-4 hours. Its bioavailability is approximately 87%. The drug is predominantly eliminated via renal excretion, with about 80% of the dose excreted unchanged in the urine. The elimination half-life is approximately 12.4 hours. Renal impairment may necessitate dose adjustments, as clearance is significantly reduced in patients with decreased renal function.

Contra-indications

• History of pancreatitis
• Severe heart failure

Adverse effects

• Headache
• Constipation
• Dizziness
• Skin reactions
• Angioedema
• Back pain
• Cutaneous vasculitis
• Joint disorders
• Myalgia
• Acute pancreatitis
• Acute renal impairment
• Stevens-Johnson syndrome
• Vomiting

Interactions

• Concomitant use with sulfonylureas or insulin may require dose adjustments
• Moderate interaction with vemurafenib (increases exposure)

Precautions

• Monitor renal function before treatment and periodically thereafter
• Discontinue if symptoms of acute pancreatitis occur, such as persistent severe abdominal pain

Pregnancy

Avoid-toxicity observed in animal studies.

Breast-feeding

Avoid-present in milk in animal studies.

Storage

Store at room temperature, away from moisture and heat.

Formulations

• Tablets: 50 mg, 100 mg

Indications

• Dry skin conditions
• Cosmetic formulations
• Emollient in topical creams and lotions
• Emulsifying agent in pharmaceutical preparations

Dosage

Children: For pediatric use, refer to specific product formulations and guidelines, as dosing may vary based on the formulation and concentration.

Adults: Stearyl alcohol is used topically in various formulations. Specific dosing is typically determined by the formulation and intended use, refer to product guidelines for detailed instructions.

Mechanism of action

Stearyl alcohol functions primarily as an emollient and emulsifier. It aids in the formation of stable emulsions by reducing the surface tension between oil and water phases, allowing for the creation of creams and lotions. Its hydrophobic tail interacts with lipids, while the hydroxyl group can form hydrogen bonds with water, enhancing moisture retention in the skin.

Pharmacodynamics

Stearyl alcohol acts by providing a protective barrier on the skin, reducing transepidermal water loss and enhancing hydration. Its emollient properties make it effective in softening and smoothing the skin, which can alleviate dryness and improve the overall appearance of the skin. Additionally, it can enhance the delivery of other active ingredients in topical formulations.

Pharmacokinetics

Stearyl alcohol is not significantly absorbed systemically when applied topically. Its primary action is local to the site of application, where it exerts its emollient effects. The compound is metabolized in the body to various fatty acids and alcohols, and it is excreted primarily through the skin and gastrointestinal tract, with minimal systemic exposure.

Pregnancy

Stearyl is generally considered safe for use during pregnancy; however, specific formulations should be evaluated for their ingredients.

Breast-feeding

Stearyl can be used while breastfeeding, but it's recommended to consult a healthcare provider for specific concerns regarding topical applications.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Cream
• Ointment
• Lotion

Dosage

Children: Refer to specific product formulations for guidelines, as dosing can vary based on the formulation and therapeutic context.

Adults: Refer to specific product formulations for guidelines, as dosing can vary based on the formulation and therapeutic context.

Mechanism of action

Stearates, such as magnesium stearate, function primarily by reducing friction during tablet manufacturing and enhancing the flow properties of powders. They do not exert a therapeutic pharmacological action in the body but facilitate the delivery of other active substances.

Pharmacodynamics

Given that stearates are primarily excipients, they do not exhibit traditional pharmacodynamic properties as active drugs do. Their role is to optimize the formulation of drugs, enhancing physical characteristics such as texture and consistency, which indirectly affect the performance of the active ingredients.

Pharmacokinetics

Stearates are poorly absorbed in the gastrointestinal tract due to their lipid nature. When ingested, they may pass through the digestive system with minimal systemic absorption. Their primary action occurs at the site of formulation, where they assist in the dispersion and release of active ingredients rather than being metabolized or exerting effects in the body.

Pregnancy

The safety of sterate during pregnancy has not been established. It should only be used if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether sterate is excreted in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a cool, dry place away from light. Keep out of reach of children.

Mechanism of action

Metformin is widely used to treat hyperglycemia. However, metformin treatment may induce intrahepatic cholestasis and liver injury in a few patients with type II diabetes through an unknown mechanism. Here we show that metformin decreases SIRT1 protein levels in primary hepatocytes and liver. Both metformin-treated wild-type C57 mice and hepatic SIRT1-mutant mice had increased hepatic and serum bile acid levels. However, metformin failed to change systemic bile acid levels in hepatic SIRT1-mutant mice. Molecular mechanism study indicates that SIRT1 directly interacts with and deacetylates Foxa2 to inhibit its transcriptional activity on expression of genes involved in bile acids synthesis and transport. Hepatic SIRT1 mutation elevates Foxa2 acetylation levels, which promotes Foxa2 binding to and activating genes involved in bile acids metabolism, impairing hepatic and systemic bile acid homeostasis. Our data clearly suggest that hepatic SIRT1 mediates metformin effects on systemic bile acid metabolism and modulation of SIRT1 activity in liver may be an attractive approach for treatment of bile acid-related diseases such as cholestasis. Metformin is antihyperglycemic, not hypoglycemic. It does not cause insulin release from the pancreas and does not cause hypoglycemia, even in large doses. Metformin has no significant effects on the secretion of glucagon, cortisol, growth hormone or somatostatin. Metformin reduces glucose levels primarily by decreasing hepatic glucose production and by increasing insulin action in muscle and fat. ... May decrease plasma glucose by reducing the absorption of glucose from the intestine. /Salt not specified/ Metformin potentiates the effect of insulin by mechanisms not fully understood. Metformin does not stimulate pancreatic beta cells to increase secretion of insulin; insulin secretion must be present for metformin to work properly. It is postulated that metformin decreases hepatic glucose production and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. /Salt not specified/ People with Type 2 diabetes mellitus (T2DM) have reduced bone mineral density and an increased risk of fractures due to altered mesenchymal stem cell (MSC) differentiation in the bone marrow. This leads to a shift in the balance of differentiation away from bone formation (osteogenesis) in favour of fat cell development (adipogenesis). The commonly used anti-diabetic drug, metformin, activates the osteogenic transcription factor Runt-related transcription factor 2 (Runx2), which may suppress adipogenesis, leading to improved bone health. Here we investigate the involvement of the metabolic enzyme, AMP-activated protein kinase (AMPK), in these protective actions of metformin. The anti-adipogenic actions of metformin were observed in multipotent C3H10T1/2 MSCs, in which metformin exerted reciprocal control over the activities of Runx2 and the adipogenic transcription factor, PPARgamma, leading to suppression of adipogenesis. These effects appeared to be independent of AMPK activation but rather through the suppression of the mTOR/p70S6K signalling pathway. Basal AMPK and mTOR/p70S6K activity did appear to be required for adipogenesis, as demonstrated by the use of the AMPK inhibitor, compound C. This observation was further supported by using AMPK knockout mouse embryo fibroblasts (MEFs) where adipogenesis, as assessed by reduced lipid accumulation and expression of the adipogeneic transcription factor, C/EBPbeta, was found to display an absolute requirement for AMPK. Further activation of AMPK in wild type MEFS, with either metformin or the AMPK-specific activator, A769662, was also associated with suppression of adipogenesis. It appears, therefore, that basal AMPK activity is required for adipogenesis and that metformin can inhibit adipogenesis through AMPK-dependent or -independent mechanisms, depending on the cellular context.

Mechanism of action

Metformin's mechanisms of action are unique from other classes of oral antihyperglycemic drugs. Metformin decreases blood glucose levels by decreasing hepatic glucose production (also called gluconeogenesis), decreasing the intestinal absorption of glucose, and increasing insulin sensitivity by increasing peripheral glucose uptake and utilization. It is well established that metformin inhibits mitochondrial complex I activity, and it has since been generally postulated that its potent antidiabetic effects occur through this mechanism. The above processes lead to a decrease in blood glucose, managing type II diabetes and exerting positive effects on glycemic control. After ingestion, the organic cation transporter-1 (OCT1) is responsible for the uptake of metformin into hepatocytes (liver cells). As this drug is positively charged, it accumulates in cells and in the mitochondria because of the membrane potentials across the plasma membrane as well as the mitochondrial inner membrane. Metformin inhibits mitochondrial complex I, preventing the production of mitochondrial ATP leading to increased cytoplasmic ADP:ATP and AMP:ATP ratios. These changes activate AMP-activated protein kinase (AMPK), an enzyme that plays an important role in the regulation of glucose metabolism. Aside from this mechanism, AMPK can be activated by a lysosomal mechanism involving other activators. Following this process, increases in AMP:ATP ratio also inhibit _fructose-1,6-bisphosphatase_ enzyme, resulting in the inhibition of gluconeogenesis, while also inhibiting _adenylate cyclase_ and decreasing the production of cyclic adenosine monophosphate (cAMP), a derivative of ATP used for cell signaling. Activated AMPK phosphorylates two isoforms of acetyl-CoA carboxylase enzyme, thereby inhibiting fat synthesis and leading to fat oxidation, reducing hepatic lipid stores and increasing liver sensitivity to insulin. In the intestines, metformin increases anaerobic glucose metabolism in enterocytes (intestinal cells), leading to reduced net glucose uptake and increased delivery of lactate to the liver. Recent studies have also implicated the gut as a primary site of action of metformin and suggest that the liver may not be as important for metformin action in patients with type 2 diabetes. Some of the ways metformin may play a role on the intestines is by promoting the metabolism of glucose by increasing glucagon-like peptide I (GLP-1) as well as increasing gut utilization of glucose. In addition to the above pathway, the mechanism of action of metformin may be explained by other ways, and its exact mechanism of action has been under extensive study in recent years. Metformin is widely used to treat hyperglycemia. However, metformin treatment may induce intrahepatic cholestasis and liver injury in a few patients with type II diabetes through an unknown mechanism. Here we show that metformin decreases SIRT1 protein levels in primary hepatocytes and liver. Both metformin-treated wild-type C57 mice and hepatic SIRT1-mutant mice had increased hepatic and serum bile acid levels. However, metformin failed to change systemic bile acid levels in hepatic SIRT1-mutant mice. Molecular mechanism study indicates that SIRT1 directly interacts with and deacetylates Foxa2 to inhibit its transcriptional activity on expression of genes involved in bile acids synthesis and transport. Hepatic SIRT1 mutation elevates Foxa2 acetylation levels, which promotes Foxa2 binding to and activating genes involved in bile acids metabolism, impairing hepatic and systemic bile acid homeostasis. Our data clearly suggest that hepatic SIRT1 mediates metformin effects on systemic bile acid metabolism and modulation of SIRT1 activity in liver may be an attractive approach for treatment of bile acid-related diseases such as cholestasis. Metformin is antihyperglycemic, not hypoglycemic. It does not cause insulin release from the pancreas and does not cause hypoglycemia, even in large doses. Me

Pharmacodynamics

**General effects** Insulin is an important hormone that regulates blood glucose levels. Type II diabetes is characterized by a decrease in sensitivity to insulin, resulting in elevations in blood glucose when the pancreas can no longer compensate. In patients diagnosed with type 2 diabetes, insulin is unable to exert adequate effects on tissues and cells (i.e. insulin resistance) and insulin deficiency may also be present. Metformin reduces hepatic production of glucose, decreases the intestinal absorption of glucose, and enhances insulin sensitivity by increasing both peripheral glucose uptake and utilization. In contrast with drugs of the sulfonylurea class, which lead to hyperinsulinemia, the secretion of insulin is unchanged with metformin use. **Effect on fasting plasma glucose (FPG) and Glycosylated hemoglobin (HbA1c)** HbA1c is an important periodic measure of glycemic control used to monitor diabetic patients. Fasting plasma glucose is also a useful and important measure of glycemic control. In a 29-week clinical trial of subjects diagnosed with type II diabetes, metformin decreased the fasting plasma glucose levels by an average of 59 mg/dL from baseline, compared to an average increase of 6.3 mg/dL from baseline in subjects taking a placebo. Glycosylated hemoglobin (HbA1c) was decreased by about 1.4% in subjects receiving metformin, and increased by 0.4% in subjects receiving placebo only.

Mechanism of action

Inhibition of DPP-4 by sitagliptin slows DPP-4 mediated inactivation of incretins like GLP-1 and GIP. Incretins are released throughout the day and upregulated in response to meals as part of glucose homeostasis. Reduced inhibition of incretins increase insulin synthesis and decrease glucagon release in a manner dependant on glucose concentrations. These effects lead to an overall increase in blood glucose control which is demonstrated by reduced glycosylated hemoglobin (HbA1c). Januvia is a member of a class of oral anti-hyperglycemic agents called dipeptidyl peptidase 4 (DPP-4) inhibitors. The improvement in glycemic control observed with this medicinal product may be mediated by enhancing the levels of active incretin hormones. Incretin hormones, including glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are released by the intestine throughout the day, and levels are increased in response to a meal. The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis. When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by intracellular signaling pathways involving cyclic AMP. Treatment with GLP-1 or with DPP-4 inhibitors in animal models of type 2 diabetes has been demonstrated to improve beta cell responsiveness to glucose and stimulate insulin biosynthesis and release. With higher insulin levels, tissue glucose uptake is enhanced. In addition, GLP-1 lowers glucagon secretion from pancreatic alpha cells. Decreased glucagon concentrations, along with higher insulin levels, lead to reduced hepatic glucose production, resulting in a decrease in blood glucose levels. The effects of GLP-1 and GIP are glucose-dependent such that when blood glucose concentrations are low, stimulation of insulin release and suppression of glucagon secretion by GLP-1 are not observed. For both GLP-1 and GIP, stimulation of insulin release is enhanced as glucose rises above normal concentrations. Further, GLP-1 does not impair the normal glucagon response to hypoglycemia. The activity of GLP-1 and GIP is limited by the DPP-4 enzyme, which rapidly hydrolyzes the incretin hormones to produce inactive products. Sitagliptin prevents the hydrolysis of incretin hormones by DPP-4, thereby increasing plasma concentrations of the active forms of GLP-1 and GIP. By enhancing active incretin levels, sitagliptin increases insulin release and decreases glucagon levels in a glucose-dependent manner. In patients with type 2 diabetes with hyperglycemia, these changes in insulin and glucagon levels lead to lower hemoglobin A1c (HbA1c) and lower fasting and postprandial glucose concentrations. The glucose-dependent mechanism of sitagliptin is distinct from the mechanism of sulfonylureas, which increase insulin secretion even when glucose levels are low and can lead to hypoglycemia in patients with type 2 diabetes and in normal subjects. Sitagliptin is a potent and highly selective inhibitor of the enzyme DPP-4 and does not inhibit the closely-related enzymes DPP-8 or DPP-9 at therapeutic concentrations. Sitagliptin is a DPP-4 inhibitor, which is believed to exert its actions in patients with type 2 diabetes by slowing the inactivation of incretin hormones. Concentrations of the active intact hormones are increased by Januvia, thereby increasing and prolonging the action of these hormones. Incretin hormones, including glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are released by the intestine throughout the day, and levels are increased in response to a meal. These hormones are rapidly inactivated by the enzyme, DPP-4. The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis. When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by

Pharmacodynamics

Sitagliptin inhibits DPP-4 which leads to increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide(GIP), decreased levels of glucagon, and a stronger insulin response to glucose.