Diapride MS1 Forte Tablet

Composition

Indication

Mechanism of Action (Triple-pathway approach)

1. Glimepiride (Sulfonylurea) - stimulates the pancreatic beta cells to release more insulin; also improves peripheral tissue insulin sensitivity.
2. Metformin (Biguanide) - reduces hepatic glucose production (gluconeogenesis/glycogenolysis); improves insulin sensitivity in muscle and fat; does not cause hypoglycemia on its own.
3. Sitagliptin (DPP-4 inhibitor) - inhibits the enzyme dipeptidyl peptidase-4, which prolongs the action of incretin hormones (GLP-1 and GIP), thereby enhancing glucose-dependent insulin secretion and suppressing glucagon release.

How to Take

• Take orally with food to reduce GI side effects.
• Swallow the tablet whole - do not crush or chew.
• Take at the same time each day.
• Do not stop abruptly without consulting your doctor.

Common Side Effects

Contraindications

• Type 1 diabetes mellitus
• Diabetic ketoacidosis or acute/chronic metabolic acidosis
• Active bladder cancer or history of bladder cancer
• Severe renal impairment (metformin-related lactic acidosis risk)
• Pregnancy / breastfeeding (consult doctor)

Dosage

• Dose and duration are set by the treating physician based on blood glucose levels and patient response.
• Do not self-adjust the dose.
• Overdose may cause severe hypoglycemia - seek medical attention.
• If a dose is missed, take it as soon as you remember unless it is almost time for the next dose; never double-dose.

Drug Interactions (Key)

• Other antidiabetics, insulin - increased hypoglycemia risk
• NSAIDs, beta-blockers, alcohol - can mask or worsen hypoglycemia
• Contrast agents (iodinated) - hold Metformin 48 hours around imaging due to lactic acidosis risk
• Rifampicin, corticosteroids - may reduce hypoglycemic effect

Monitoring

• Regular blood glucose (fasting + post-prandial) and HbA1c
• Renal function tests (Metformin requires adequate kidney function)
• Liver function tests periodically

Key Points to Remember

• This is a triple-drug combination for patients who need more aggressive glycemic control.
• Lifestyle measures (diet, exercise, weight management) remain essential alongside this medication.
• The GRADE trial found that in patients on metformin, adding liraglutide or basal insulin provided slightly better glycemic control than glimepiride or sitagliptin alone, which is worth discussing with your physician if targets are not met.
• Never stop this medicine abruptly - blood sugar can rebound dangerously.