ISTAMET D XR 500 Tablet 7's

Introduction About ISTAMET D XR 500 TABLET

ISTAMET D XR 500 Tablet is a combination medicine containing dapagliflozin (10mg), sitagliptin (100mg), and metformin hydrochloride (500mg). It is designed to help manage blood glucose levels in adults diagnosed with type 2 diabetes. Regular use alongside a balanced diet and exercise routine supports effective blood sugar control.

Take ISTAMET D XR 500 TABLET as directed by your physician. Taking this medicine after meals helps to avoid stomach upset. Do not stop using ISTAMET D XR 500 TABLET without talking to your doctor. Prior to the management, your doctor may want you to take several blood tests to understand your existing kidney condition.

ISTAMET D XR 500 TABLET is not recommended for use during pregnancy or in breastfeeding women. It is also not suitable for use if you have respiratory failure, severe kidney disease, liver disease, heart failure, or a recent myocardial infarction. Therefore, consult your doctor before taking it.

The most common side effects of taking ISTAMET D XR 500 TABLET are hypoglycemia (low blood glucose level), nausea, vomiting, headache, flatulence, genital infections, and increased or more frequent urination. Consult your doctor if any of the side effects worsen.

Uses Of ISTAMET D XR 500 TABLET

• Manages Type II diabetes mellitus

Benefits of ISTAMET D XR 500 TABLET

• Helps maintain stable blood glucose levels in type 2 diabetes
• Convenient, once-daily oral tablet for adults
• Supports a holistic diabetes care approach with diet and exercise
• Contains evidence-backed ingredients for blood sugar regulation.

How ISTAMET D XR 500 TABLET Works

The mechanism of action of ISTAMET D XR 500 Tablet is based on the combined effects of its three active ingredients: dapagliflozin, metformin, and sitagliptin. Together, they support blood sugar control through different pathways:

• Dapagliflozin increases the removal of glucose from the body by helping the kidneys excrete excess sugar in the urine.
• Metformin reduces glucose production in the liver and decreases glucose absorption from food, while also improving the body's sensitivity to insulin.
• Sitagliptin enhances the release of insulin from the pancreas in response to high blood sugar and signals the liver to reduce sugar production when blood glucose is elevated.

This multifaceted approach helps regulate blood sugar levels effectively in adults with type 2 diabetes when used alongside diet and exercise.

How to use ISTAMET D XR 500 TABLET

Take the tablet exactly as prescribed by your healthcare provider. Swallow it whole with a glass of water, preferably with a meal to reduce stomach upset. Avoid breaking, crushing, or chewing the tablet to maintain its extended-release properties. Consistent daily intake at the same time helps in maintaining steady blood levels.

How to Take ISTAMET D XR 500 Tablet Safely

• Follow your doctor’s instructions strictly.
• Do not exceed or skip doses.
• Drink plenty of fluids to prevent dehydration, especially if you experience increased urination.
• Inform your doctor of all medications, supplements, or health conditions to avoid interactions.
• Monitor your blood sugar levels regularly during therapy.

Daily Routine and Tablet Intake Tips

• Take the tablet at a consistent time each day, ideally aligned with a meal.
• Use reminders or pill organizers to help remember doses.
• Maintain a balanced diet and regular exercise as part of your diabetes management plan.
• Avoid alcohol and inform your healthcare provider if you experience any side effects.

Special Instructions for Elderly and Kidney Patients

Use caution in elderly patients and those with kidney impairment. Regular kidney function monitoring is recommended. Dosage adjustments may be necessary, so consult your healthcare provider regularly for assessment and guidance.

Safe Oral Diabetes Medication Guide

• Swallow the tablet whole with water.
• Store the medication in a cool, dry place away from direct sunlight and moisture.
• Keep out of reach of children.
• Avoid sudden discontinuation of the tablet as it may cause blood sugar levels to rise.
• Continue routine monitoring and follow-ups as advised by your healthcare professional.

What if I forgot to take ISTAMET D XR 500 TABLET

If a dose is missed, take it as soon as you remember unless it is nearly time for the next dose. In that case, skip the missed dose and resume your normal schedule. Do not double the dose to make up for the missed one.

Overdose

If you or anyone else accidentally took too much of this medicine, consult your doctor immediately. The symptoms include hypoglycemia, feeling cold or uncomfortable, severe nausea or vomiting, stomach pain, unexplained weight loss, muscular cramps, or rapid breathing.

Side Effects Of ISTAMET D XR 500 TABLET

Common Side Effects of ISTAMET D XR 500 TABLET:

• Hypoglycemia (low blood glucose level)
• Nausea, vomiting
• Headache
• Flatulence
• Genital infections
• Increased or more frequent urination
• Drowsiness, dizziness
• Diarrhea, constipation
• Stomach pain
• Itching
• Dry mouth
• Decreased weight
• Thirst

When to consult your doctor?

• Symptoms of acute pancreatitis, such as severe and persistent abdominal pain that might reach through your back with or without nausea and vomiting
• Symptoms of allergic reactions such as rash, hives, blisters on the skin or peeling skin, and swelling of the face, lips, tongue, and throat that may cause difficulty breathing or swallowing
• Signs of bullous pemphigoid, such as blistering of the skin
• Symptoms of lactic acidosis include vomiting, abdominal pain, muscle cramps, a general feeling of not being well, severe tiredness, difficulty breathing, reduced body temperature, and a slow heartbeat
• The symptoms of diabetic ketoacidosis are nausea, vomiting, stomach pain, excessive thirst, fast and deep breathing, confusion, unusual sleepiness or tiredness, a sweet smell to your breath, a sweet or metallic taste in your mouth, or a different odour to your urine or sweat, or rapid weight loss
• Signs of severe infections of the urinary tract include fever, chills, a burning sensation during urination, pain in your back or side, and blood in your urine

How To Manage Side Effects

Constipation

Include fiber-rich foods in your diet, such as fresh fruits, vegetables, and whole-grain cereals, and drink plenty of fluids. Exercise more regularly and stay active. Contact your doctor if constipation persists.

Diarrhea

Drink lots of fluids, such as water or fruit juices, to keep yourself hydrated. Do not take any medicine on your own to manage diarrhea. Contact your doctor if your diarrhea does not improve.

Warning & Precautions

Pregnancy

Consult your doctor

There are no well controlled human studies regarding the use of Dapagliflozin + Sitagliptin + Metformin in pregnant women. Animal studies have indicated few harmful side effects in their progeny. Therefore, ISTAMET D XR 500 TABLET should be taken by pregnant women only if your doctor considers it as clearly necessary.

Breastfeeding

Consult your doctor

It is not known whether the medicines, Dapagliflozin + Sitagliptin + Metformin gets excreted in breast milk. Animal studies have reported the excretion of medicine in milk as well as pharmacologically mediated effects in nursing offspring. A risk to the infant cannot be excluded. Therefore, breastfeeding women should not take ISTAMET D XR 500 TABLET unless considered necessary by the physician.

Driving and Using Machines

Use with Caution

Do not drive or operate any machines if you have dizziness and drowsiness after taking ISTAMET D XR 500 TABLET.

Alcohol

Consult your doctor

Avoid consumption of alcohol while taking ISTAMET D XR 500 TABLET, as it may increase the risk of lactic acidosis.

Kidney

Consult your doctor

ISTAMET D XR 500 TABLET is not recommended for use in patients with severe kidney disease. It should be used with caution in patients with mild to moderate kidney disease. Consult your doctor before taking it.

Liver

Contraindicated

ISTAMET D XR 500 TABLET is not recommended for use if you have liver disease. Consult your doctor before taking it.

Allergy

Contraindicated

ISTAMET D XR 500 TABLET is not recommended for use if you are allergic to dapagliflozin, metformin, sitagliptin, or any of the other ingredients of this medicine.

Lungs

Contraindicated

ISTAMET D XR 500 TABLET is not recommended for use if you have respiratory failure. Consult your doctor before taking it.

Heart Disease

Contraindicated

ISTAMET D XR 500 TABLET is not recommended for use if you have heart failure or a recent myocardial infarction. Consult your doctor before taking it.

Use In Pediatrics

Contraindicated

ISTAMET D XR 500 TABLET is not recommended for use in children and adolescents below 18 years of age as safety and efficacy are not clinically established. Contact your doctor before taking.

Use In Geriatrics

Use with Caution

ISTAMET D XR 500 TABLET should be used with caution in elderly patients (aged 65 years or older). Contact your doctor before taking.

Other Warnings for ISTAMET D XR 500 TABLET

Before taking ISTAMET D XR 500 TABLET, inform your doctor if you:

• Have a history of pancreatitis
• Have or have had gallstones
• Have very high levels of triglycerides (a form of fat) in your blood

Who should not take [GBNKEYWORD

ISTAMET D XR 500 TABLET is not recommended for use if you:

• Have Type 1 diabetes mellitus
• Have acute metabolic acidosis (such as lactic acidosis or diabetic ketoacidosis)
• Have diabetic pre-coma
• Have dehydration
• Have a severe infection
• Have shock
• Are scheduled for a lab test
• Are planned for surgery

Diet and Lifestyle Advice

• Adopt a Balanced Diet
  Focus on whole grains, fresh vegetables, fruits (in moderation), lean proteins, and healthy fats. Avoid excessive sugar, refined carbs, and processed foods.
• Control Portion Sizes
  Eating smaller, frequent meals helps maintain stable blood sugar levels.
• Limit Sugary and High-Glycemic Foods
  Reduce intake of sweets, sugary drinks, white bread, and bakery products that can cause rapid blood sugar spikes.
• Stay Hydrated
  Drink plenty of water throughout the day to support overall metabolic health.
• Engage in Regular Physical Activity
  Aim for at least 30 minutes of moderate exercise daily, like walking, cycling, or swimming, after consulting your healthcare provider.
• Maintain a Healthy Weight
  Losing excess weight improves insulin sensitivity and blood sugar control.
• Avoid Alcohol or Consume Moderately
  Alcohol can affect blood sugar; discuss safe limits with your doctor.
• Manage Stress Effectively
  Practice relaxation techniques such as deep breathing, meditation, or yoga to reduce blood sugar fluctuations caused by stress.
• Get Adequate Sleep
  Aim for 7-8 hours of restful sleep nightly to support metabolic balance.
• Coordinate with Medications
  Follow medication timings and dosage as prescribed by healthcare professionals to complement diet and lifestyle efforts.

Drug - Drug interaction

• Combining with sulfonylureas or insulin may increase risk of low blood sugar (hypoglycemia).
• Medicines like ketoconazole, itraconazole (antifungals), ritonavir (antiviral), and clarithromycin (antibiotic) may interact.
• Corticosteroids (e.g., dexamethasone) can alter blood sugar control.
• Diuretics such as furosemide may increase dehydration and low blood pressure risk with ISTAMET.
• NSAIDs and COX-2 inhibitors (ibuprofen, celecoxib) may impair kidney function when combined.
• Blood pressure medications like ACE inhibitors (enalapril) and angiotensin II receptor blockers (losartan) require monitoring.
• Digoxin (heart condition medicine) interactions merit caution.
• Alcohol consumption may heighten side effect risks, especially lactic acidosis.

Synopsis

More Information

How Does ISTAMET D XR 500 Stand Out Compared to ISTAMET XR 500?

Tips to monitor blood sugar level

• Use a Reliable Glucometer
  Choose a quality blood glucose meter approved by health authorities. Follow the manufacturer’s instructions for accurate readings.
• Test at Recommended Times
  Common testing times include fasting (before breakfast), 2 hours after meals, before exercise, and at bedtime. Follow your healthcare provider’s schedule.
• Keep a Logbook or Digital Record
  Record all readings with date, time, and notes on meals, activity, or symptoms to detect patterns.
• Follow Proper Testing Technique
  Wash hands before testing to avoid contamination. Use fresh test strips and change lancets regularly for comfort and accuracy.
• Understand Your Target Levels
  Know your personal target glucose ranges as advised by your doctor or diabetes educator.
• Look for Trends, Not Just Single Readings
  Patterns over days or weeks help guide treatment decisions more than individual values.
• Adjust Lifestyle Accordingly
  Use your readings to inform dietary choices, physical activity, and medication timing, always in consultation with your healthcare provider.
• Report Abnormal Results Promptly
  Very high or low readings should be discussed with your doctor immediately to prevent complications.
• Avoid Testing Stress
  Stay calm during tests, and don’t let occasional irregular readings discourage you.
• Schedule Regular Reviews
  Share your logs during medical visits to optimize your diabetes management plan.

FAQs About ISTAMET D XR 500 TABLET

Q: What is ISTAMET D XR 500 TABLET used for?

A: It is used to manage type 2 diabetes mellitus along with diet and exercise when diabetes cannot be controlled with other medicines.

Q: Who should not take ISTAMET D XR 500 TABLET?

A: ISTAMET D XR 500 TABLET is not recommended for use if you have respiratory failure, severe kidney disease, liver disease, heart failure, recent myocardial infarction, Type 1 diabetes mellitus, acute metabolic acidosis (such as lactic acidosis and diabetic ketoacidosis), diabetic pre-coma, dehydration, severe infection, or shock. Consult your doctor before taking it.

Q: Can I take alcohol while using ISTAMET D XR 500 TABLET?

A: No. Avoid consumption of alcohol while taking ISTAMET D XR 500 TABLET, as it may increase the risk of lactic acidosis.

Q: Is ISTAMET D XR 500 TABLET safe for kidneys?

A: ISTAMET D XR 500 TABLET is not recommended for use in patients with severe kidney disease. It should be used with caution in patients with mild to moderate kidney disease. Consult your doctor before taking it.

Q: How does ISTAMET D XR 500 TABLET work?

A: ISTAMET D XR 500 TABLET is a combination of dapagliflozin, metformin, and sitagliptin. Dapagliflozin increases urinary glucose excretion and reduces blood glucose levels. Metformin decreases the amount of glucose you absorb from your food and the amount of glucose made by the liver. It also increases the body's response to insulin, a natural substance that controls the amount of glucose in the blood. Sitagliptin helps control blood sugar levels by increasing substances (incretins) in the body that make the pancreas release more insulin. It also signals the liver to stop producing sugar (glucose) when there is too much sugar in the blood.

Q: Can I use ISTAMET D XR 500 TABLET with other diabetic medications?

A: Your doctor may advise ISTAMET D XR 500 TABLET with or without other medications to control your blood sugar levels. However, it is advised to maintain a proper diet and exercise to achieve controlled blood sugar levels while using this medicine with or without other antidiabetic medications.

Q: Can ISTAMET D XR 500 TABLET be used during pregnancy?

A: ISTAMET D XR 500 TABLET is not recommended for use during pregnancy. Consult your doctor before taking it.

Q: Does ISTAMET D XR 500 TABLET cause low blood sugar?

A: Yes. ISTAMET D XR 500 TABLET may cause low blood sugar. Stop taking ISTAMET D XR 500 TABLET and contact your doctor if you experience any unusual symptoms like weakness, shaking, sweating, drowsiness, dizziness, feeling very anxious, fast heartbeat, hunger, headache, change in vision, change in mood or confusion, and irritability.

Q: Is ISTAMET D XR 500 TABLET safe for kids?

A: ISTAMET D XR 500 TABLET is not recommended for use in children and adolescents below 18 years of age as safety and efficacy are not clinically established. Contact your doctor before taking.

Q: What are the side effects of ISTAMET D XR 500 TABLET?

A: The most common side effects of taking ISTAMET D XR 500 TABLET are hypoglycemia (low blood glucose level), nausea, vomiting, headache, flatulence, genital infections, and increased or more frequent urination. Consult your doctor if any of the side effects worsen.

References

1. K.D. Tripathi. Insulin, oral hypoglycaemic drugs and glucagon. Essentials of Medical Pharmacology. Seventh Edition. 2013. Page - 278, 275.

2. Clifford J Bailey, Jorge L Gross, Delphine Hennicken, Nayyar Iqbal, Traci A Mansfield, and James F List. Uses of metformin and dapagliflozin. Biomed Central (BMC). February 2013. [Accessed on 9th September 2025] 

3. La Renon Healthcare. Dapagliflozin+Metformin+Sitagliptin. [Accessed on 9th September 2025] 

4. TORRENT PHARMACEUTICALS LTD. Dapagliflozin and Sitagliptin. [Accessed on 9th September 2025] 

5. TORRENT PHARMACEUTICALS LTD. Sitagliptin and Metformin. [Accessed on 9th September 2025] 

Useful Diagnostic Tests

• Random Blood Sugar (RBS)
• Fasting Blood Sugar (FBS)
• Post Prandial Blood Sugar (PPBS)
• Sugar Risk Package
• HbA1C, Also known as Glycated Hemoglobin, Glycosylated Hemoglobin

Author Details

Written By Dr. Karthikeyan Rajagopal - M.Pharm (Pharmacology)

Reviewed For Accuracy By Dr. Jaya Prabakaran - MBBS, MD (Diabetology and Family Medicine)

Last updated on 10 Sep 2025 | 03:41 PM(IST)