ISTAMET D XR 1000 Tablet 7's

Introduction About ISTAMET D XR TABLET

ISTAMET D XR 1000 Tablet combines three active ingredients such as dapagliflozin 10mg, metformin 1000mg, and sitagliptin 100mg which belonging to the class of antidiabetic medications. It is designed to help regulate blood sugar levels in individuals with type 2 diabetes. This formulation works by enhancing insulin sensitivity, promoting better glucose control, and helping to lower excess blood sugar.

ISTAMET D XR 1000 tablet can be taken with or without food, at any time of day. However, it is recommended to take it at the same time each day. Your doctor will determine the appropriate dose, so do not stop taking it without their guidance. Stopping the medication without consulting your doctor may lead to increased blood sugar levels and raise the risk of serious complications, such as kidney damage and blindness. Remember, this medication is just one part of your overall management plan, which should also include a balanced diet, regular exercise, and weight management as recommended by your doctor.

The most common side effects of this medicine includes headache, gastrointestinal discomfort (e.g., nausea, bloating), increased urination, fatigue or tiredness, dry mouth, urinary tract infection, nasal congestion, sore throat, and upper respiratory tract infection. Drinking plenty of fluids while taking this medication can helps to reduce dehydration. In some cases, individuals may experience fungal infections in the genital area. Practicing good hygiene can helps to reduce the risk of this occurring.

Before taking ISTAMET D XR 1000 tablet, inform your doctor if you have any kidney or liver problems or urinary tract infection, or are taking diuretics (water pills). Pregnant or breastfeeding women should consult a doctor before taking this medication. It's also advisable to avoid excessive alcohol consumption while taking it, as it could raise the risk of certain side effects. Additionally, regularly monitor your blood sugar levels while on this medication.

Uses Of ISTAMET D XR TABLET

• Type 2 diabetes mellitus
• Weight management (Off label use)

Benefits of ISTAMET D XR TABLET

01) Improved Blood Sugar Control: Dapagliflozin works by reducing excess glucose in the bloodstream through the kidneys.

02) Enhanced Insulin Sensitivity: Metformin supports better utilization of insulin in the body, helping to maintain stable blood sugar levels.

03) Balanced Blood Sugar Levels: Sitagliptin helps regulate glucose production in the liver and improves insulin response after meals.

04) Convenient Once-Daily Dosing: The extended-release formulation ensures that the tablet can be taken once a day, making it easier for patients to manage their condition.

05) Minimal Risk of Weight Gain:The combination helps minimize weight gain, a common concern with certain diabetes medications.

How ISTAMET D XR TABLET Works

ISTAMET D XR 1000 Tablet, which contains Dapagliflozin (10mg), Metformin (1000mg), and Sitagliptin (100mg), helps control blood sugar in people with type 2 diabetes by using three different actions. Dapagliflozin helps the kidneys remove excess sugar from the body through urine. Metformin reduces sugar production in the liver and helps the body use insulin more effectively. Sitagliptin increases insulin release and reduces sugar production after meals. Together, these medications work to lower blood sugar levels and improve overall glucose control.

How Dapagliflozin Works to Lower Blood Sugar:

Dapagliflozin, an SGLT2 inhibitor, works by inhibiting the sodium-glucose co-transporter 2 (SGLT2) in the kidneys, which leads to the increased excretion of glucose through urine. This helps reduce excess blood glucose levels without affecting insulin secretion.

Understanding the Role of Metformin in Blood Glucose Control:

Metformin, a biguanide, primarily works by reducing the amount of glucose produced by the liver and increasing insulin sensitivity in muscle cells, allowing the body to use insulin more effectively. It also reduces glucose absorption from the digestive tract.

Sitagliptin’s Action on Insulin Secretion and Glucose Production:

Sitagliptin, a DPP-4 inhibitor, helps regulate blood sugar by increasing insulin secretion from the pancreas in response to meals and reducing the amount of glucose produced by the liver. It enhances the body's natural ability to regulate blood glucose levels after eating.

Combined Mechanism of Action of Dapagliflozin, Metformin, and Sitagliptin:

The combination of Dapagliflozin, Metformin, and Sitagliptin works synergistically to provide comprehensive blood glucose control. Dapagliflozin lowers glucose levels by increasing renal glucose excretion, Metformin improves insulin sensitivity, and Sitagliptin enhances insulin secretion after meals.

What is the Role of SGLT2 Inhibitors in Diabetes Management?

SGLT2 inhibitors like Dapagliflozin play an important role in managing diabetes by preventing glucose reabsorption in the kidneys, thereby reducing high blood sugar levels. They provide a novel way to control glucose that doesn’t directly affect insulin levels.

How Extended-Release Formulation Enhances Blood Sugar Control:

The extended-release formulation of ISTAMET D XR 1000 Tablet ensures that the active ingredients are released gradually over time, leading to more stable blood sugar levels throughout the day and reducing the likelihood of glucose spikes or dips.

How to use ISTAMET D XR TABLET

Follow your doctor's instructions regarding the exact dosage. Do not exceed the recommended daily dosage.

Recommended Dosage for ISTAMET D XR 1000 Tablet:

The typical recommended dosage of ISTAMET D XR 1000 Tablet is 1 tablet once daily. However, your doctor may adjust the dose based on your individual needs and medical condition. Always follow your doctor’s instructions.

When Should You Take ISTAMET D XR 1000 Tablet:

It is best to take ISTAMET D XR 1000 Tablet at the same time every day to help you remember. You can take the tablet at any time during the day, but it’s important to maintain a consistent routine.

Instructions for Administering ISTAMET D XR 1000 Tablet:

Take ISTAMET D XR 1000 Tablet with a full glass of water. Do not crush or chew the tablet, as it is an extended-release formulation. Swallow the tablet whole for optimal effectiveness.

Should ISTAMET D XR 1000 Tablet Be Taken With Food:

ISTAMET D XR 1000 Tablet can be taken with or without food. If you experience stomach upset when taking the tablet on an empty stomach, you may try taking it with food to reduce discomfort.

What if I forgot to take ISTAMET D XR TABLET

If you miss a dose of ISTAMET D XR 1000 Tablet, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and take your next dose at the regular time. Never take two doses at the same time to make up for a missed dose.

Side Effects Of ISTAMET D XR TABLET

Like all medicines, ISTAMET D XR 1000 tablet may cause certain side effects in some individuals, although not everybody gets them.

The most common side effects of taking ISTAMET D XR 1000 tablet are:

• Headache
• Gastrointestinal discomfort (e.g., nausea, bloating)
• Increased urination
• Fatigue or tiredness
• Dry mouth
• Urinary tract infection
• Nasal congestion
• Sore throat
• Upper respiratory tract infection

When to consult your doctor?

• Severe allergic reactions symptoms such as rash, itching, swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing.
• Lactic acidosis symptoms such as unusual tiredness, muscle pain, difficulty breathing, stomach pain, dizziness, or feeling cold.
• Pancreatitis symptoms such as severe abdominal pain (with or without vomiting), nausea, or fever.
• Low blood sugar (hypoglycemia) symptoms such as sweating, shaking, confusion, dizziness, or fainting, especially if used with other diabetic medications.
• Kidney problems symptoms such as decreased urination, swelling of the legs or feet, or fatigue.
• Urinary tract or genital infections symptoms such as painful urination, increased urgency, or signs of a yeast infection
• Severe dehydration symptoms such as dry mouth, extreme thirst, dizziness, or confusion, which could occur with Dapagliflozin due to fluid loss.

How To Manage Side Effects

Headache

• Rest in a Quiet, Dark Room: Find a calm, quiet space away from bright lights and loud noises. Lie down and close your eyes.
• Hydrate: Dehydration can contribute to headaches, so drink plenty of water.
• Apply a Cold or Warm Compress: A cold pack on your forehead may reduce pain, or a warm compress on your neck or shoulders can relieve tension.
• Over-the-Counter Pain Relief: You can take over-the-counter pain relievers like acetaminophen or ibuprofen if appropriate for you. Follow the recommended dosage.
• Practice Relaxation Techniques: Deep breathing exercises, meditation, or gentle stretching can help reduce stress and alleviate headache symptoms.

Nausea And Vomiting

• Eat Small, Frequent Meals: Avoid heavy or greasy foods. Opt for bland foods like crackers, toast, or bananas.
• Stay Hydrated: Sip on clear fluids like water, ginger tea, or electrolyte drinks, Avoid caffeinated and carbonated beverages.
• Ginger: Ginger is a natural remedy for nausea. Try ginger tea, ginger candies, or ginger ale (ensure it contains real ginger).
• Avoid Strong Odors: Minimize exposure to smells that might trigger nausea, such as perfumes or cooking odors.

Warning & Precautions

Pregnancy

Consult your doctor

There are no well controlled human studies regarding the use of ISTAMET D XR 1000 Tablet in pregnant women. Animal studies have indicated few harmful side effects in their progeny. Therefore, ISTAMET D XR 1000 Tablet should be taken by pregnant women only if your doctor considers it as clearly necessary. Consult your doctor before taking this medication.

Breastfeeding

Consult your doctor

It is not known whether ISTAMET D XR 1000 tablet 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 1000 Tablet unless considered necessary by the physician. Consult your doctor before taking this medication.

Driving and Using Machines

Use with Caution

Do not drive or operate any machines if you experience dizziness or drowsiness after taking ISTAMET D XR 1000 Tablet.

Alcohol

Consult your doctor

Avoid consumption of alcohol while taking ISTAMET D XR 1000 Tablet, as it may increase the risk of lactic acidosis, low blood sugar (hypoglycemia) and dehydration.

Kidney

Consult your doctor

ISTAMET D XR 1000 Tablet is not recommended for use in patients with severe kidney disease and should be used with caution in patients with mild to moderate kidney disease. Consult your doctor before taking it.

Liver

Contraindicated

ISTAMET D XR 1000 Tablet is not recommended for use in patients with liver disease.Consult your doctor before taking it.

Allergy

Contraindicated

Do not take ISTAMET D XR 1000 Tablet if you are allergic to Dapagliflozin or Metformin or Sitagliptin or any other ingredients of this medicine.

Lungs

Contraindicated

ISTAMET D XR 1000 Tablet is not recommended for use in patients with respiratory failure. Consult your doctor before taking it.

Heart Disease

Contraindicated

ISTAMET D XR 1000 Tablet is not recommended for use in patients with heart failure or a recent myocardial infarction. Consult your doctor before taking it.

Use In Pediatrics

Contraindicated

ISTAMET D XR 1000 Tablet is not recommended for use in children and adolescents below 18 years of age as safety and efficacy are not clinically established. Consult your pediatrician before giving it.

Use In Geriatrics

Use with Caution

ISTAMET D XR 1000 Tablet should be used with caution in elderly patients (aged 65 years or older). Consult your doctor before taking it.

Other Warnings for ISTAMET D XR TABLET

Before taking ISTAMET D XR 1000 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 1000 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 severe dehydration
• Have a severe infection
• Have shock
• Are scheduled for a lab test
• Are planned for surgery

Drug - Drug interaction

Inform your physician if you are taking any of the following medicine before taking ISTAMET D XR 1000 Tablet:

1. Diuretics (e.g., Thiazides like Hydrochlorothiazide)

• Interaction: Diuretics, particularly thiazide diuretics, can reduce renal function and may increase blood sugar levels, which can counteract the blood sugar-lowering effect of Istamet D-XR.
• Effects: Elevated blood sugar, dehydration, and increased risk of electrolyte imbalances like low potassium.
• Management: Monitor blood sugar levels closely, adjust the dosage of Istamet D-XR as needed, and monitor electrolytes, especially potassium and sodium, during therapy.

2. Insulin or Insulin Secretagogues (e.g., Glimepiride, Glyburide)

• Interaction: Both Sitagliptin and Metformin enhance insulin sensitivity and can potentiate the blood-sugar-lowering effects of insulin or other insulin-releasing medications.
• Effects: Hypoglycemia (low blood sugar) can occur, especially when taken with insulin or sulfonylureas.
• Management: Monitor blood glucose levels more frequently, especially when initiating or adjusting the dose of insulin or insulin secretagogues. A dose reduction of insulin or other oral diabetes medications may be necessary.

3. Corticosteroids (e.g., Prednisone)

• Interaction: Corticosteroids may increase blood glucose levels by promoting gluconeogenesis (sugar production in the liver) and reducing insulin sensitivity.
• Effects: Hyperglycemia (high blood sugar).
• Management: Monitor blood glucose more frequently, especially during periods of corticosteroid use. Your doctor may adjust the dosage of Istamet D-XR or other diabetes medications as needed.

4. ACE Inhibitors (e.g., Enalapril, Lisinopril)

• Interaction: ACE inhibitors may have a synergistic effect on kidney function, which is already influenced by Dapagliflozin and Metformin.
• Effects: Possible hypotension (low blood pressure), dehydration, or worsening of kidney function.
• Management: Monitor blood pressure, kidney function (serum creatinine and GFR), and electrolytes. Adjust the dosage of Istamet D-XR or ACE inhibitors as required.

5. Angiotensin II Receptor Blockers (ARBs, e.g., Losartan, Valsartan)

• Interaction: Similar to ACE inhibitors, ARBs can influence kidney function and may increase the effects of Dapagliflozin and Metformin.
• Effects: Risk of dehydration, hypotension, and worsening kidney function.
• Management: Monitor kidney function and blood pressure regularly. Ensure proper hydration, and adjust medications based on kidney function.

6. Anti-hypertensive Medications

• Interaction: Anti-hypertensive drugs like beta-blockers or calcium channel blockers can lower blood pressure and may increase the risk of dehydration due to Dapagliflozin (which increases urination).
• Effects: Hypotension (low blood pressure), dehydration, dizziness, or fainting.
• Management: Monitor blood pressure regularly and assess for signs of dehydration. Adjust the dosages of antihypertensive medications if necessary.

7. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs, e.g., Ibuprofen, Naproxen)

• Interaction: NSAIDs may impair kidney function, especially in combination with Dapagliflozin and Metformin, increasing the risk of kidney damage.
• Effects: Acute kidney injury, reduced effectiveness of Istamet D-XR.
• Management: Avoid prolonged or high-dose NSAID use, especially in patients with pre-existing kidney conditions. Monitor kidney function closely during concurrent therapy.

8. Rifampin (an antibiotic)

• Interaction: Rifampin can induce the metabolism of Sitagliptin, potentially reducing its effectiveness by increasing its elimination from the body.
• Effects: Decreased effectiveness of Sitagliptin, leading to higher blood sugar.
• Management: Monitor blood glucose levels closely. If necessary, adjust the dosage of Istamet D-XR to maintain blood sugar control.

9. CYP3A4 Inhibitors (e.g., Ketoconazole, Clarithromycin)

• Interaction: CYP3A4 inhibitors can increase the levels of Sitagliptin by inhibiting its metabolism, leading to a possible increased risk of side effects.
• Effects: Increased risk of side effects like headache, nausea, or dizziness.
• Management: Monitor for side effects, and adjust the Istamet D-XR dosage if necessary. If side effects become problematic, consult your doctor for an alternative treatment option.

10. Digoxin

• Interaction: Digoxin can interact with Dapagliflozin, leading to an increased risk of digoxin toxicity due to changes in electrolyte balance (particularly potassium).
• Effects: Symptoms of digoxin toxicity may include nausea, vomiting, and arrhythmias (irregular heartbeats).
• Management: Monitor electrolytes (especially potassium) and digoxin levels, and adjust medication as needed.

11. Carbonic Anhydrase Inhibitors (e.g., Acetazolamide)

• Interaction: Carbonic anhydrase inhibitors can increase the risk of lactic acidosis when used with Metformin.
• Effects: Increased risk of lactic acidosis, which is a serious condition.
• Management: Avoid concurrent use or closely monitor for signs of lactic acidosis. Adjust medications based on clinical need and response.

Synopsis

More Information

1. Diet and Lifestyle Guidance

2. Why is ISTAMET D XR 1000 Tablet effective in managing blood glucose levels?

ISTAMET D XR 1000 Tablet is highly effective in managing blood glucose levels due to its unique combination of three active ingredients: Dapagliflozin (10mg), Metformin (1000mg), and Sitagliptin (100mg). Each of these ingredients works in a different way to control blood sugar levels, and together, they provide a comprehensive approach to managing type 2 diabetes. Here's a detailed explanation of how each component works:

1. Dapagliflozin (10mg)

Dapagliflozin is a SGLT-2 inhibitor (Sodium-Glucose Co-Transporter 2 inhibitor) that works primarily on the kidneys. It helps to lower blood glucose levels by blocking the SGLT-2 protein in the kidneys, which is responsible for reabsorbing glucose back into the blood. By inhibiting this process, dapagliflozin allows excess glucose to be excreted in the urine, thus reducing blood sugar levels. This also results in some weight loss, as glucose is eliminated through urine.

Key Benefit: Helps remove excess glucose through the urine, reducing blood sugar levels and contributing to weight loss.

2. Metformin (1000mg)

Metformin is a biguanide that works in multiple ways to help control blood glucose. Its primary action is in the liver, where it reduces glucose production. Metformin also helps to improve the body’s sensitivity to insulin, making the cells respond better to insulin and use glucose more efficiently. This is important because many individuals with type 2 diabetes have insulin resistance, meaning their body’s cells do not respond properly to insulin.

Key Benefit: Reduces glucose production in the liver and improves insulin sensitivity, helping to lower blood sugar levels and reduce insulin resistance.

3. Sitagliptin (100mg)

Sitagliptin is a DPP-4 inhibitor (Dipeptidyl Peptidase-4 inhibitor) that works by increasing the levels of incretin hormones, which help to regulate blood sugar. Incretins are natural hormones released after eating, which stimulate the pancreas to release insulin when needed and reduce the amount of glucose produced by the liver. Sitagliptin helps to enhance insulin release from the pancreas after meals and also reduces the amount of glucose the liver produces.

Key Benefit: Increases insulin secretion after meals and decreases glucose production by the liver, helping to control blood sugar, especially post-meal spikes.

How These Ingredients Work Together

The combination of these three medications in ISTAMET D XR 1000 Tablet creates a synergistic effect, targeting different mechanisms to control blood glucose:

• Dapagliflozin helps remove excess glucose from the body through the urine.
• Metformin reduces the liver's glucose production and enhances insulin sensitivity.
• Sitagliptin stimulates insulin release when blood sugar is high and helps prevent the liver from producing too much glucose.

By acting on different aspects of glucose metabolism, ISTAMET D XR 1000 Tablet helps to maintain steady blood sugar control, reduce blood sugar spikes after meals, and lower overall fasting blood glucose levels.

Additional Benefits

• Weight loss: Due to the glucose excretion induced by Dapagliflozin, weight loss may occur, which is beneficial for individuals with type 2 diabetes, who are often overweight.
• Improved cardiovascular health: Some studies suggest that Dapagliflozin and Sitagliptin may have cardiovascular benefits, which is important since people with type 2 diabetes are at higher risk for heart disease.

Conclusion

ISTAMET D XR 1000 Tablet is effective in managing blood glucose levels because it combines three complementary actions that target the body’s insulin response, glucose production, and glucose excretion. This multi-pronged approach provides comprehensive and long-lasting blood sugar control, making it an effective management for people with type 2 diabetes.

FAQs About ISTAMET D XR TABLET

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 21st May 2025] 

3. La Renon Healthcare. Dapagliflozin+Metformin+Sitagliptin. [Accessed on 21st May 2025] 

4. TORRENT PHARMACEUTICALS LTD. Dapagliflozin and Sitagliptin. [Accessed on 21st May 2025] 

5. TORRENT PHARMACEUTICALS LTD. Sitagliptin and Metformin. [Accessed on 21st May 2025] 

Useful Diagnostic Tests

• HbA1C, Also known as Glycated Hemoglobin, Glycosylated Hemoglobin
• Blood Glucose Fasting (FBS)
• Random Blood Sugar (RBS)

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 22 May 2025 | 08:50 PM(IST)