📋 Indications & Clinical Dosage
*Type 2 diabetes mellitus monotherapy or in combination with sulphonylureas or metformin when metformin alone is inadequate:*
Adults: Initial: 2 mg twice daily or 4 mg once daily. Titrate: May increase after 8-12 weeks to 4 mg twice daily or 8 mg once daily. Max: 8 mg/day as monotherapy or with metformin, sulfonylureas, or sulfonylureas plus metformin; 4 mg/day with insulin. Decrease insulin by 10-25% if Fasting Plasma Glocose<100 mg/dL; adjusted according to response.
Children: Not recommended.
⛔ Contraindications
Hepatic impairment raised liver enzymes, cardiac failure or history of cardiac failure, pregnancy and lactation.
⚠️ Precautions & Warnings
Severe renal impairment. Monitor for signs of cardiac failure (discontinue if deteriorates). Monitor for signs of hepatic dysfunction and measure liver enzymes before treatment and periodically thereafter. Monitor for weight gain and anaemia.
🔄 Drug Interactions
Insulin (contraindicated), NSAIDs, paclitaxel, gemfibrozil, rifampicin, other inducers of CYP2C8.
⚠️ Adverse Reactions / Side Effects
GI upset, anaemia, headache, fatigue, oedema, hypercholesterolaemia, hypoglycaemia, weight gain.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Not recommended.
Lactation / Breastfeeding:
Contraindicated or not recommended.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.