Introduction
Aromet-2 is a combination medicine that helps control blood sugar levels. This medicine is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. It helps in proper utilisation of insulin, thereby lowering the blood sugar level.
Aromet-2 should be taken in the dose and duration as advised by your doctor. It must be taken with food to avoid stomach upset. If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose. Overdose may lead to low blood sugar (hypoglycemia).
Some people may develop common side effects like nausea, loss of appetite, taste changes, stomach pain, diarrhea, edema (swelling), weight gain, bone fracture, blurred vision, and respiratory tract infection. However, these are temporary and usually subside on their own. If these do not resolve or bother you, please consult your doctor.
Before taking this medicine, inform your doctor if you have any kidney, liver or heart problems. Pregnant or breastfeeding women should also consult their doctor before taking it. Your doctor will check your kidney function tests before starting treatment with it. Avoid excessive alcohol intake while taking it as this may increase the risk of developing some side effects.
Side effects of Aromet-2
Common
- Nausea
- Loss of appetite
- Taste change
- Stomach pain
- Diarrhea
- Edema (swelling)
- Weight gain
- Bone fracture
- Blurred vision
- Respiratory tract infection
How to use Aromet-2
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Aromet-2 is to be taken with food.
How Aromet-2 works
Aromet-2 is a combination of two antidiabetic medicines: Rosiglitazone and Metformin. Rosiglitazone is a thiazolidinedione which works by increasing the body's sensitivity to insulin. Metformin is a biguanide. It works by lowering sugar production in the liver, delaying sugar absorption from intestines and increasing the body's sensitivity to insulin.
Adult Dose
Oral
Type 2 Diabetes
The recommended starting dose of Rosiglitazone/Metformin is 2 mg/500 mg once or twice daily.
HbA1c >11% or fasting plasma glucose (FPG) >270 mg/dL, a starting dose of 500 mg/2 mg PO BID may be considered
May titrate by increments of 500 mg/2 mg at 2-week intervals, not to exceed 2000 mg/8 mg per day
For patients inadequately controlled on Metformin monotherapy, the usual starting dose is 4 mg Rosiglitazone (daily dose) plus the dose of Metformin already being taken.
For patients inadequately controlled on Rosiglitazone monotherapy, the usual starting dose is 1000 mg Metformin (daily dose) plus the dose of Rosiglitazone already being taken.
Child Dose
Safety and efficacy not established
Renal Dose
Renal impairment
Obtain eGFR before starting metformin
eGFR <30 mL/min/1.73 m²: Contraindicated
eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate treatment
Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly)
If eGFR falls below 45mL/min/1.73 m² while taking metformin, risks and benefits of continuing therapy should be evaluated
If eGFR falls below 30 mL/min/1.73 m²: while taking metformin, discontinue the drug
Contraindication
It is contraindicated in patients with renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels .1.5 mg/dl (males), 1.4 mg/dl (females), or abnormal creatinine clearance), acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma & known hypersensitivity to rosiglitazone maleate or metformin HCl.
Mode of Action
Rosiglitazone: Lowers glucose by improving target cell response to insulin without increasing pancreatic cell secretion; activates nuclear peroxisome proliferator-activated receptor gamma, which influences the production of gene products involved in glucose and lipid metabolism.
Metformin: Biguanide; acts by decreasing endogenous hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization; improves glucose tolerance and lowers both basal and postprandial plasma glucose .
Precaution
Rosiglitazone: should not be used in patients with type 1 diabetes. This should be used with caution in patients with edema. Dose-related weight gain was seen with rosiglitazone alone and rosiglitazone together with other hypoglycemic agents.
Metformin: Monitoring of renal function: Patients with serum creatinine levels above the upper limit of normal should not receive this tablet. In patients with advanced age, the dose should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function.
Lactation: not known if crosses into breast milk, avoid
Side Effect
>10%
Edema (6% to 25% ),Upper respiratory infections (16-20%),Diarrhea (12.7% to 14%),Hypoglycemia (12% )
1-10%
Anemia (4% to 7%),Fatigue (6%),Headache (6%),Sinusitis (6%),Arthralgia (5%),Back pain (5%),Viral infection (5%)
Frequency Not Defined (serious)
Angioedema (rare ),Congestive heart failure,Death, from cardiovascular causes,Stevens-Johnson syndrome (rare ),Lactic acidosis (rare ),Hepatotoxicity (rare),Anaphylaxis (rare),Diabetic macular edema,Pleural effusion,Pulmonary edema
Interaction
Additive effect w/ sulfonylureas. Thiazide diuretics, corticosteroids, phenothiazines, OC, sympathomimetics, niacin, Ca channel blockers and isoniazid may exacerbate loss of glycaemic control. ACE inhibitors may reduce fasting blood glucose concentrations. May increase serum level w/ cimetidine.
Potentially Fatal: Concurrent use w/ iodinated contrast agents may increase the risk of metformin-induced lactic acidosis.