Endocrinology Case No 6. Diabetes Type -2.

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Endocrinology Case No 6. Diabetes Type -2.

DM T2

1st line always Metformin unless contraindicated..

Tablet 1:-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Indications of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Nobesit tablet is indicated for the treatment of type 2 diabetes mellitus, particularly in overweight patients when dietary management and exercise alone does not result in adequate glycaemic control.

In adults: Nobesit may be used as monotherapy or in combination with other oral antidiabetic agents or with insulin.
In children from 10 years of age and adolescents: Nobesit may be used as monotherapy or in combination with insulin.

A reduction of diabetic complications has been shown in overweight type 2 diabetic adult patients treated with metformin as first-line therapy after diet failure.

Pharmacology of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Metformin is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is different from those of sulfonylureas and it does not produce hypoglycemia. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization.

Dosage & Administration of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Metformin immediate release tablet: Dosage of Metformin Hydrochloride must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily doses.

Adult: The usual starting dose of Metformin is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in divided doses. For those patients requiring additional glycemic control, Glucomin may be given to a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given three times a day with meals.
Children: The usual starting dose of Metformin is 500 mg twice a day, given with meals. Dosage increases should be made in increments of 500 mg weekly up to a maximum of 2000 mg per day, given in divided doses.

Metformin extended release tablet: Swallow Metformin XR tablet whole and never crush, cut or chew.

Adult: The usual starting dose of Metformin XR is 500 mg once daily with the evening meal. Dose should be increased in increments of 500 mg weekly, up to a maximum of 2000 mg once daily with the evening meal, alternatively increased to 1000 mg twice daily taken with meal. Patient receiving Metformin immediate release tablet may be switched to Metformin extended release tablet up to a maximum recommended daily dose.
Children: Metformin extended release tablet has not been studied in children.
Renal impaired patient: Do not use Metformin in patients with eGFR below 30 mL/min/1.73 m². Asses risk/benefit of counting if eGFR falls below 45 mL/min/1.73 m².

Contraindications of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Hypersensitivity to the active substance or to any of the excipients.
Any type of acute metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis).
Severe renal failure (GFR <30 mL/min).
Acute conditions with the potential to alter renal function such as: dehydration, severe infection, shock.
Acute or chronic disease, which may cause tissue hypoxia such as: cardiac or respiratory failure, recent myocardial infarction, shock, Hepatic insufciency, acute alcohol intoxication, alcoholism.

Side Effects of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Blood and lymphatic system disorders: Not known: Hemolytic anemia

Metabolism and nutrition disorders: Very rare: Lactic acidosis. Decrease of vitamin B12 absorption with a decrease of serum levels during long-term use of metformin. Consideration of such etiology is recommended if a patient presents with megaloblastic anemia. Cases of peripheral neuropathy in patients with vitamin B12 deficiency have been reported in post-marketing experience (frequency not known)

Nervous system disorders: Common: Taste disturbance. Not known: Encephalopathy

Gastrointestinal disorders: Very common: Gastrointestinal disorders, such as nausea, vomiting, diarrhea, abdominal pain, and loss of appetite. These undesirable effects occur most frequently during the initiation of therapy and resolve spontaneously in most cases. To prevent them, it is recommended that metformin be taken in 2 or 3 daily doses during or after meals. A slow increase of the dose may also improve gastrointestinal tolerability.

Hepatobiliary disorders: Very rare: Isolated reports of liver function test abnormalities or hepatitis resolving upon metformin discontinuation.

Skin and subcutaneous tissue disorders: Very rare: Skin reactions, such as erythema, pruritus, urticaria.

Pregnancy & Lactation of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Pregnancy: Uncontrolled diabetes during pregnancy (gestational or permanent) is associated with an increased risk of congenital abnormalities and perinatal mortality. When the patient plans to become pregnant and during pregnancy, it is recommended that diabetes is not treated with metformin but insulin be used to maintain blood glucose levels as close to normal as possible, to reduce the risk of malformations of the foetus.

Breastfeeding: Metformin is excreted into human breast milk. No adverse efects were observed in breastfed newborns/infants. However, as only limited data are available, breastfeeding is not recommended during metformin treatment. A decision on whether to discontinue breastfeeding should be made, taking into account the benefit of breastfeeding and the potential risk to adverse effects on the child.

Therapeutic Class of Tablet :-Nobesit 500mg (AS A Metformin Hydrochloride AS A Biguanides).

Biguanides

2nd line:

DPP4 inhibitor:(sitagliptin/linagliptin) যদি financial প্রবলেম না থাকে এবং comorbidity না থাকে...

Tablet 2.Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Indications of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Monotherapy and Combination Therapy: Sitagil is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Important Limitations of Use: Sitagil should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. Sitagil has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for the development of pancreatitis while using Sitagil.

Pharmacology of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Sitagliptin is a DPP-4 inhibitor, which is believed to exert its actions in patients with type 2 diabetes by slowing the inactivation of incretin hormones. Concentrations of the active intact hormones are increased by Sitagliptin, thereby increasing and prolonging the action of these hormones. Incretin hormones, including glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are released by the intestine throughout the day, and levels are increased in response to a meal. These hormones are rapidly inactivated by the enzyme, DPP-4. The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis. When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by intracellular signaling pathways involving cyclic AMP. GLP-1 also lowers glucagon secretion from pancreatic alpha cells, leading to reduced hepatic glucose production. By increasing and prolonging active incretin levels, Sitagliptin increases insulin release and decreases glucagon levels in the circulation in a glucose-dependent manner. Sitagliptin demonstrates selectivity for DPP-4 and does not inhibit DPP-8 or DPP-9 activity in vitro at concentrations approximating those from therapeutic doses.

Dosage & Administration of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

The recommended dose of sitagliptin is 50 mg twice a day and 100 mg once daily. Sitagliptin can be taken with or without food.

Interaction of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Effects of Sitagil on other Drugs: Sitagil did not meaningfully alter the pharmacokinetics of metformin, glyburide, simvastatin, rosiglitazone, warfarin, or oral contraceptive.

Digoxin: Sitagil slightly increases the mean of Digoxin concentration. However, no dose adjustment of either drug is required.

Contraindications of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

History of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis or angioedema.

Side Effects of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

The most common adverse reactions include headache, upper respiratory tract infection and nasopharyngitis. Hypoglycemia may occur in patients treated with the combination to Sitagil and sulfonylurea and add on to insulin.

Pregnancy & Lactation of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Pregnancy Category B. Reproduction studies have been performed in rats and rabbits. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Sitagliptin is secreted in the milk of lactating rats at milk to plasma ratio of 4:1. It is not known whether sitagliptin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when sitagliptin is administered to a nursing woman.

Therapeutic Class of Tablet:-Sitagil 100mg (AS A sitagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Dipeptidyl Peptidase-4 (DPP-4) inhibitor

Linagliptin

Tablet 3:-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Indications of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Ligazid is indicated in the treatment of type 2 diabetes mellitus to improve glycaemic control in adults.

As monotherapy: in patients inadequately controlled by diet and exercise alone and for whom metformin is inappropriate due to intolerance or contraindicated due to renal impairment.
As combination therapy: in combination with metformin when diet and exercise plus metformin alone do not provide adequate glycaemic control in combination with a sulphonylurea and metformin when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control.

Pharmacology of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Linagliptin is indicated to improve glycemic control in patients with type 2 diabetes mellitus. Linagliptin is an inhibitor of DPP-4 (dipeptidyl peptidase-4), an enzyme that degrades the incretin hormones GLP-1 (glucagon like peptide-1) and GIP (glucose dependent insulinotropic polypeptide). Thus, Linagliptin increases the concentrations of active incretin hormones, stimulating the release of insulin from pancreatic beta (β) cells in a glucose-dependent manner and decreasing the secretion of glucagon from pancreatic alpha (α) cells in the circulation.

Dosage & Administration of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Linagliptin 5 mg once daily. If added to metformin, the dose of metformin should be maintained and linagliptin administered concomitantly. When used in combination with a sulfonylurea, a lower dose of the sulphonylurea may be considered to reduce the risk of hypoglycaemia.

Patients with renal impairment: No dose adjustment required. Linagliptin can be taken with or without a meal at any time of the day.

Interaction of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Ligazid is a weak competitive and a weak to moderate mechanism-based inhibitor of CYP isozyme CYP3A4, but does not inhibit other CYP isozymes. The risk for clinically meaningful interactions by other medicinal products on Ligazid is low and in clinical studies Ligazid had no clinically relevant effect on the pharmacokinetics of metformin, glyburide, simvastatin, warfarin, digoxin or oral contraceptives.

Contraindications of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Hypersensitivity to the active substance or to any of the excipients.

Side Effects of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

There may be hypoglycaemia, nasopharyngitis, cough and pancreatitis in combination with metformin and sulfonylurea.

Pregnancy & Lactation of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Pregnancy category B. There are no adequate and well controlled studies in pregnant women. So, Linagliptin tablets should be used during pregnancy only if clearly needed. It is not known whether Linagliptin passes into breast milk or not.

Therapeutic Class of Tablet :-Ligazid 5mg (As a Linagliptin As a Dipeptidyl Peptidase-4 (DPP-4) inhibitor).

Dipeptidyl Peptidase-4 (DPP-4) inhibitor

2nd line:

Sulphonylurea :(Gliclazide) যদি পেশেন্ট গরিব হয়। তবে side effect হিসেবে Hypoglycemia হতে পারে মাথায় রাখতে হবে।

Tablet 4.Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Indications of Tablet:-Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Comprid is a medicine that reduces blood sugar levels (oral antidiabetic medicine belonging to the sulphonylurea group). Comprid is used in a certain form of diabetes (type 2 diabetes Mellitus) in adults, when diet, exercise and weight loss alone do not have an adequate effect on keeping blood sugar at the correct level.

Pharmacology of Tablet:-Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Gliclazide is a second generation sulfonylurea drug that has hypoglycaemic and potentially useful hematological properties. It stimulates the release of insulin from pancreatic β-cells by facilitating Ca⁺² transport across the β-cell membranes and decreases hepatic glucose output.

Dosage & Administration of Tablet:-Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Film-coated tablet: The usual initial dose is 40 to 80 mg daily. The dose can be increased up to 320 mg daily in divided doses when needed. The drug should be taken before meal. For children, Gliclazide is not used because it is contraindicated in juvenile-onset diabetes.

Modified release preparation: Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. The dose is determined by the doctor, depending on your blood and possibly urine sugar levels. Change in external factors (weight reduction, lifestyle, stress) or improvements in the blood sugar control may require changed gliclazide doses.

The recommended daily dose is one to four tablets (maximum 120 mg) in a single intake at breakfast time. This depends on the response to treatment. Gliclazide MR tablet is for oral use. Take your tablet(s) with a glass of water at breakfast time (and preferably at the same time each day). Swallow your whole tablet(s) in one piece. Do not chew or crush. You must always eat a meal after taking your tablet(s).

If a combination therapy of gliclazide with metformin, an alpha-glucosidase inhibitor, a thiazolidinedione, a dipeptidyl peptidase-4 inhibitor a GLP-1 receptor agonist or insulin is initiated your doctor will determine the proper dose of each medicine individually for you. If you notice that your blood sugar levels are high although you are taking the medicine as prescribed, you should contact your doctor or pharmacist.

If you take more Gliclazide tablets than you should: If you take too many tablets, contact your doctor or the nearest hospital Accident & Emergency department immediately. The signs of overdose are those of low blood sugar (hypoglycaemia). The symptoms can be helped by taking sugar (4 to 6 lumps) or sugary drinks straight away, followed by a substantial snack or meal. If the patient is unconscious immediately inform a doctor and call the emergency services. The same should be done if somebody, (for instance a child), has taken the product unintentionally. Unconscious patients must not be given food or drink. It should be ensured that there is always a pre-informed person that can call a doctor in case of emergency.

If you forget to take Gliclazide tablet: It is important to take your medicine every day as regular treatment works better. However, if you forget to take a dose of Gliclazide MR tablet, take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose.

If you stop taking Gliclazide MR tablet: As the treatment for diabetes is usually lifelong, you should discuss with your doctor before stopping this medicinal product. Stopping could cause high blood sugar (hyperglycaemia) which increases the risk of developing complications of diabetes. If you have any further questions on the use of this product, ask your doctor or pharmacist.

Contraindications of Tablet:-Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Do not take Gliclazide:

if you are allergic to gliclazide or to other medicines of the same group (sulfonylurea), or to other related medicines (hypoglycaemic sulfonamides)
if you have insulin-dependent diabetes (type 1)
if you have ketone bodies and sugar in your urine (this may mean you have diabetic ketoacidosis), a diabetic pre-coma or coma
if you have severe kidney or liver disease
if you are taking medicines to treat fungal infections
if you are breastfeeding

Side Effects of Tablet:-Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Like all medicines, Comprid can cause side effects, although not everybody gets them. The most commonly observed side effect is low blood sugar (hypoglycaemia). If left untreated these symptoms could progress to drowsiness, loss of consciousness or possibly coma. If an episode of low blood sugar is severe or prolonged, even if it is temporarily controlled by eating sugar, you should seek immediate medical attention.

Liver disorders: There have been isolated reports of abnormal iiver function, which can cause yellow skin and eyes. If you get this, see your doctor immediately. The symptoms generally disappear if the medicine is stopped. Your doctor will decide whether to stop your treatment.

Skin disorders: Skin reactions such as rash, redness, itching, hives, blisters, angioedema (rapid swelling of tissues such as eyelids, face, lips, mouth, tongue or throat that may result in breathing difficulty) have been reported. Rash may progress to widespread blistering or peeling of the skin. If you develop this, stop taking, seek urgent advice from a doctor and tell him that you are taking this medicine. Exceptionally, signs of severe hypersensitivity reactions have been reported: initially as flu-like symptoms and a rash on the face then an extended rash with a high temperature.

Blood disorders: Decrease in the number of cells in the blood (e.g. platelets, red and white blood cells) which may cause paleness, prolonged bleeding, bruising, sore throat and fever have been reported. These symptoms usually vanish when the treatment is discontinued.

Digestive disorders: Abdominal pain, nausea, vomiting, indigestion, diarrhoea, and constipation. These effects are reduced when Comprid is taken with a meal as recommended.

Eye disorders: Your vision may be affected for a short time especially at the start of treatment. This effect is due to changes in blood sugar levels.

As for another sulfonylurea, the following adverse events have been observed: cases of severe changes in the number of blood cells and allergic inflammation of the wall of blood vessels, reduction in blood sodium (hyponatraemia), symptoms of liver impairment (for instance jaundice) which in most cases disappeared after withdrawal of the sulfonylurea, but may lead to life-threatening liver failure in isolated cases.

Reporting of side effects: If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. By reporting side effects, you can help provide more information on the safety of this medicine.

Pregnancy & Lactation of Tablet:-Comprid 80mg (AS A Gliclazide AS a Sulfonylureas).

Gliclazide is not recommended for use during pregnancy. If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. You must not take Gliclazide while you are breastfeeding.

Therapeutic Class

Sulfonylureas

Common Questions about Comprid 80 mg Tablet

What is Comprid 80 mg Tablet?

Comprid 80 mg Tablet is a medication taken orally to help manage type 2 diabetes. It works by supporting your body in controlling blood sugar levels in two ways. First, it encourages your pancreas to release more insulin. Second, it improves your body’s ability to use the insulin it already has. Thus it lowers your blood sugar levels.

What happens if I take Comprid 80 mg Tablet without eating?

Comprid 80 mg Tablet dosage is tied to your meals. It should be skipped if you miss a meal. If you plan to eat an extra meal, talk to your doctor about adjusting your dose for that day.

What if I missed a dose of Comprid 80 mg Tablet?

The missed dose can be taken as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not take two doses together to make up for a missed dose.

How long does the effect of Comprid 80 mg Tablet last?

The effect of this medicine lasts for an average duration of 24 hours.

Are there any pregnancy warnings for Comprid 80 mg Tablet?

This medicine is not recommended for pregnant women.

General Instructions

Take Comprid 80 mg Tablet as directed by your doctor. This includes the dose and how often you should take it.
The medicine should be taken by mouth (orally) 30 minutes before breakfast.
You should monitor your blood sugar levels regularly as directed by your doctor.
Always carry a sugary candy with you to treat hypoglycemia (low blood sugar). Consistent food intake reduces the risk of hypoglycemia.

2nd line:

SGLT inhibitor:(Empagliflozin)

Heart failure/suspected HF থাকলে 2nd line হিসেবে choice. UTI একটা common side effect মাথায় রাখতে হবে।

Tablet 5:Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

Indications of Tablet :Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

Emjard is indicated in:

As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
To reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease.

Pharmacology of Tablet :Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

Empagliflozin is a sodium glucose co-transporter-2 (SGLT-2) inhibitor. SGLT2 co-transporters are responsible for reabsorption of glucose from the glomerular filtrate in the kidney. The glucuretic effect resulting from SGLT2 inhibition reduces renal absorption and lowers the renal threshold for glucose, resulting in increased glucose excretion. Additionally, it contributes to reduced hyperglycaemia, assists weight loss, and reduces blood pressure.

Dosage & Administration of Tablet :Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

The recommended dose of Empagliflozin is 10 mg once daily, taken in the morning, with or without food. In patients tolerating Empagliflozin, the dose may be increased to 25 mg once daily. In patients with volume depletion, correcting this condition prior to initiation of Empagliflozin is recommended.

Contraindications of Tablet :Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

Empagliflozin is contraindicated in patients with history of serious hypersensitivity reaction to Empagliflozin or any of its ingredients, severe renal impairment, end-stage renal disease, or dialysis.

Side Effects of Tablet :Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

The most common adverse reactions associated with Emjard are urinary tract infections and female genital mycotic infections. Others common side effects includes dehydration, hypotension, weakness, dizziness and increased thirstiness.

Pregnancy & Lactation of Tablet :Emjard 25mg (AS A Empagliflozin AS A Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors).

There are no adequate and well-controlled studies of Empagliflozin in pregnant women. Empagliflozin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known if Empagliflozin is excreted in human milk. It is not recommended when breastfeeding.

Quick Tips

Emjard 25 mg Tablet is used alone or together with other diabetes medicines to control blood sugar and avoid long-term complications.
Emjard 25 mg Tablet may cause your body to lose too much fluid (dehydration) or you may urinate more often. Drink plenty of water and stay hydrated.
Emjard 25 mg Tablet may cause hypoglycemia (low blood sugar level) when used with other antidiabetic medicines, alcohol or if you delay or miss a meal.
Always carry some sugary food or fruit juice with you in case you experience hypoglycemia symptoms such as cold sweats, cool pale skin, tremor and anxiety.
Emjard 25 mg Tablet can cause genital fungal and/or urinary tract infections (UTIs) in both females and males, so practice good hygiene.
Monitor your blood sugar regularly while taking Emjard 25 mg Tablet.
Inform your doctor immediately if you experience constant dizziness, joint pain, cold-like symptoms or unexplained nausea/vomiting.

Digest medicine

Raiyyan Tahsan Date:20-01-2025 Monday Time:4-37-55 PM.

Raiyyan Tahsan

Raiyyan Tahsan