Carlina M 2.5/1000 Tablet 1 Strip

Carlina-M 2.5/1000 Tablet is a combination antidiabetic medicine containing Linagliptin and Metformin, used alongside a healthy diet and regular exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Maintaining good glucose control helps reduce the risk of diabetes-related complications such as kidney damage, vision loss, heart attack, and stroke.

Indications

Carlina-M 2.5/1000 Tablet is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both linagliptin and metformin is appropriate.

Pharmacology

Carlina-M combines two medicines with complementary mechanisms of action:

• Linagliptin is a DPP-4 inhibitor that increases levels of incretin hormones (GLP-1 and GIP), stimulating glucose-dependent insulin release while reducing glucagon secretion, helping lower both fasting and post-meal blood glucose.
• Metformin is a biguanide that decreases glucose production in the liver, reduces intestinal glucose absorption, and improves the body's sensitivity to insulin, resulting in better blood sugar control.

Dosage & Administration

• Take with meals to reduce gastrointestinal side effects associated with metformin.
• Swallow the tablet whole with water. Do not crush or chew unless advised by your physician.

Adults:

• Patients not currently taking metformin: Usually start with Linagliptin 2.5 mg/Metformin 500 mg twice daily.
• Patients already taking metformin: Start with a tablet containing Linagliptin 2.5 mg plus the current metformin dose, taken twice daily.
• Maximum recommended daily dose: Linagliptin 5 mg and Metformin 2000 mg.

Renal impairment:

• Assess eGFR before starting treatment.
• eGFR <30 mL/min/1.73 m²: Contraindicated.
• eGFR 30-45 mL/min/1.73 m²: Initiation is not recommended.
• Monitor kidney function regularly during treatment.

Children: Safety and efficacy in patients under 18 years have not been established.

Take the medicine exactly as prescribed by your physician.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular schedule. Do not take a double dose.

Interactions

Carlina-M may interact with:

• Rifampicin and other strong CYP3A4/P-glycoprotein inducers, which may reduce the effectiveness of linagliptin.
• Ritonavir, which may increase linagliptin exposure.
• Digoxin, as linagliptin may slightly affect its transport.
• Alcohol, which increases the risk of metformin-associated lactic acidosis.
• Cimetidine and other cationic drugs eliminated by the kidneys, which may increase metformin levels.
• Iodinated contrast media, which may increase the risk of kidney injury and lactic acidosis.

Contraindications

Do not use Carlina-M in patients with:

• Hypersensitivity to linagliptin, metformin, or any component of the formulation.
• Type 1 diabetes mellitus.
• Diabetic ketoacidosis or diabetic pre-coma.
• Severe renal impairment (eGFR <30 mL/min/1.73 m²).
• Severe hepatic impairment.
• Acute alcohol intoxication or chronic alcoholism.
• Conditions associated with tissue hypoxia (e.g., severe heart failure, respiratory failure, recent myocardial infarction).
• Breastfeeding.

Side Effects

Common side effects include:

• Diarrhea
• Nausea
• Vomiting
• Upset stomach
• Headache
• Nasal congestion
• Sore throat
• Respiratory tract infection

Less common but serious adverse effects include:

• Hypoglycemia (especially when used with insulin or sulfonylureas)
• Pancreatitis
• Allergic reactions (rash, itching, angioedema)
• Lactic acidosis (rare but potentially life-threatening)

Pregnancy & Lactation

• Use during pregnancy only if clearly recommended by a healthcare provider.
• Breastfeeding is generally not recommended, as metformin passes into breast milk and the effects of linagliptin in nursing infants are not fully established.

Precautions & Warnings

Use Carlina-M cautiously in patients with:

• Kidney impairment
• Liver disease
• History of pancreatitis
• Heart failure
• Conditions predisposing to lactic acidosis

Additional precautions:

• Monitor kidney function before and during treatment.
• Stop the medication temporarily before elective surgery or procedures involving iodinated contrast agents.
• Limit alcohol consumption due to the increased risk of lactic acidosis.
• Monitor blood glucose regularly.
• Patients taking insulin or sulfonylureas may require dose adjustment to reduce the risk of hypoglycemia.

Seek immediate medical attention if symptoms of lactic acidosis (persistent nausea, vomiting, abdominal pain, rapid breathing, unusual weakness) or pancreatitis (severe abdominal pain) occur.

Storage

Store below 30°C in a dry place, protected from moisture and direct sunlight. Keep out of the reach of children.