PATIENT INFORMATION LEAFLET MEDICINE TO TREAT: DIABETES α-glucosidase inhibitor Biguanide DPP-IV inhibitor Meglitinide Sulphonylurea SGLT-2 Inhibitors 1. What are these medicines used for? These medicines are used to control your diabetes by lowering your blood sugar level. They work in different ways. Medicine Group α-glucosidase inhibitor Examples of medicines in this group Acarbose How the medicine works Helps to stop the quick rise in blood sugar after a meal Biguanide Metformin Helps the body to use insulin better Decrease the amount of sugar made by the liver DPP-IV inhibitor Sitaglipitin Linagliptin Helps to increase insulin release after a meal Decrease amount of sugar made by the liver Meglitinide Repaglinide Helps the pancreas to release more insulin Sulphonylurea Gliclazide Glimepiride Glipizide Tolbutamide Helps the pancreas to release more insulin SGLT-2 Inhibitors Dapagliflozin Removes excess sugar from the body through the urine. Page 1 of 6
2. How should I take the medicines? Do not stop taking your medicines without checking with your doctors. You should follow the dose on the medicine label and take the medicine regularly and exactly as what your doctor or pharmacist tells you. Medicine Acarbose Metformin Sitaglipitin Linagliptin Repaglinide Gliclazide Glimepiride Glipizide Tolbutamide How to take this medicine Take this medicine with the first mouthful of food or just before eating Take this medicine with or after food Take this medicine with or without food Take this medicine just before food Take this medicine just before food Dapagliflozin Take this medicine with or without food What to do with a missed dose Skip the dose you missed. Do not take acarbose between your meals. If you miss a dose, take the missed dose as soon as you remember. Remember to take it with food. If you miss a dose, take the missed dose as soon as you remember. dose Take your next dose immediately before food. Skip the dose you missed. Do not Take your next dose immediately before food. Skip the dose you missed. Do not If you miss a dose, take the missed dose as soon as you remember. dose Page 2 of 6
3. What are the possible side effects of the medicines? Low blood sugar The most common side effect with the use of diabetes medicines is low blood sugar. If you take diabetes medicines but do not eat on time, your blood sugar may become too low. Low blood sugar levels might also happen if you do not eat well. Symptoms of low blood sugar are weakness, dizziness, hunger, sweating, trembling, blurred vision, unsteady walk or fast heartbeat. If you experience any of these low blood sugar symptoms, do the following immediately: Step 1: Take 15 grams of sugar. The following are examples of 15 grams of sugar. 3 glucose tablets or Half a glass of fruit juice or 2 4 teaspoons of sugar, honey or syrup Do note that if you are taking acarbose tablets, only glucose tablets will help reduce the symptoms of low blood sugar. Step 2: You should feel better in about 15 minutes. If you have a home blood sugar meter, you should check your blood sugar level. Step 3: If your blood sugar level is less than 4mmol/L or you still have symptoms of low blood sugar, you should repeat step 1 from above. If your symptoms still do not get better, see a doctor or go to the hospital immediately. Stomach discomfort / Bloating or gas / Diarrhoea These symptoms may happen but should get better over time. Check with your doctor if any of these symptoms are serious or do not go away. Nausea / vomiting or Loss of appetite You may experience these symptoms if you are taking metformin. The medicine should be taken after food or with food to help reduce these symptoms. Check with your doctor if any of these symptoms are serious or do not go away. Page 3 of 6
Pancreatitis (inflammation of the pancreas) Pancreatitis is a rare and serious side effect of sitagliptin and linagliptin. You should stop taking your medicine and check with your doctor right immediately if these symptoms happen: o Severe pain in the stomach, abdomen or back area o Nausea or vomiting that does not go away o Loss of appetite Low blood pressure You may feel giddy or lightheaded, especially when you get up from a lying or sitting position, if you are taking dapagliflozin. This is more likely to happen in the morning or when you first get out of bed. Getting up slowly may help but if the problem continues, check with your doctor. Dehydration (not having enough water in the body) You might experience dehydration if you are taking dapagliflozin as it removes the excess sugar in your body through your urine. You should take extra 1-2 glasses of water every day unless your doctor told you that you need to control the amount of liquid you take. Infections Females taking dapagliflozin have a higher chance of getting vaginal yeast infections. Symptoms include white or yellowish vaginal discharge, bad smelling discharge or itch at the vaginal area. Males taking dapagliflozin have a higher chance of getting yeast infection of the penis. Symptoms include rash, redness, itch or swelling of the penis, bad smelling discharge from the penis or pain around the penis. Dapagliflozin may also increase the chance of getting a urinary tract infection. Symptoms include a burning feeling when you pass urine, a need to urine often, an urge to urinate often or if you see blood in your urine. If you notice any of the above symptoms, you should check with your doctor. Ketoacidosis (increase in ketones in your blood or urine) Ketoacidosis is a serious and rare side effect of Dapagliflozin. You should stop taking your medicine and check with your doctor immediately if you experience any of these symptoms: o Pain in the stomach, abdominal area o Nausea or vomiting o Feeling confused, tired or unusually sleepy o Trouble with breathing o Feeling very thirsty o Sweet fruity smell in your breath Page 4 of 6
4. How do I know if I am allergic to these medicines? The symptoms of a drug allergy include one or more of the following: Swollen face/eyes/lips Difficulty in breathing Itchy skin rashes over your whole body If you experience any of these symptoms, you should stop your medicine immediately and see your doctor. 5. What precautions should I follow when taking the medicines? Before taking the medicines, inform your doctor if: o you are allergic to this medicine or any other medicines o you are taking other prescription and non-prescription medicines o you have a heart condition, kidney or liver problem o you are going for any surgery o you are pregnant or planning to get pregnant o you are breastfeeding o you have suffered from diabetic ketoacidosis in the past o you have a history of urinary tract infections or bladder cancer o you drink alcohol often If you drink alcohol without eating, it may cause a very low blood sugar level. Your blood sugar levels should be tested with a home blood sugar meter as instructed by your doctor or pharmacist. If you visit another doctor, do inform him that you are taking medicines for diabetes. If you are taking metformin, you should let you doctor know if you need to do any scan or x-ray procedures. You may need to stop taking metformin for a few days. If your doctor informed you that you need to do a fasting blood test, do not take your diabetes medicine until after you have had your blood taken and are ready to eat. If you are eating less because you are sick, have a surgery or changed diet, please inform your doctor as there may be a need to adjust your medicines. Page 5 of 6
6. How should I store the medicines? Keep your medicines in the original container or packaging, tightly closed or sealed in a cool and dry place, away from direct sunlight. Keep the medicine out of reach of children. Throw away all expired medicines. This leaflet answers some common questions about this medicine. It does not contain all the available information. It also does not take the place of talking to your doctor or pharmacist. Page 6 of 6