Uses of Xultophy

The insulin degludec component of Xultophy, after being absorbed, binds specifically to the human insulin receptor and leads to a pharmacological effect similar to that of human insulin, which is to regulate glucose metabolism. Insulin and its analogues stimulate the absorption of glucose in the periphery (skeletal muscle and fat), thereby reducing blood glucose levels, and at the same time inhibiting glucose production in the liver. Insulin also inhibits lipolysis and proteolysis, while enhancing protein synthesis.
Liraglutide is a Glucagon-Like Peptide-1 (GLP-1) analogue with 97% structural similarity to human GLP-1, which binds to and activates the GLP-1 receptor (GLP-1R). Liraglutide is a GLP-1 receptor agonist and improves glycemic control by reducing fasting and postprandial blood glucose.
Liraglutide stimulates insulin secretion and reduces Glucagon secretion dependent on Glucose, that is, when blood glucose is high, Liraglutide will stimulate insulin secretion and inhibit Glucagon secretion. In contrast, during hypoglycemia, Liraglutide reduces insulin secretion and does not decrease Glucagon secretion. The mechanism of hypoglycemia is also associated with a delay in gastric emptying. Xultophy is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.
However, Xultophy is not recommended as first-line therapy for patients who cannot control their blood sugar with diet and exercise. At the same time, use in combination with any other product containing Liraglutide or other GLP-1 receptor agonists is not recommended. Xultophy has not been studied in combination with extracorporeal insulin.

Hypersensitivity to any ingredient of Xultophy . History of allergy to drugs containing the active ingredients Insulin degludec or Liraglutide. Patients with insulin-dependent diabetes mellitus (Type 1 diabetes mellitus) Patients with a history of or current diabetic ketoacidosis. Patient is in hypoglycemia. Patients with a history of or current thyroid carcinoma. Patients with a history of or current multiple endocrine neoplasia type 2 (MEN2). Use with caution in the elderly, children, pregnant or lactating women.

3.1. How to use Xultophy is injected subcutaneously once a day at the same time each day with or without meals.
3.2. Dosage In insulin or GLP-1 receptor agonists nave, initial dose: Subcutaneous injection of 10 units of Insulin degludec and 0.36 mg of Liraglutide once daily.
In people currently using basal insulin or a GLP-1 receptor agonist:
Stop treatment with insulin or a GLP-1 receptor agonist before starting Xultophy treatment. Initial dose: Subcutaneous injection of 16 units of Insulin degludec and 0.58 mg of Liraglutide once daily.
Units of Insulin Degludec and mg of Liraglutide in each dose of Xultophy

3.3. Recommendations After starting with the recommended starting dose of Xultophy, the dose should be titrated up or down by two units once weekly or twice weekly, based on the patient's metabolic needs, results according to the patient's metabolic needs. Monitor blood glucose and target glycemic control until desired fasting plasma glucose levels are achieved. To minimize the risk of hypoglycaemia or hyperglycemia, dosage adjustment may be necessary when there are changes in physical activity, dietary changes, or impaired kidney or liver function; during acute illness.
Recommended dose adjustment of Xultophy

Treatment with Xultophy at high doses or for a long time, can cause side effects such as:
Hypoglycemia. Digestive disorders: Nausea, diarrhea, vomiting, constipation, dyspepsia, gastritis, abdominal pain, flatulence, dyspepsia, gastroesophageal reflux disease, abdominal distension and decreased appetite. Nervous system: Headache, migraine, dizziness, dizziness, drowsiness. Local inflammatory reactions: Hematoma at the injection site, pain, hemorrhage, erythema, nodule, swelling, discoloration, inflammation, itching, heat at the injection site. Hypersensitivity reactions: Systemic skin reactions, angioedema, bronchospasm, hypotension and anaphylaxis. Biochemistry: Abnormal liver enzymes, mild increase in serum Bilirubin, increase in Calcitonin, increase in Lipase and Amylase, decrease in acute renal function. Increase heart rate. Weight gain. Electrolytes: Peripheral edema due to sodium retention, hypokalemia. Lipodystrophy such as lipoatrophy (thinning of adipose tissue). Cholelithiasis, cholecystitis. Thyroid carcinoma. Should stop the drug as soon as detecting the above symptoms after using Xultophy or promptly inform the treating doctor about the use of the drug and immediately go to the nearest medical facility for supportive treatment.

Caution should be taken when using Xultophy in people with impaired liver function, severe kidney disease, people with a history or current of thyroid C-cell tumors, pancreatitis, acute gallbladder disease, hypoglycemia, kidney damage acute, hypokalemia. Some studies suggest that there may be a risk to the fetus from exposure to Liraglutide during pregnancy. Therefore, Xultophy should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus. There are no data on the presence of Liraglutide or Insulin degludec in breast milk, effects on the nursing infant or on milk production. The developmental and health benefits of breastfeeding should be considered in conjunction with the mother's clinical need for Xultophy. Drivers or machine operators may experience side effects such as headache, dizziness, and dizziness after using Xultophy.

Drugs that increase the risk of hypoglycemia of Xultophy: Other antidiabetic drugs, Angiotensin II receptor blockers, Disopyramide, Monoamine oxidase inhibitors, Pentoxifylline, Pramlintide... Xultophy's blood sugar: Atypical antipsychotics such as Olanzapine and Clozapine, oral contraceptives, Phenothiazines, Progestogens, Protease inhibitors... Drugs that can increase or decrease the hypoglycemic effect of Xultophy: Alcohol, Clonidine, Lithium, Pentamidine... Drugs that hide the symptoms of hypoglycemia when used with Xultophy: Beta-blockers, Clonidine, Guanethidine, Reserpine... The above is general information and cautions when using Xultophy drug use. In order to bring the best treatment results for you and your family, you should carefully read the instructions for use on the Xultophy product packaging and strictly follow the instructions of the endocrinologist.