Diabetes medications: Metformin alternatives and analogs. Prices on the market

“Metformin Zentiva” for type 2 diabetes. Differences and price

“Metformin Zentiva” is a hypoglycemic product for patients with diabetes mellitus type 2 and is produced by a pharmaceutical company Zentiva. Metformin is the main active ingredient.

Metformin Zentiva for Type 2 diabetes

A main difference of “Metformin Zentiva” is that every pill contains an increased dose of the active ingredients – 850 mg. This dose is indicated for people with a high level of sugar in the blood when a single therapeutic dose of 500 mg does not give the required hypoglycemic response.

Due to the convenient dose of 850 mg, it is easier to take “Metformin Zentiva”, and the use of the pills may be reduced up to 2 times per day taking 1700 mg Metformin 2 times.

There are no other differences between Metformin and “Metformin Zentiva” because they are developed on the basis of the identical molecular formula.

A cost of “Metformin Zentiva” starts from $0,7 per pill in the USA. This cost is available for customers in the online pharmacies. In the city pharmacies, it is difficult to find Metformin from Zentiva company. But if you can find the pills in the city pharmacies, a cost of “Metformin Zentiva” will start from $1,83 per pill.

Treatment of diabetes with “Metformin-Richter” tablets. Pills prices.

A manufacturer of “Metformin-Richter” is the largest pharmaceutical company in the Eastern Europe – Gedeon Richter.

“Metformin-Richter” is indicated for the treatment of diabetes mellitus type 2 in patients with insulin-resistance and obesity. A medical product increases the receptiveness of the receptors of the peripheral tissues to insulin during the correct use, and it leads to the increased utilization of glucose. The pills contain Metformin hydrochloride.

“Metformin-Richter” is supplied in the doses of 500 mg and 850 mg. The 2-3 pills of the medication should be taken a day depending on the severity of diabetes mellitus and relevant complications.

The pharmacy networks in the USA do not often supply Metformin-Richter within the territory of the country, they prefer to sell more expensive analogues. A cost of “Metformin-Richter” varies from $0,72 per pill up to $0,37 per pill depending on a dose and a size of the pack.

“Metformin-Richter” may be found at these prices on the internet only, in one of the online pharmacies that supply this medication to the territory of the USA and a factory-manufacturer in Europe.

“Glyformin” – other name of “Metformin”. Cost in USA and canadian pharmacies.

The Cyprian pharmaceutical company “Remedica Products” produces Metformin under the trade name “Glyformin”. The pills are released in the doses of 500 mg and 850 mg.

Remedica Products Glyformin

The effectiveness of Glyformin in the treatment of diabetes mellitus has been proved because the company-manufacturer of the drug uses the original chemical formula of Metformin and does not do any changes in the content.

It has been proved that a stable lowering of the glucose level in the blood begins in patients with diabetes mellitus during the use of Glyformin within a week, if they follow a balanced diet. Due to the drug, the glucose level may be reduced by 20% in no time. This rate is increased by means of the physical activity and a diet.

Glyformin is prescribed patients only during diabetes mellitus type 2 because it influences on the glucose synthesis in the liver and does not increase a production of insulin. Due to this, taking Glyformin does not usually cause hypoglycemia. The body synthesizes insulin and regulates the intensity of the production of this hormone depending on the glucose level in the blood.

The supplier of Glyformin is not only “Remedica Products” but also a large Indian pharmaceutical company Jocund India Ltd. The differences between the drugs of both companies are absent, because they use the identical formula of Metformin but a cost of Glyformin from “Remedica Products” and “Jocund India Ltd” differs.

  • The average cost of Glyformin from “Remedica Products” is $0,37 per pill in the online pharmacy.
  • The average cost of Glyformin from “Jocund India Ltd” is $0,09 per pill in the online pharmacy.

As the Indian manufacturers do not invest big sums into the marketing, a cost of medications is significantly lower, and it is allowed reducing the expenses of customers during the treatment of diabetes mellitus.

It is impossible to buy Glyformin at a low cost in the city pharmacies of the USA and Canada, and therefore the most optimal option will be a purchase of Glyformin on the internet. The main thing is to specify what a supplier is used for the delivery of the pills and to read reviews.

“Formetin” medication: one of the best diabetes drugs. Prediabetes treatments.

Formetin is one of the analogs of Metformin and is released in the pills for the oral use. Every pill may contain various amount of the active ingredient: 500 mg, 850 mg, and 1000 mg. Metformin hydrochloride is the active ingredient.

The therapeutic effect of Formetin is conditioned by the action of the active ingredients on the liver functions, as a result of which gluconeogenesis is inhibited. Due to this process, patients with diabetes mellitus have a decrease of the glucose level in the blood, the transportation of glucose to the tissues is restored, and the blood vessels become better.

Formetin is prescribed for the treatment of diabetes mellitus type 2 and a prevention of prediabetes, and the treatment of the obesity in patients with diabetes.

Every patient depending on the severity of the disease should take an individual dose:

  • If the second degree of diabetes mellitus, it is recommended to take a pill of Formetin 500 mg 2 times per day.
  • If the third degree of diabetes mellitus, it is recommended to take a pill of Formetin 500 mg 3 times per day, or a pill of Formetin 850 mg 3 times per day.

A manufacturer of Formetin is the biggest Russian pharmaceutical company “Pharmstandard”.

A cost of Formetin depends on a supplier and a number of pills in a pack. The average cost of Formetin varies from $0,37 per pill to $0,7 per pill.

“Onglyza (Saxagliptin)” and “Januvia (Sitagliptin)” for type 2 diabetes.

The drugs of the new generation “Saxagliptin” and “Januvia (Sitagliptin)” for the treatment of diabetes mellitus have been represented as the main competitors to Metformin. They have a completely another mechanism of the pharmacological action, and increase the natural physiological process during the high level of glucose in the blood.

Onglyza (Saxagliptin)

Saxagliptin and Januvia (Sitagliptin) are medications from the group of Dipeptidyl peptidase-4 (DPP4) inhibitors. The mechanism of the action consists in the increased production of insulin as a reaction to the increased synthesis of glucose in the liver, or during a great amount of sugar in the intestine.

Despite of this, these medications show the high efficiency during the treatment of diabetes mellitus, they have many drawbacks, i.e. a lower level of the pharmacological safety. Saxagliptin and Januvia (Sitagliptin) influence on the insulin level, they can cause hypoglycemia and an affection of the pancreatic gland. Therefore, the use of Saxagliptin and Sitagliptin is allowed only patients who have healthy pancreatic gland and have signs of insulin deficit.

Januvia (Sitagliptin)

A cost of these medications is higher than the cost of Metformin. Only original pills of Januvia (Sitagliptin) and Onglyza (Saxagliptin) may be found in the pharmacies in the USA. Their cost differs depending on a supplier. The large pharmaceutical retailers in the USA and Canada sell these medications at high extra charge, and therefore the purchase may hit you in the wallet. It is more cost-efficient to buy Saxagliptin and Sitagliptin in the online pharmacies, where the cost is lower and the quality is the same.

We have prepared a table where you can see a cost of Onglyza (Saxagliptin) and Januvia (Sitagliptin):

Januvia (Sitagliptin) Saxagliptin 5 mg
Cost of large retailers in the USA (per one pill) $14.5 $13.1
Cost in the internet shops (per one pill) $2.60 $3.9

Effective drugs for the treatment of type 2 diabetes.

Modern medicine does not stop looking for more and more new drugs for the treatment of type 2 diabetes. There are several groups of drugs that make life easier for diabetics, reduce the risk of dangerous complications, slow down or prevent the onset of the disease in people who are glucose tolerant.

The drugs are selected individually for each person, because they have a different mechanism of action and different benefits. Some type 2 diabetes pills can be taken in combination with each other, thereby increasing their overall therapeutic effect.

Peculiarities of prescribing medicines for diabetes.

First of all, preference is given to drugs with a minimal risk of hypoglycemia: biguanides, gliptins, incretins. If a person suffers from obesity and arterial hypertension, incretins are better suited – they allow you to reduce weight and regulate blood pressure.

Biguanide prescription: the initial dose of metformin is 500 mg 2-3 times a day after meals. The next dose increase is possible approximately 2 weeks after the start of therapy. The maximum daily dosage of this medication should not exceed 3000 mg. The gradual increase is due to the fact that there are fewer side effects from the gastrointestinal tract.

Gliptins: drugs for diabetes of the latest generation, taken 1 tablet (25 mg) per day, regardless of food intake.

Incretins: drugs in this group are presented in the form of injection solutions. They are introduced 1 or 2 times a day, depending on the generation.

If monotherapy gives poor results, then the following combinations of antihyperglycemic drugs are used:

1. “Metformin” + Glyptins.

2. Incretins + “Metformin”.

3. “Metformin” + sulfonylurea preparations.

4. Glinides + “Metformin”.

The first two combinations have a minimal risk of developing hypoglycemia, their body weight remains stable.

Sulfonylurea prescribing regimen: it depends on the generation of the drug. Usually drugs are taken once a day in the morning. With an increase in dosage, the receptions can be divided into morning and evening.

Scheme of prescribing glinides: a feature of the use of these drugs is that the drugs of this group are confined to a meal and are taken immediately before it. Usually the tablets are drunk 3 times a day.

Alpha-glucosidase inhibitors: The effectiveness of medication is only observed if the tablets are taken immediately before meals. The initial dose of 50 mg is taken 3 times a day. The average daily dosage is 300 mg. Maximum – 200 mg 3 times a day. If necessary, the dose is increased after 4-8 weeks.

Thiazolidinediones: the drugs are taken 1-2 times a day, depending on the generation. The timing of the meal does not affect their effectiveness. If necessary, increase the dosage, it increases after 1-2 months.

List of hypoglycemic drugs.

The doctor selects certain groups of drugs, taking into account the individual characteristics of a person: concomitant diseases, excess weight, problems with the cardiovascular system, diet and so on.

It is forbidden to select or change the appointment of an endocrinologist on your own!

1. Biguanides. The drug “Siofor” (“Berlin-Chemie”, Germany). The maximum dosage is 1000 mg.

2. Derivatives of sulfonylureas. Preparations: “Diabeton” 60 mg (“Servier Laboratories”, France), “Amaryl” 4 mg (“Sanofi-Aventis”, Germany), “Glurenorm” 30 mg (“Boehringer Ingelheim International”, Germany), “Glibenese Retard” 10 mg (“Pfizer”, France), “Maninil” 5 mg (“Berlin-Chemie”, Germany).

3. Incretins. “Byetta” 250 mg / ml (“Eli Lilly and Company”, Switzerland), “Victoza” 6 mg / ml (“Novo Nordisk”, Denmark).

4. Glyptins. “Januvia” 100 mg (“Merck Sharp & Dohme B.V.”, Netherlands), “Galvus” 50 mg (“Novartis Pharma AG”, Switzerland), “Onglyza” 5 mg (“AstraZeneca”, Great Britain), “Trajenta” 5 mg (“Boehringer Ingelheim International”, Germany), “Vipidia” 25 mg (“Takeda Pharmaceuticals”, USA).

5. Inhibitors of alpha glucosidase. “Glucobay” 100 mg (“Bayer”, Germany).

6. Glinides. “NovoNorm” 2 mg (“Novo Nordisk”, Denmark), “Starlix” 180 mg (“Novartis Pharma”, Switzerland).

7. Thiazolidinediones. “Pioglar” 30 mg (“Sun Pharmaceutical Industries”, India), “Avandia” 8 mg (“GlaxoSmithKline Trading”, Spain).

Biguanides.

Among all the drugs in this group, the most popular are the methylbiguanide derivatives – Metformin. Its mechanisms of action are presented in the form of a decrease in the production of glucose by the liver and a decrease in insulin resistance in muscle and adipose tissues.

The main active ingredient is metformin.

Metformin-based drugs:

1. “Merifatin”;
2. “Formetin Long”;
3. “Glyformin”;
4. “Diasfor”;
5. “Glucophage”;
6. “Siofor”;
7. “Diaformin”.

Main advantages:

1. Biguanides do not affect or reduce body weight;
2. They can be combined with other tableted forms of hypoglycemic agents;
3. Biguanides have a low risk of hypoglycemia;
4. Biguanides do not increase the secretion of their own insulin;
5. Drugs reduce the risk of certain cardiovascular diseases;
6. Biguanides slow down or prevent the development of diabetes in people with impaired carbohydrate metabolism;
7. Acceptable cost.

Disadvantages of Biguanides:

1. Biguanides often cause side effects from the gastrointestinal tract, so they are prescribed at first in low dosages;
2. Biguanides can cause lactic acidosis.

Contraindications:

1. Compliance with a low-calorie diet (less than 1000 kcal per day).
2. Allergic reactions to any of the components.
3. Liver problems, including alcoholism.
4. Severe forms of renal and heart failure.
5. The period of pregnancy.
6. Children under 10 years old.

Sulfonylurea derivatives.

The main mechanism of action of these drugs is to stimulate the secretion of its own insulin. The main active ingredients and drugs for type 2 diabetes of this group are:

1. Gliclazide. Trade names: “Golda MR”, “Gliklada”, “Diabetalong”, “Glydiab MR”. “Diabeton MR”, “Diabefarm MR”, “Diabinax”.

2. Glimepiride: “Instolit”, “Glimepiride”, “Diamerid”, “Amaryl”, “Meglimid”.

3. Gliquidonum: “Uglin”, “Glurenorm”.

4. Glipizide: “Glibenese retard”.

5. Glibenclamide: “Statiglin”, “Maninil”, “Glibex”, “Glimidstada”.

Some drugs are available in a prolonged form – referred to as MR (modified release) or retard. This was done in order to reduce the number of pills taken per day. For example, Glidiab MR contains 30 mg of the substance and is taken once a day, even if the dose is increased, and the usual Glidiab – 80 mg, the intake is divided into morning and evening.

The main advantages of this group are:

1. Fast effect;
2. Drugs reduce the risk of complications of type 2 diabetes associated with blood vessels;
3. Low cost.

Disadvantages:

1. The risk of developing hypoglycemia;
2. The body quickly gets used to them – resistance develops;
3. Increase in body weight is possible;
4. It can be dangerous in case of problems with the cardiovascular system.

Contraindications:

1. Diabetes mellitus type 1;
2. children’s age;
3. the period of pregnancy and lactation;
4. allergy to sulfonamides and sulfonylurea derivatives;
5. diseases of the gastrointestinal tract;
6.ketoacidosis, diabetic precoma and coma.

Incretins.

This is the general name for hormones that stimulate the production of insulin. These include glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide. Endogenous (own) incretins are produced in the gastrointestinal tract in response to food intake and are active for only a few minutes. For people with diabetes mellitus, exogenous (coming from outside) incretins were invented, which have a longer activity.

Mechanisms of action of glucagon-like peptide-1 receptor agonists:

1. Glucose-dependent insulin stimulation.
2. Decreased secretion of glucagon.
3. Reducing the production of glucose by the liver.
4. The food bolt leaves the stomach more slowly, which leads to reduced food intake and weight loss.

Active substances and drugs that mimic the action of glucagon-like peptide-1:

1. “Exenatide (Byetta)”.

2. “Liraglutide (Victoza, Saxenda)”.

Advantages:

1. The drugs have the same effects as their own glucagon-like peptide-1;
2. Against the background of the use of drugs, a decrease in body weight occurs;
3. Decreases glycated hemoglobin.

Disadvantages:

1. There are no tablet forms, drugs are injected;
2. High risk of hypoglycemia;
3. Frequent side effects from the gastrointestinal tract;
4. High cost.

Contraindications:

1. Diabetes mellitus type 1;
2. The period of pregnancy and lactation;
3. Individual intolerance to any of the components;
4. Children’s age.

Glyptins.

Scientifically, they are called type 4 dipeptidyl peptidase inhibitors. They also belong to the incretin group, but they are more perfect. The mechanism of action is due to the acceleration of the production of its own gastrointestinal hormones, which stimulate the synthesis of insulin in the pancreas in accordance with the concentration of sugar. They also glucose-dependently reduce the production of glucagon and reduce the production of glucose by the liver.

There are several substances and preparations of the Gliptin group:

1. “Sitagliptin” (“Januvia”, “Yasitara”, “Xelevia”).
2. “Vildagliptin (Galvus)”.
3. “Saxagliptin (Onglyza)”.
4. “Linagliptin (Trajenta)”.
5. “Alogliptin (Vipidia)”.

Benefits:

1. Low risk of developing hypoglycemia;
2. The drugs do not affect body weight;
3. The drugs stimulate the regeneration of pancreatic tissue, which allows diabetes to progress more slowly;
4. Substances are available in tablet form.

Disadvantages of drugs:

1. There is no reliable data on safety with long-term use of drugs;
2. High cost.

Contraindications:

1. The period of pregnancy and lactation.
2. Diabetes mellitus type 1.
3. Diabetic ketoacidosis.
4. Children’s age.

Alpha glucosidase inhibitors.

The main mechanism of action is to slow down the absorption of carbohydrates in the intestine. Substances reversibly inhibit the activity of enzymes responsible for the breakdown of disaccharides and oligosaccharides to glucose and fructose in the lumen of the small intestine. Moreover, they do not affect the cells of the pancreas.

This group includes the substance of acarbose, which is part of the drug “Glucobay”.

The advantages of this drug:

1. The drug does not affect body weight gain;
2. Extremely low risk of developing hypoglycemia;
3. “Glucobay” reduces the risk of type 2 diabetes mellitus in people with impaired glucose tolerance;
4. “Glucobay” reduces the risk of cardiovascular complications.

Cons of the drug ”
Glucobay (Acarbose)”:

1. Frequent side effects from the gastrointestinal tract;
2. The effectiveness of the drug is lower than that of other oral glucose-lowering drugs;
3. Frequent use – 3 times a day.

Main contraindications:

1. The period of pregnancy and lactation.
2. Children’s age.
3. Allergic reactions to any of the components of the drug.
4. Bowel diseases.
5. Severe renal failure.

Glinides.

The main mechanism of action is to stimulate insulin production. Unlike other pharmacological groups, they cause an increase in insulin secretion in the first 15 minutes after eating, thereby reducing the “peaks” of blood glucose concentration. The concentration of the hormone itself returns to its original value 3-4 hours after the last dose.

At low blood sugar levels, insulin synthesis is slightly stimulated, which helps to avoid hypoglycemia when a meal is skipped.

The main substances and preparations of glinides are:

1. “Repaglinide”. Trade names: “Iglinid”, “Diaglinide”, “NovoNorm”.
2. “Nateglinide (Starlix)”.

The advantages of the Glinide group of drugs:

1. The speed of action at the beginning of therapy;
2. The possibility of using people who have irregular food;
3. Control of postprandial hyperglycemia – when the blood sugar level rises after a normal meal to 10 mmol / L or more.

Disadvantages of Glinides:

1. Increase in body weight;
2. The safety of drugs has not been confirmed with long-term use;
3. The frequency of application is equal to the number of meals;
4. Cost.

Contraindications for Glinides:

1. Children’s and old age;
2. The period of pregnancy and breastfeeding;
3. Diabetes mellitus type 1;
4. Diabetic ketoacidosis.

Thiazolidinediones.

Their other name is glitazones. They are a group of sensitizers – they increase the sensitivity of tissues to insulin, that is, they reduce insulin resistance. The mechanism of action is to increase the utilization of glucose in the liver. Unlike sulfonylurea derivatives, these drugs do not stimulate the production of insulin by the beta cells of the pancreas.

The main substances and preparations of Thiazolidinediones are:

1. “Pioglitazone”. Trade names: “Pioglar”, “Diab-Norm”, “Amalvia”, “Diaglitazon”, “Astrozone”, “Pioglit”.
2. “Rosiglitazone (Avandia)”.

General benefits of Thiazolidinediones:

1. Reducing the risk of macrovascular complications;
2. Low risk of developing hypoglycemia;
3. Protective effect in relation to beta cells of the pancreas;
4. Reducing the risk of developing type 2 diabetes in people predisposed to it;
5. Decrease in triglyceride levels and increase in high density lipoprotein in the blood.

Disadvantages of Thiazolidinediones:

1. Increase in body weight;
2. Swelling of the extremities often appears;
3. The risk of fractures of tubular bones in women increases;
4. The effect develops slowly;
5. Cost.

Contraindications for Thiazolidinediones:

1. Diseases of the liver;
2. Diabetes mellitus type 1;
3. Diabetic ketoacidosis;
4. The period of pregnancy and breastfeeding;
5. Severe heart failure;
6. Children’s age;
7. Edema of any origin.

Insulin for type 2 diabetes.

They try not to prescribe insulin preparations until the last – at first they manage with tablet forms. But sometimes insulin injections become necessary even at the very beginning of treatment.

Indications for Insulin:

1. The first detection of type 2 diabetes mellitus, when the glycated hemoglobin index is more than 9% and the symptoms of decompensation are expressed.
2. Lack of effect when prescribing maximum permissible dosages of tableted forms of antihyperglycemic drugs.
3. The presence of contraindications and severe side effects from the pills.
4. Ketoacidosis.
5. Temporary transfer is possible when a person is awaiting surgical interventions or exacerbations of certain chronic diseases have appeared, in which decompensation of carbohydrate metabolism is possible.
6. Pregnancy (in many cases).

Drugs for the prevention and treatment of diabetes complications.

Sugar-lowering drugs are far from the only ones that are required by diabetics. There are several groups of drugs that help maintain health, prevent the development of complications due to type 2 diabetes or treat those that have already arisen. Without these drugs, quality of life can deteriorate dramatically.

Antihypertensive drugs.

Hypertensive disease together with diabetes form a truly explosive mixture – the risk of heart attacks, strokes, blindness and other dangerous complications increases. To reduce the likelihood of their development, diabetics are forced to monitor their blood pressure more carefully than others.

Groups of antihypertensive drugs:

1. Blockers of calcium channels.
2. Angiotensin-converting enzyme inhibitors.
3. Diuretics.
4. Beta blockers.
5. Angiotensin-2 receptor blockers.

Angiotensin-converting enzyme inhibitors are most often prescribed for type 2 diabetes. This group includes:

1. “Berlipril”;
2. “Diroton”;
3. “Captopril”;
4. “Zocardis 30”;
5. “Amprilan”.

Statins.

They are a group of substances that help lower levels of low density lipoprotein and cholesterol in the blood. There are several generations of statins:

1. “Lovastatin”, “Pravastatin”, and “Simvastatin”.
2. “Fluvastatin”.
3. “Atorvastatin”.
4. “Pitavastatin”, “Rosuvastatin”.

To maintain the health of people with type 2 diabetes, drugs based on atorvastatin and rosuvastatin are most often used.

Preparations, the active ingredient of which is Atorvastatin:

1. “Liprimar”;
2. “Torvacard”;
3. “Atoris”.

Rosuvastatin based drugs:

1. “Crestor”;
2. “Roxera”;
3. “Rosucard”.

Positive influence of Statins:

1. Prevention of blood clots.
2. Improving the condition of the inner lining of blood vessels.
3. The risk of ischemic complications, myocardial infarction, stroke and death due to them decreases.

Alpha Lipoic (Thioctic) Acid.

It is a metabolic agent and an endogenous antioxidant. It is used to regulate lipid and carbohydrate metabolism, stimulate cholesterol metabolism. The substance helps to reduce the concentration of glucose in the blood, increase glycogen in the liver and overcome insulin resistance.

Alpha lipoic acid preparations have the following beneficial effects:

1. Hepatoprotective effect.
2. Lipid-lowering effect.
3. Hypocholesterolemic effect.
4. Hypoglycemic effect.
5. The trophism of neurons improves.

Thioctic acid-based medicines are available in different dosages and dosage forms. Some trade names:

1. “Berlition”;
2. “Thiogamma”;
3. “Thiolepta”;
4. “Octolipen”.

Diabetics take these drugs for polyneuropathy – loss of sensitivity due to damage to nerve endings, mainly in the legs.

Neuroprotective agents.

Neuroprotective agents are a combination of several groups of substances, the purpose of which is to protect the neurons of the brain from damage, they are also able to positively affect metabolism, improve the energy supply of nerve cells and protect them from aggressive factors.

Types of neuroprotective agents:

1. Nootropics.
2. Antioxidants.
3. Adaptogens.
4. Substances of plant origin.

Drugs in these groups are used by people with type 2 diabetes who have diabetic or hypoglycemic encephalopathy. Diseases occur as a result of metabolic and vascular disorders in connection with diabetes.