The recommended use of probiotics treat gastrointestinal diseases😈😈😈

There are many products content probiotics in the supermarket. You can easy to buy products to supplement probiotics. Those products always claim that is good for both people with/without gastrointestinal diseases.

Probiotics are active microorganisms that can produce health benefits when consumed in sufficient quantities. As an effective method to change the intestinal microbes, probiotics are used more and more widely in the treatment of gastrointestinal diseases.

Although there were a large number of studies on probiotics in various gastrointestinal diseases, the microbial strains, route of administration, doses and research methods of studies were various. 

In order to provide clear and reasonable guidance for the proper use of probiotics in specific gastrointestinal diseases, the American Gastroenterological Association (AGA) has proposed some recommendations for the role of probiotics in the management of gastrointestinal diseases.

Here is the summary of the recommendations:

1. The AGA guidelines recommended that probiotics be used to patients with ulcerative colitis, Clostridium difficile infection and Crohn's disease, or symptomatic patients with irritable bowel syndrome only in clinical trials.

2. It is recommended to use probiotics to prevent C. difficile infection of the patients taking antibiotics. (Low quality of evidence)

3. Advise patients with pouchitis to use a combination of probiotics. (Very low quality of evidence)

4. Premature low birth weight infants with necrotizing enterocolitis are recommended to use a combination of probiotics. (Medium to high quality of evidence)

5. Probiotics are not recommended for North American children with acute transmissible gastroenteritis.

More high-quality clinical trials are needed to provide supporting in the use of probiotics to treat gastrointestinal diseases.

For more detail, click on the link below👇

https://www.gastrojournal.org/article/S0016-5085(20)34729-6/fulltext

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Some advices prevent the recurrence of peptic ulcer disease👍👍👍

The gastric juice (gastric acid, pepsin) makes the mucosal tissue loss and  shedding in the gastrointestinal tract which is covered by the juice. It call Peptic Ulcer Disease.  That mucosal ulcers always occur in the stomach or duodenum (gastric ulcer and duodenal ulcer). The causes and treatments of them are similar. It is about one-tenth of the population has suffered from peptic ulcer, which shows that the incidence is very high.

There was no effective drugs to treat peptic ulcers before the 1970s. There was used to drink soda or milk to treat stomach pains, and even treated them by surgical removal of their stomachs. After the doctors figured out the cause of peptic ulcer which is believed causing by excessive gastric acid production. Then they have invented the gastric acid secretory inhibitors (such as ranitidine, cimetidine, omeprazole.). Taking oral medicine to cure peptic ulcer has become very easy.

However, there are another problem arising. Although most patients can heal their ulcer within 1 to 2 months after taking the medicine, they will recur easily. Over 70% of patients relapse ulcers within one year after stopping the drug. Some patients even recurred every year.

Until the 1990s, the peptic ulcer was understood further more. It was discovered that in addition to excessive gastric acid. The cause of ulcer was also infected with a special kind of bacteria (Helicobacter pylori) in the stomach. Afterward there was explored to eliminate Helicobacter pylori in the stomach. 

Studies have found that over 70% of patients with gastric ulcers and over 95% of duodenal ulcers are infected with Helicobacter pylori. After regular treatment and removal of bacteria in the gastrointestinal tract, the recurrence rate of peptic ulcer has dropped from more than 70% to less than 5%. Therefore, the key to solving the recurrence of peptic ulcer is to eliminate Helicobacter pylori for most patients.

The following advices should be noticed in the treatment of peptic ulcer and prevent the recurrence:

1. Clarify the etiological diagnosis of peptic ulcer via gastroscopy and standardized treatment. Without the gastroscopy, it is difficult to distinguish peptic ulcer, chronic gastritis, dyspepsia and cholecystitis based on symptoms alone. The treatment ways for each disease are different. 

2. After the diagnosis is confirmed, the patient should adhere to the course of treatment (generally 6 to 8 weeks for gastric ulcer and 4 to 6 weeks for duodenal ulcer). The gastric acid secretory inhibitors are effective. The symptoms are eliminated by taking the drugs once or twice. Many patients will stop taking the medicines when the symptoms disappeared. In fact, the course of treatment is insufficient and the ulcer is not healed.

3. Determine the presence of Helicobacter pylori infection as soon as possible and prevent the treatment mistakes. Using standardized and effective antibacterial treatment plan to avoid causing bacterial resistance.

4. Long-term medication is not recommended. There are some patients take the gastric acid secretory inhibitors for many years to prevent the recurrence of ulcers. However, there is no evidence that prolonging the medication time can prevent the recurrence of ulcers. As long as Helicobacter pylori is present, it is still easily relapse after stopping the drug.

5. Patients should change their bad lifestyle. Such as tobacco and alcohol habits, irregular meals, staying up late,  long-term emotional stress and anxiety. There is no clear evidence show that spicy foods will aggravate ulcers. The patient's diet is kept soft and easy to digest.

6. Using the drugs (such as NSAIDs) that induce or aggravate the ulcer carefully.

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Some knowledge about scar removal products 😍😍😍

Scar is the appearance and pathological changes of normal skin tissue caused by various traumas, such as after burns, surgery, skin inflammation (such as folliculitis, acne.). It is an unavoidable product in the process of human wound repair. Scars influences the appearance of the patient and easily influences the patient's psychology. There are many methods (such as laser therapy, surgery, external scar removal products) to treat scar. Here will introduce a few external scar removal products.

Dermatix®

It is composed of polysiloxane, silicon dioxide and silicone resin. It can inhibit the growth of scars, flatten the scars on the skin, and relieve itching or pain of scars. It is not suitable for the unhealed wounds. 

Clean and dry the scar. Use appropriate amount of gel applying along the scar. Do not apply back and forth on the scar.

Kelo-Cote®

Its effective ingredients are polydimethylsiloxane and cyclopentasiloxane. It can prevent the appearance of scars, repair scars that have formed, and regenerate the skin. 

Clean and dry the scar. Apply a thin layer on the scar 1-2 times a day. 

Hirudoid®

Its effective ingredient is Mucopolysaccharide Polysulphate. It is used to treat varicose veins, remove blood stasis, relieve swelling and pain, inhibit scar formation and soften scars. 

When it is used to soften scars, it needs to be massaged forcefully so that it can fully penetrate into the skin.

Cica-Care®

It is a silicon gel sheet and is made of medical polymer materials. It is suitable for adjuvant treatment of hypertrophic scar due to body surface trauma, burns and after surgical healing.

It should be used for at least 12 hours a day, preferably 24 hours, and continue to use it for 2 to 4 months. Apply it for 4 hours a day for the first two days and 8 hours a day for the next two days, then increase by 2 hours a day until it can be applied 24 hours a day. This using method can avoid skin allergies. Each sheet can be used repeatedly for 14 to 28 days. When it becomes difficult to clean or stick, it needs to be replaced a new one. Do not use on the unhealed wounds.

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Is the COVID-19 drug better than vaccine??? 😲😲😲

On October 1st, Merck and Ridgeback Biotherapeutics reported the results from their COVID-19 drug Molnupiravir from phase 3 study in patients with mild to moderate COVID-19. 

In their study, the risk of hospitalization or death are reduced by about 50%. Only 7.3% patients who got Molnupiravir were either hospitalized or died during the research. And the placebo group is 14.1%. The Molnupiravir group is no one dead and the placebo group is reported 8 people dead. 

But after a few days of that announcement, a source with the drug controller general of India reported that Molnupiravir is no significant efficacy toward the moderate COVID-19 and that effective effect is only against the mild COVID-19.

Although Merck said that no significant safety issues have been observed in the study, some scientists have expressed doubts about the safety of Molnupiravir. The structure of Molnupiravir is similar to the nucleotide of RNA. That makes the virus produce ineffective RNA to stop virus replication. Those scientists believe that this function will have adverse effects on the human too.

So, is the COVID-19 drug better than vaccine?

It is hard to say which one is better. The vaccine is always being the first way for diseases. It can protect people to avoid getting sick. The treated drugs will be used when the people get sick. Therefore, we should not compare with drug and vaccine. You can think that they are two different things.

Although Molnupiravir is highly cheaper than other COVID-19 treatment methods, it is still much more expensive than the widely vaccinated COVID-19 vaccine.

As the first oral small molecule antiviral drug supported by clinical data, Molnupiravir has obvious advantages over the current neutralizing antibody treatment of COVID-19: 

1. It does not require low-temperature storage and transportation.

2. It can be taken orally.

3. It provides a life defense for people who cannot or refuse to receive the COVID-19 vaccine.

The convenience and price of Molnupiravir make it more approachable for the early-stage patients or high-risk groups.

The FDA will discuss for an emergency es authorization for Molnupiravir to treat COVID-19 on 30th November 2021. Let's look forward about it.

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Can we smoke when taking medicines???💣💣💣

 Smoking (Most drugs)

For most drugs, we should not smoke at least 30 minutes before and after taking the drug. For some drugs, such as aminophylline, the dosages need to be adjusted after you quit smoking.

In flue-cured cigarettes, The amount of tar is about 11mg. Some substances in tar can induce the drug-metabolizing enzymes in liver, such as CYP1A1, CYP1A2, CYP2E1. It will promote the metabolism of drugs (For example, it increases the clearance rate of aminophylline by 58-100%), and significantly reduce the efficacy of drugs.

The amount of nicotine is about 1mg in flue-cured cigarettes. Nicotine is mainly metabolized by the drug-metabolizing enzymes in liver (CYP2A6). And the drugs (such as Methoxsalen) reduce the metabolism of nicotine by inhibiting CYP2A6. It causes dizziness, headache, nausea, vomiting, and even severe arrhythmia.

Especially when you are taking below drugs:

Antipyretic analgesics: such as Acetaminophen

Anticoagulants: such as Warfarin

Antipsychotics: such as Mirtazapine

Antiarrhythmic drugs: such as Mexiletine

Antiasthmatic drugs: such as Theophylline

Adrenergic receptor agonists and blockers: such as Metoprolol

Antihypertensive drugs: such as Nifedipine

Hypoglycemic drugs: such as Insulin

Other drugs

For women who taking oral contraceptives, the incidence and death rate of myocardial infarction in smokers are 10 times higher than non-smokers of the same age.

***For your health, quit smoking please~😁

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Should we avoid to drink alcohol/tea/milk when taking medicine??💣💣💣

Not only the oral drugs have food contraindications, but also injections and transdermal absorption preparations. The drugs enter the gastrointestinal tract through oral administration. They can interact with food in the gastrointestinal tract. The drugs enter the blood through veins and muscles, they also interact with the chemical components of food, beverages, tobacco and alcohol in the blood.

1. Alcohol (All drugs)

For all drug, alcohol is forbidden within 2 hours before and after taking the drug. For some drugs, alcohol is forbidden 1 day before taking the drug and 3 days after the drug is stopped. Some drugs, such as cefmetazole, cefpiramide, and cefmino are prohibiting to drink alcohol for 1 week after drug withdrawal.

In the gastrointestinal tract, The ethanol contained in the alcohol will release the sustained-release drugs and controlled-release drugs in a short period of time (burst release). It will lead to a sudden increasing the drug concentration in the blood and causing drug poisoning;

Ethanol can also induce drug-metabolizing enzymes in the liver. It will accelerate the metabolism of some drugs (such as phenobarbital and phenytoin) in the body, thereby reducing the efficacy of these drugs and causing seizures.

Cephalosporin antibiotics can inhibit acetaldehyde dehydrogenase and cause acetaldehyde accumulation in the body. It causes a "disulfiram-like reaction", which can be fatal in severe cases.

Ethanol has the effects of central depression, gastrointestinal mucosal stimulation, liver damage, lowering blood pressure and blood glucose. It can also aggravate the adverse reactions of sedatives, non-steroidal anti-inflammatory drugs and other drugs.

Especially when you are taking below drugs:

Cephalosporins: Cefuroxime, Cefoperazone, Ceftazidime, Cefoxitin, Cefmenoxime, Cefmendole, Laoxycephalosporin, Cefmetazole, Cefpiam, Cefminox, etc.

Nitroimidazoles: Metronidazole, Tinidazole, Secnidazole.

Sulfonamides: Trimethoprim/sulfamethoxazole.

Sulfonylurea hypoglycemic drugs: Glyburide, Glipizide, Glimepiride. 

We should not drink alcohol in 2 days before medication and at least 7 days after drug withdrawal.

2. Tea (Most drugs)

People should not drink tea within 2 hours before and after taking most drugs. Tea contains about 10% tannin, which is decomposed into tannic acid in the human body. Tannic acid will comprise precipitates with alkaloid drugs and metal salt drugs (iron, calcium, bismuth, zinc, etc.). This will greatly reduce the absorption of the drug.

Caffeine and theophylline in tea will inhibit the central nervous system depressants such as phenobarbital and chlorpromazine. It can greatly reduce or reverse the efficacy of the drug.

The caffeine in tea can also stimulate the secretion of gastric acid, aggravate the gastrointestinal side effects of drugs, and even induce gastric bleeding and gastric perforation.

Especially when you are taking below drugs:

Alkaloid drugs: such as Berberine

Antibacterial drugs: such as Tetracyclines

Non-steroidal anti-inflammatory drugs: such as Aspirin, Ibuprofen

Cardiac glycosides: such as Digoxin

Sedative hypnotics: such as Zopiclone, Estazolam

3. Milk (Antibacterial drugs, metal ion-containing drugs)

Antibacterial drugs and drugs containing polyvalent metal ions (antacids, gastric mucosal protective drugs, iron, calcium, and trace elements) should not be taken with milk.

The metal ions (such as calcium and iron) in milk are consisted of the complexes or insoluble salts with these drugs. This makes the drugs difficult to absorb.

The drugs containing polyvalent metal ions can comprise precipitates with the protein in milk. It is not only affecting the drug absorption, but also greatly reduces the absorption of nutrition in milk.

Especially when you are taking below drugs:

Quinolones drugs: such as Ofloxacin

Gastric drugs: such as Bismuth subcarbonate, Aluminum hydroxide

Metal element supplement drugs: such as Zinc gluconate, Calcium carbonate, Ferrous fumarate

Other drugs 

People should not drink milk before and after 1 hour of taking above drugs.

Normal food has no effect on the bioavailability of ciprofloxacin, but the metal ions in milk products can reduce the bioavailability of ciprofloxacin by 30% to 36% due to the chelation. It may lead to treatment failure. The metal ions in enteral nutrition can also chelate with quinolones.

Doxycycline and minocycline have lower binding power with calcium ions compared with tetracycline. Although they can be taken with food and milk, they still cannot be taken with drugs containing aluminum, bismuth, calcium, magnesium, and zinc ions.

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How to take the stomach medicines???😵😵😵

Use the medicine to treat gastric disease, the time of taking is very important!!!

There are many kinds of medicines for treating gastric diseases. Due to different pharmacological effects and dosage forms, the time of taking each kind of medicine is very important.

1. Promoting gastric motility drugs

    Such as Mosapride and Domperidone tablets should be taken 15-30 minutes before meals. Trimebutine can be taken before or after meals.

2. Antacids

    Such as aluminum hydroxide, magnesium oxide, magnesium trisilicate, etc., can neutralize gastric acid directly, and should generally be taken half an hour to one hour before a meal or when stomach pain occurs.

3. Antisecretory drugs

    Such as cimetidine, ranitidine, and famotidine can be taken before going to bed or after breakfast and dinner. Omeprazole, lansoprazole, and rabeprazole are best taken in the morning or on an empty stomach before going to bed.

4. Anti-helicobacter pylori requires combined medication.

    Proton pump inhibitors are taken half an hour before meals. Colloidal bismuth should be taken between meals. Antibacterial drugs should be taken according to the interaction with food, the possible digestive tract discomfort, etc., and the time of taking according to the drug instructions.

5. Gastric mucosal protective drugs

    They are best taken between meals or before going to bed.

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Follow the doctor's advice and use sleeping pills scientifically😷😷😷

To treat insomnia, we should follow the doctor's advice and use sleeping pills scientifically.

Using the hypnotic drugs requires detailed analysis and evaluation by doctors. The patients with insomnia should not use the hypnotic drugs by themselves without the prescriptions. They should have a comprehensive treatment method under the guidance of doctors and pharmacists.

The hypnotic drugs should start with a small dose and the dose should not be easily adjusted after achieving the effective dose. It should be administered as required, intermittently and in sufficient amount. For the special populations such as children, pregnant women, lactating women, as well as patients with liver or kidney damage, severe sleep apnea syndrome or myasthenia gravis, it is not suitable to use sleeping medications.

The treatment program of hypnotic drugs is generally shorter than 4 weeks. If the drug intervention is over 4 weeks, the patient need to go to the hospital for the regular evaluation at least every month.

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Highly processed foods will harm memory in the elderly~~👴👵

A new research found that after only four weeks of a highly processed food diet , the brains of aging rats have a strong inflammatory response, accompanied by behavioral signs of memory loss.

In the study, the diet mimics ready-to-eat product, which are usually packaged for a long time and have a long shelf life (such as potato chips and other snacks), frozen food (such as pasta and pizza), and cooked meats containing preservatives. Highly processed diets are also associated with obesity and type 2 diabetes, which suggests that it is best for elderly to reduce eating ready-to-eat products. 

Eating highly processed foods can cause severe memory deficits. In the elderly, rapid memory decline is more likely to develop into neurodegenerative diseases such as Alzheimer's disease.

The researchers also found that the intake of omega-3 fatty acid dietary supplements can prevent memory problems and almost completely reduce the effects of inflammation in elderly rats. 

Maybe people should limit to eat highly processed foods in the diet and increase the intake of foods rich in omega-3 fatty acids to prevent or slow down this deterioration.

Reference：

Michael J. Butler, Nicholas P. Deems, Stephanie Muscat, Christopher M. Butt, Martha A. Belury, Ruth M. Barrientos. Dietary DHA prevents cognitive impairment and inflammatory gene expression in aged male rats fed a diet enriched with refined carbohydrates. Brain, Behavior, and Immunity, 2021; 98: 198 DOI: 10.1016/j.bbi.2021.08.214

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What functions do the electrolytes do in the body (Part 3.) ?😤

Finally, here is the last part about the electrolutes. 

Chlorine

Cl^- is one of the most important anions in the extracellular fluid, which can regulating the osmotic pressure and acid-base balance of the cell body.

Chlorine is mainly came from sodium chloride in the food. Therefore, the change of chlorine in the body is basically equaled to the sodium. However, there is an opposite relationship between the level of chlorine and the level of bicarbonate. It is because the anions in the body also need to be maintained at a certain concentration. As the two most important anions in the body, chlorine and bicarbonate are normally keeping at a balance way.

Normal serum Cl^- is 96-108 mmol/L. Increased serum Cl^- is common in hypernatremia and high chlorine metabolic acidosis.

In clinical, decreased serum Cl^- is more common and its cause is insufficient intake or increased loss of sodium chloride.

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What functions do the electrolytes do in the body (Part 2.) ?😤

This time will talk about the other important electrolytes in the body: 

Sodium

Na⁺ is the main cation in the extracellular fluid, and it plays a vital role in maintaining many important physiological activities in the body, such as maintaining the osmotic pressure of the extracellular fluid. 

Adult normal serum sodium is 135.0-145.0 mmol/L. Changing the concentration of Na⁺ in the extracellular fluid may caused by changes in the content of sodium and water, so sodium balance disorders are often accompanied by water balance disorders.

The balance of Na⁺ is mainly regulated by changes the volume of extracellular fluid and the concentration of plasma sodium. When the volume of extracellular fluid decreases or the concentration of plasma sodium decreases, it can activate the renin-angiotensin-aldosterone system to promote the reabsorption of Na⁺.

When the amount of extracellular fluid or the concentration of Na⁺ increases, it can lead to increase secreting the natriuretic peptides, reduce the re-collection of Na⁺ by the kidneys, increase sodium excretion, and cause increasing urine output and promote the water excretion.

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What functions do the electrolytes do in the body (Part 1.) ?😤

Electrolytes have the ability to maintain the osmotic pressure of body fluids the normal distribution of body fluids. There are composed of various anions and cations. Potassium, sodium, and chlorine are the three important electrolytes that are most relevant to the diseases and are most closely connected to the patient's life. Firstly, let's talk about potassium and the others will talk in the next two issue.

Potassium

Potassium is the most important cation distributed in the intracellular fluid. It has important physiological functions in maintaining the osmotic pressure of the intracellular fluid, acid-base balance, and maintaining the irritability of muscles and nerves.

1. Normal blood K⁺ concentration

The normal concentration of serum  K⁺  is about 3.5-5.5 mmol/L, the plasma K⁺ is about 0.5 mmol/L lower than the serum K⁺, because when the blood coagulates, K⁺ in platelets and other blood cells will release a few number to the serum.

2. Hyperkalemia and its causes

    a.) The cells are dismantled and potassium ions are forced to flow out to the external fluid. 

The K⁺ concentration of the intracellular fluid is 150.0 mmol/L, which is about 40 times the serum K⁺ concentration. When tissue cells are destroyed (such as    large-area burns, crush injuries), the K⁺ ions in the cells will be flow out to the serum, it result the increasing in blood K⁺. If the upper limit (5.5 mmol/L) is exceeded, it is hyperkalemia. It can lead to heart block, circulatory failure, cardiac arrest in diastole and finally die. 

There are some reasons lead to hemolysis. It can cause false increasing in blood K⁺ which is quite common. Therefore, when the samples with elevated K⁺, it is necessary to check whether the patient's sample is hemolyzed.

    b.) Potassium ions from the outside

Too much K⁺ input from the outside can also cause hyperkalemia, such as the input of a large amount of potassium solution or a large amount of stored blood.

    c.) In acidosis, potassium ions are used to exchange protons

Based on the acid-base balance,  in acidosis, there are many pumps on the cell membrane that can pump a H⁺ of the external fluid into the cell, and then pump a K⁺ out in addition to the regulation of lungs and kidneys. Therefore, patients with acidosis are often accompanied by hyperkalemia. Similarly, when patients have hyperkalemia, there will be a reverse operation, K⁺ is pumped back, and H⁺ is pumped out, and acidosis occurs. Interestingly, hyperkalemia not only leads to metabolic acidosis, but also abnormal alkaline urine.

3. Hypokalemia and its causes

Hypokalemia is also very common in clinical. In hypokalemia, patients may have mental abnormalities, increased heart rate, heart failure, and cardiac arrest in systole. The main causes of hypokalemia are insufficient intake, excessive loss, and potassium from outside the cell into the cell.

Glucose and insulin can drive potassium into the cell. When too much glucose with insulin is input, insulin promotes glucose to enter the cell then synthesize glycogen, it also brings potassium in.

OH^- also has this ability. In alkalosis, H⁺ is needed to neutralize, it pump H⁺ out of the cell and K⁺ back to the cell. Alkalosis is accompanied by hypokalemia, which can also lead to metabolic alkalosis and abnormal aciduria.

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Why some doctors prescribe levothyroxine tablets to the hyperthyroidism or hypothyroidism patient?😨😨😨

Do you see the doctor do that? Do you feel confused? Let's see why the doctor do it~~

Levothyroxine

It is a thyroid medicine that can substitute hormone normally produced by the thyroid gland to regulate the body's metabolism and energy. 

So, it is easy to understand why the doctor prescribes it to the hypothyroidism patient. It will supply the patient enough material to transform into thyroxine.

But why the hyperthyroidism patient is also prescribed it?

Clinically, the hyperthyroidism patients with exophthalmos or goiter, can be given appropriate amount of levothyroxine. The purpose is to inhibit thyroid stimulating hormone (TSH). Because when the antithyroid drugs are given to treat hyperthyroidism, the patient's thyroxine will gradually decrease, the inhibition of TSH gradually weakens. The increasing TSH will aggravate exophthalmos or goiter.

In another case, some patient will have hypothyroidism when the antithyroid drugs are a little more, and they will have hyperthyroidism when the antithyroid drugs are slightly reduced. It is difficult to adjust the dosage. Using levothyroxine and antithyroid drugs can better balance the level of thyroid hormones.

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What should you do if you forget to take your oral diabetes drug??😨😨

It is very common to see that the patient forget to take his diabetes drug. But what should you do if you forget to take it? Today will talk about that and how the medicine taken.

Metformin

General and sustained-release dosage form are taken during or after meal. Enteric-coated dosage form is taken before meals.

If you forget to take the medicine, take it as soon as possible. If the time is close to the next dose, do not take it and must not double the next dose!

Acarbose

Take the tablets with meal (chew together with the food and then swallow). Capsule form should be swallowed the whole immediately before meals. Do not take acarbose if you do not have a meal!!!

If you forget to take acarbose while eating, you can chew it during or immediately after the meal. If it is close to the next dose, do not take it and must not double the next dose!

Gliclazide sustained-release tablets / Glipizide controlled-release tablets

Take it before breakfast. If you haven't breakfast, take the medicine before the first meal.

If you forget to take the medicine before breakfast, you can take it during or immediately after breakfast.  If it is close to the next dose, do not take it and must not double the next dose!

Nateglinide / Repaglinide

Take the medicine immediately before meal. Do not take medicine if you do not have a meal.

If you forget to take the medicine before a meal, you can take it immediately during or after a meal. If it is close to the next dose, do not take it and must not double the next dose!

Rosiglitazone Tablets / Pioglitazone Dispersible Tablets

Take the medicine before or after meal. 

If you forget to take the medicine, take it as soon as possible. If it is close to the next dose, do not take it and must not double the next dose!

Sitagliptin / Saxagliptin / Alogliptin / Vildagliptin / Linagliptin

These medicines are not affected by food. They can be taken with or without food

If you forget to take the medicine, take it as soon as possible. If it is close to the next dose, do not take it and must not double the next dose!

Dapagliflozin

Take medicine in the morning. Can be taken with or without food. 

If you forget to take the medicine, take it as soon as possible. If it is close to the next dose, do not take it and must not double the next dose!

Canagliflozin

Take it before the first meal every day.

If you forget to take the medicine, take it as soon as possible. If it is close to the next dose, do not take it and must not double the next dose!

***Summary, metformin and acarbose will irritate intestine, so they should be taken during or after meal. And if you forget to take your diabetes drugs, take it as soon as possible. But if the time is close to the next dose, just take the next dose and must not double the dose!!!!!

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