BRAND NAME: ALNAMET-MYO TABLETS
COMPOSITION: METFORMIN 500 SR + MYO INOSITOL 600MG TABLETS
PACKING-10*10 BLISTER PACK
PCOS (POLY CYSTIC OVARY SYNDROME)
Polycystic ovarian syndrome (PCOS) also known as hyperandrogenic anovulation syndrome or Stein- Leventhal syndrome is an endocrine disorder, characterized by anovulation, oligomenorrhea, amenorrhea, features of androgenic hormone excess (hirsutism, acne, alopecia, seborrhea) and insulin resistance. Global prevalence ranges from 2.2% to 26%.
PCOS is one of the leading causes of female subfertility. The consequences of PCOS include menstrual irregularities and skin problems while on long term it can result in infertility, obesity, diabetes and cardiovascular diseases.
PCOS include any two of the following three criteria viz. oligo- and/or anovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovaries on ultrasound; other etiologies must be excluded. Hyperinsulinemia is the mainstay of the pathophysiology of PCOS. A decrease in the insulin resistance is reflected in terms of clinical and biochemical improvement in PCOS. Hyperinsulinemia contributes to hyperandrogenism by the following mechanism:
• By binding to IGF-1 receptor, it augments the thecal androgen response to LH.
• Inhibition of hepatic synthesis of SHBG (Sex hormone binding globulin), resulting in greater concentration of free androgen.
• Inhibition of hepatic synthesis of Insulin –like growth factor binding protein -I, which allows an increase in circulating levels of IGF-I and greater local activity of IGF-I in the ovary. Increased levels of testosterone, itself reduces the hepatic synthesis of SHBG, resulting in a vicious cycle of hyperandrogenism and the clinical features corresponding to same.
Metformin, a time-tested drug for PCOS and has been used since long, in a dose of 500 mg three times a day with a success rate of 20 to 96%.5-11 It acts by suppressing hepatic gluconeogenesis. It also increases insulin sensitivity, enhances peripheral glucose uptake, and decreases insulin induced suppression of peripheral fatty acid oxidation. However, in such a dose it is often associated with side effects such as nausea, vomiting, abdominal cramps and diarrhoea.
Myoinositol is an upcoming drug in the management of PCOS. A deficiency of inositols has been postulated as a key factor in the pathogenesis of PCOS. An increased excretion of inositol in urine has also been observed in patients of PCOS thus leading to its deficiency.12 Based on these findings, inositols were used for the management of PCOS.
Inositols (6 carbon polyols) are second messengers which are responsible for glucose transport intracellularly. It also increases the translocation of GLUT 4 to the cell membrane. At ovarian level, it has been observed that myoinositol based second messenger is involved in both glucose uptake and FSH signalling. Various studies have found a success ranging from 22 to 88% in the management of PCOS.13-19 Though the side effects are minimal, the cost of treatment with 2-4g/day for 3-6 months duration, is one of the major constraints.
BENEFIT OF COMBINATION
As both myoinositol and metformin have different mechanisms of action in improving insulin resistance and controlling hyperinsulinemia, it has been postulated that both the drugs in combination may have additive effect in management of hyperinsulinemia in PCOS with the reduction in the doses of individual drug to achieve similar efficacy.
INDICATIONS OF ALNAMET-MYO TABLETS