Description:
Indications
Treatment of type 2 diabetes mellitus, especially in overweight patients, when nutrition and exercise alone are unable to provide optimal glycemic control.
Metformin can be used alone or in conjunction with other oral antidiabetic drugs or insulin in adults.
Metformin can be administered alone or in conjunction with insulin in children and adolescents as young as ten years old.
In overweight type 2 diabetes adult patients treated with metformin as first-line therapy following diet failure, there was a reduction in diabetic complications.
Pharmacology
Metformin is an antihyperglycemic medication of the biguanide class that is used to treat type 2 diabetes. Both baseline and postprandial plasma glucose levels are reduced. It has a different mode of action than sulfonylureas and does not cause hypoglycemia. Metformin lowers hepatic glucose synthesis, lowers glucose absorption in the intestine, and increases insulin sensitivity through increasing insulin resistance.
Dosage & Administration
Metformin immediate release tablet: Dosage of Metformin Hydrochloride must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily doses.
Adult: The usual starting dose of Metformin is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in divided doses. For those patients requiring additional glycemic control, Glucomin may be given at a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given three times a day with meals.
Children: The usual starting dose of Metformin is 500 mg twice a day, given with meals. Dosage increases should be made in increments of 500 mg weekly up to a maximum of 2000 mg per day, given in divided doses.
Interaction
Co-administration with Carbonic anhydrase (Topiramate, Zonisamide) may increase the risk of lactic acidosis. Drugs (Ranolazine, dolutegravir, Cimetidine) that reduce Metformin clearance may increase the accumulation of Metformin. Alcohol can potentiate the effect of Metformin on lactate metabolism.
Contraindications
Hypersensitivity to the active substance or to any of the excipients.
Any type of acute metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis).
Severe renal failure (GFR <30 mL/min).
Acute conditions with the potential to alter renal function such as dehydration, severe infection, and shock.
Acute or chronic disease, which may cause tissue hypoxia such as cardiac or respiratory failure, recent myocardial infarction, shock, Hepatic insufficiency, acute alcohol intoxication, alcoholism.
Side Effects
Disorders of the circulatory and lymphatic systems: The following is unknown: Hemolytic anemia is a kind of anemia in which the red blood cells
Disorders of metabolism and nutrition: Lactic acidosis is a very unusual condition. During long-term metformin treatment, there is a decrease in vitamin B12 absorption along with a fall in serum levels. If a patient comes with megaloblastic anemia, such an etiology should be considered. In post-marketing experience, cases of peripheral neuropathy in patients with vitamin B12 insufficiency have been observed (frequency not known)
Pregnancy & Lactation
Uncontrolled diabetes (gestational or permanent) during pregnancy is linked to an increased risk of congenital malformations and perinatal mortality. When a patient expects to become pregnant or is pregnant, it is suggested that diabetes be treated with insulin rather than metformin to keep blood glucose levels as close to normal as possible, reducing the risk of gestational diabetes.
Precautions & Warnings
Metformin Hydrochloride is known to be substantially excreted by the kidney and the risk of Metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Metformin may lower vitamin B12 levels. It also increases the risk of hypoglycemia when used in combination with insulin or insulin secretagogue.
Storage Conditions
Keep the temperature below 30?C and away from light and moisture. Keep out of children’s reach.
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