Indications:
- Treatment of newly diagnosed diabetes as adults, with or while not excess weight and if the diet doesn't work.
- As a mix therapy in patients who are unresponsive therhadap sulfonylurea monotherapy either primary or secondary.
- As an auxiliary drug to cut back the dose of insulin when required.
Contra Indications:
Patients with cardiovascular, renal failure, liver failure, dehydration and alcohol, diabetic coma, ketoacidosis, myocardial infarction, acute chronic disease states related to tissue hypoxia, a state related to lactic acidosis bleak shock, pulmonary insufficiency, a history of lactic acidosis.
Composition:
Metformin five hundred
Each film coated pill contains:
Metformin HCL ....................................... 500 mg
Metformin 850
Each film coated pill contains:
Metformin HCL ....................................... 850 mg
Pharmacology:
Metformin is an oral agent antihiperglikemik biguanid cluster for individuals with diabetes mellitus while not dependence on insulin. Precise mechanism of action of metformin isn't clear, but metformin could improve hepatic and peripheral sensitivity to insulin while not stimulating insulin secretion and decreased absorption of glucose from the gastrointestinal tract. Metformin reduces blood glucose levels solely in an exceedingly state of hyperglycemia and doesn't cause hypoglycemia when administered as one agent. Metformin doesn't cause weight gain and even tends to cause weight loss.
Dose:
Metformin ought to be given along with food or once meals in divided doses.
Tablets five hundred mg
Dosage: one pill three times daily
Tablets 850 mg
Initial dose: one x daily one pill (morning)
Maintenance dose: one pill a pair of times daily (morning and evening)
Note:
In combination treatment with sulfonylurea or insulin, blood sugar levels ought to be checked, considering the likelihood of hipoglikimea.
- Dosage ought to be gradually enlarged, one pill of five hundred mg three times daily or one pill of 850 mg a pair of times daily is usually enough to regulate diabetes. this will be accomplished in an exceedingly few days, however not sometimes these new effects achieved among 2 weeks. If desired result is achieved, the dose could also be increased cautiously to a most of three g daily. When needed 850 mg tablets could also be administered 3 times on a daily basis. When the symptoms of diabetes has been controlled, there's the likelihood of a dose will be lowered.
- When combined with sulfonylurea treatment the result's less adequate, initially given one five hundred mg pill, then the dose of metformin is raised slowly to get most management. typically the dose of sulfonylurea could also be continued with metformin as one drug.
- When given in conjunction with insulin will follow these instructions:
a. If the insulin dose is a smaller amount than sixty units on a daily basis, initially given one pill of metformin five hundred mg, then the insulin dose was gradually reduced (4 units each 2-4 days).
Use of the pill will be added every weekly interval.
b. If the insulin dose is quite sixty units on a daily basis, generally metformin causes a decrease in blood sugar levels quickly. Such patients ought to be observed rigorously throughout the primary twenty four hours once administration of metformin, thereafter, could follow the directions provided in (a) on top of.
Dose single trial:
Determination of blood sugar levels once administration of a dose experiments gave no indication whether or not someone with diabetes can give a response to metformin. the most doable result of newly acquired once patients received treatment metformin for weeks and so the dose of one experiment cannot be used for assessment.
Side Effects:
Side effects are reversible within the gastrointestinal tract embrace anorexia, abdomen upset, nausea, vomiting, metallic style within the mouth and diarrhea.
Can cause lactic acidosis, however deaths attributable to this lower incidence of 10-15 times of fenformin and less than the case of hypoglycemia caused by glibenclamide / sulfonylurea. Cases of lactic acidosis with sodium bikorbonat will dibati. Individual case with metformin is megaloblastic anemia, pneumonitis, vasculitis.
Warning and Caution:
- matters that triggers hypoxia and lactate accumulation will cause lactic acidosis is harmful, then metformin mustn't be administered to patients with disease of the cardiovascular, renal failure, liver failure, dehydration and alcohol drinkers.
- Long-term metformin therapy, will cause absorption of vitamin B12 and folic acid within the gastrointestinal tract, thus it must be examined within the serum levels of vitamin B12 per annum.
- though metformin doesn't cause embryonic facet effects in pregnant ladies with diabetes, insulin is healthier than antihiperglikemik oral agents to regulate hyperglycemia in pregnancy.
- Not suggested to be given to breastfeeding ladies.
- the likelihood of interaction between metformin and sure anticoagulants, during this case the anticoagulant dosage changes could also be required.
- have to be compelled to be careful for elderly individuals, and high infections in an exceedingly state of trauma.
Drug Interactions:
- Alpha-glucosidase inhibitor Acarbose cut backs the bioavailability of metformin and reduce the height plasma concentration of metformin on average, however the time to achieve peak concentration isn't modified.
- Guar gum will cut back the speed of absorption of metformin and metformin reduces the concentration within the blood.
- Cimetidine inhibits renal tubular secretion of metformin on a competitive basis and increase the world underneath the curve of plasma concentrations of metformin on time and to cut back renal excretion of metformin.
- Oral anticoagulant phenprocoumon elimination of those medicine increase, increase liver blood flow and extraction of the consequences of metformin on liver microsomal enzyme activity.
Storage:
Store at space temperature (25-30 degrees Celsius).
