Management of type 2 diabetes mellitus.
Metformin is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is different from those of sulfonylureas and it does not produce hypoglycemia. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization.
Adults : Starting dose of Comet (Metformin Hydrochloride tablet) 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. Starting dose of Comet XR (Metformin Hydrochloride extended release tablet) is 500 mg once daily with the evening meal. Dosage increases should be made in increments of 500 mg weekly, up to a maximum of 2000 mg once daily with the evening meal. If glycemic control is not achieved on Comet XR 2000 mg once daily, a trial of Comet XR 1000 mg twice daily should be considered. Pediatrics : Starting dose of Comet 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.
No information is available about the interaction of Metformin and Furosemide when co-administered chronically. Nifedipine appears to enhance the absorption of Metformin. Metformin had minimal effects on Nifedipine. Cationic drugs (e.g., Amiloride, Digoxin, Morphine, Procainamide, Quinidine, Quinine, Triamterene, Trimethoprim, or Vancomycin) that are eliminated by renal tubular secretion theoretically have the potential for interaction with Metformin by competing for common renal tubular transport systems. Metformin had no effect on Cimetidine pharmacokinetics. Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, Estrogens, Oral contraceptives, Phenytoin, Nicotinic Acid, sympathomimetics, calcium channel blocking drugs, and Isoniazid.
Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels > 1.5 mg/ dL [males], > 1.4 mg/dL [females] or abnormal creatinine clearance), Congestive heart failure requiring pharmacologic treatment, Known hypersensitivity to metformin hydrochloride, Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Pregnant mothers: Pregnancy Category B. Metformin should not be used during pregnancy unless clearly needed. Nursing mothers : Because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Diarrhea, nausea, vomiting, flatulence, asthenia, indigestion, abdominal discomfort, headache etc.
While it does cross the placenta, metformin has not been associated with an increased risk of birth defects or complications. Therefore, if you're already taking metformin before you get pregnant, your doctor may encourage you to continue using the drug throughout your pregnancy. The very limited amounts of metformin observed in breast milk are highly unlikely to lead to substantial exposure in the breastfed baby. Metformin can be considered a safe medication for the treatment of type 2 diabetes in a breastfeeding mother.
Hypoglycemia has not been seen with Metformin doses up to 85 gm, although lactic acidosis has occurred in such circumstances. Lactic acidosis is a medical emergency and must be treated in hospital. The most effective method to remove lactate and Metformin is hemodialysis.
Keep below 30°C temperature, protected from light & moisture. Keep out of the reach of children.
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