Metformin is an oral hypoglycemic drug for the treatment of diabetes.
Release form and composition
Metformin dosage form - enteric-coated tablets: round, convex on both sides (500 mg - 10 pieces in blisters, 3, 5, 6, 10 or 12 blisters in packs of cardboard; 15 pieces in blisters, 2, 4 or 8 blisters in packs of cardboard, 850 and 1000 mg - 10 pieces in blisters, 3, 5, 6, 10 or 12 blisters in packs of cardboard).
The composition of the drug:
- Active ingredient: Metformin hydrochloride - 500, 850 or 100 mg in 1 tablet;
- Auxiliary components: crospovidone, corn starch, magnesium stearate, povidon K90, talc.
The composition of the shell: macrogol 6000, talc, titanium dioxide, Eudragit L 100-55 (methacrylic acid and methyl methacrylate copolymer).
Indications for use
As a single agent, Metformin is prescribed to patients with type 2 diabetes mellitus without a tendency to ketoacidosis with poor diet therapy (especially for patients suffering from obesity).
In combination with insulin, the drug is used in diabetes mellitus type 2, which is accompanied by secondary insulin resistance (especially in patients with severe obesity).
- Diabetic ketoacidosis or precoma, as well as coma;
- Acute and chronic diseases accompanied by clinically pronounced manifestations that can lead to the development of tissue hypoxia, such as acute myocardial infarction, respiratory or heart failure;
- Impaired renal function;
- Acute diseases that can lead to impaired renal function: hypoxia (sepsis, shock, bronchopulmonary diseases, renal infections), serious infectious diseases, fever, dehydration (with diarrhea or vomiting);
- Acute alcohol poisoning, chronic alcoholism;
- Impaired liver function;
- Lactic acidosis currently or in history;
- Serious surgery and trauma in cases where insulin therapy is indicated;
- Compliance with a low-calorie diet (less than 1000 calories / day);
- Use at least within 2 days before and 2 days after conducting radiological or radioisotope studies with the introduction of iodine-containing contrast material;
- Hypersensitivity to the drug.
Metformin is not recommended for people over 60 years old who perform heavy physical work, because they have a high risk of developing lactic acidosis.
Dosing and Administration
The drug should be taken orally, swallowing the pill whole and squeezed them with a glass of water, during meals or immediately after a meal.
The doctor sets a specific dose individually for each patient, based on the data of the analysis of the level of glucose in the blood.
The initial dose for adults is 500 mg from 1 to 3 times a day, or 850 mg 1-2 times a day. If necessary, with a 1-week intervals, the dose is gradually increased, up to 2000-3000 mg. The maximum allowable daily intake for elderly patients is 1000 mg.
The initial dose for children older than 10 years is 500 or 850 mg 1 time per day or 500 mg 2 times per day. If necessary, with a 1-week intervals, the daily dose is gradually increased, up to 2000 mg in 2-3 doses.
10-15 days after the start of treatment, a study is conducted to determine the level of glucose in the blood and, if necessary, adjust the dose.
A dose reduction is required for patients with severe metabolic disorders (due to the risk of developing lactic acidosis).
When conducting combination therapy, the dose of Metformin is 500-850 mg 2-3 times a day. The dose of insulin is selected individually depending on the level of glucose in the blood.
- Allergic reactions: skin rash;
- Digestive system: metallic taste in the mouth, nausea, lack of appetite, flatulence, diarrhea, abdominal pain, vomiting (most often these symptoms occur at the beginning of treatment, but usually go away on their own; reduce their manifestation by prescribing antispasmodics, antacids or atropine derivatives);
- Endocrine system: hypoglycemia;
- Hematopoietic organs: in individual cases - megaloblastic anemia;
- Metabolism: rarely - lactacidosis; with prolonged use - hypovitaminosis B12.
The entire period of treatment with Metformin should monitor kidney function, at least 2 times a year, as well as the development of myalgia to determine the content of lactate in the blood plasma. In addition, every six months is necessary to control the level of creatinine in the blood serum (especially in the elderly). If this figure exceeds 110 µmol / l in women and 135 µmol / l in men, the drug should be discontinued.
If necessary, Metformin can be used in combination with sulfonylurea derivatives, but in this case the concentration of glucose in the blood should be carefully controlled.
If you have an infectious disease of the urogenital system or a bronchopulmonary infection, you should immediately consult a doctor.
Patients undergoing treatment with this drug are advised to refrain from drinking alcohol and taking medications containing ethanol.
If necessary, a radiopaque study (urography or intravenous angiography) should cancel Metformin for 48 hours and not take it within 48 hours after the study.
Metformin, used as a monodrug, does not affect the reaction rate and ability to concentrate. However, in the case of the additional use of other hypoglycemic agents (insulin or sulfonylurea derivatives), there is a likelihood of developing hypoglycemic states in which attention may be disturbed and the reaction rate may decrease.
During treatment with metformin, danazol is not recommended because With such a combination, the development of the hyperglycemic action of the latter is possible. If such a need nevertheless arises, the entire period of use of danazol and after its cancellation should be monitored dose of metformin hydrochloride, depending on the level of glycemia. The same goes for neuroleptics.
Chlorpromazine used in high doses (100 mg per day) simultaneously reduces insulin release and thus increases glycemia, so this combination should be administered with extreme caution.
Sulfonylurea derivatives, monoamine oxidase inhibitors, clofibrate derivatives, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, insulin, acarbose, beta-adrenoblockers, cyclophosphamide can enhance the hypoglycemic effect of metformin.
Glucocorticosteroids, oral contraceptives, epinephrine, sympathomimetics, thyroid hormones, glucagon, thiazide and loop diuretics, nicotinic acid derivatives, phenothiazine derivatives can reduce the hypoglycemic effect of metformin.
Cimetidine slows down the elimination of metformin, which increases the risk of lactic acidosis. The same is possible when taking ethanol during acute alcohol intoxication, especially in patients with liver failure, starving or following a low-calorie diet of people.
Metformin can reduce the effect of anticoagulants derived from coumarin.
Terms and conditions of storage
Store at a temperature of 15-25 ° C in a place protected from light and moisture, inaccessible to children.
Shelf life - 3 years.