Metforshin 850
Metformin
Indication
Metformin is indicated as the first line drug for type 2 diabetes. It is used as monotherapy or in combination with other antidiabetic agents in patients with type 2 diabetes who cannot be controlled by diet or if patient is overweighed. It is useful in the prevention of type 2 diabetes in middle-ag...
Dosage and Administration
Children (10 - 19 years):
Initial dose: 500 mg or 850 mg, once daily Maximum dose: 2 g daily in 2 or 3 divided dose.
Treatment of children between 10 to 12 years is only recommended on specific advice from physician, as experience in this age group is limited.
Adult:
Initial dose: 500 mg or 850 mg, 2 or 3 times daily Maximum dose (GFR > 60 mL/min): 3 g daily in 2 or 3 divided dose
Maximum dose (GFR 45 to 59 mL/min): 2 g daily in 2 or 3 divided dose
Maximum dose (GFR 30 to 44 mL/min): 1 g daily in 2 or 3 divided dose.
It should be taken during or after meals.
Dose should be adjusted on the basis of blood glucose measurements after 10 to 15 days. A slow increase of dose may improve gastrointestinal tolerability.
Composition
Each film-coated caplet contains:
Metformin Hydrochloride B.P ... 850 mg.
Description
Metformin hydrochloride tablet is an oral anti-hyperglycemic drug used in the management of non-insulin dependent diabetes mellitus. Chemically, it is (I, I-dimethyl biguanide hydrochloride) and its empirical formula is C4H12N5C I. Molecular weight is 165.62.
Clinical Pharmacology
The primary effect of metformin is to activate enzyme AMP-activated protein kinase and reduce hepatic glucose production. Metformin acts the following three mechanisms:
Increase peripheral utilization of glucose
Inhibit hepatic gluconeogenesis
Reduce absorption of glucose from the intestine.
Metformin can decrease body weight in some patients. Patients with type 2 diabetes have considerably less fasting hyperglycemia as well as lower postprandial hyperglycemia after administration of biguanides; however, hypoglycemia is rare. These agents are more approximately termed euglycemic agents.
Pharmacokinetics
It is absorbed mainly from the small intestine. Food decreases rate and extent of absorption. Metformin does not bound to plasma protein, not metabolized and its half-life is 1.5 - 3 hours. It is excreted by the kidney as the active compound. As a consequence of blockage of gluconeogenesis, metformi...
Contraindication
Metformin is contraindicated in patients who have the following conditions:
Diabetes coma and ketoacidosis
Impairment of liver and renal function
Chronic liver disease
Cardiac failure
Recent myocardial infarction Alcoholism (acute or chronic)
Hypoxaemia condition
History of lactic acidosis eg. shock or pulmonary insufficiency.
Precaution
Metformin is excreted by the kidney therefore regular monitoring of renal function should be advised in all diabetes patients. Metformin hydrochloride extended release alone does not cause hypoglycemia but occur with calorie intake is deficient or concomitant use with hypoglycemic agents (sulphonylu...
Adverse Effects
Common effects are gastrointestinal disturbances (anorexia, nausea, vomiting, metallic taste, abdominal discomfort and diarrhea) but it can be minimized by starting at low dose and slowly titrating the dose upward with food. It may have to be discontinued in 3 - 5% of patients because of persistent ...
Drug Interaction
Increased Effect/ Toxicity: Frusemide and cimetidine may increase metformin blood levels. Cationic drugs (eg. Amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim and vancomycin) which are eliminated by renal tubular secretion have the potential to in...
Decreased effect: Drugs which tend to produce hyperglycemic (e.g. Diuretics, corticosteroids, phenothiazine, thyroid products, estrogens, oral contraceptive, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid) may lead to a loss of glucose control.
Ethanol: Avoid or limit ethanol (may cause hypoglycemia).
Food: Food may decrease the extent and slightly delay absorption; may decrease absorption of vitamin B12 and folic acid.
Herb/ Nutraceuticals: Caution with Chromium, garlic, gymnema (may cause hypoglycemia).
Storage
Store below 30°C in cool, dry place. Protect from light and moisture. Keep out of reach and sight of children.
Presentation
10 x 10’s Blisters.