P / L : Contraindication for pregnancy & lactation (breast feeding)
Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with Metformin/Metformin extended-release (XR) tablets; when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis may also occur in association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever there is significant tissue hypoperfusion and hypoxemia. Lactic acidosis is characterized by elevated blood lactate levels (>5 mmol/L), decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. When metformin is implicated as the cause of lactic acidosis, metformin plasma levels >5 µg/mL are generally found.
The reported incidence of lactic acidosis in patients receiving metformin hydrochloride is very low (approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient-years). In more than 20,000 patient-years exposure to metformin in clinical trials, there were no reports of lactic acidosis. Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications. Patients with congestive heart failure requiring pharmacologic management, in particular those with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia, are at increased risk of lactic acidosis. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient's age. The risk of lactic acidosis may, therefore, be significantly decreased by regular monitoring of renal function in patients taking Metformin and by use of the minimum effective dose of Metformin. In particular, treatment of the elderly should be accompanied by careful monitoring of renal function. Metformin treatment should not be initiated in patients â‰¥80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced, as these patients are more susceptible to developing lactic acidosis. In addition, Metformin should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis. Because impaired hepatic function may significantly limit the ability to clear lactate, Metformin should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or chronic, when taking Metformin, since alcohol potentiates the effects of metformin hydrochloride on lactate metabolism. In addition, Metformin should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure.
The onset of lactic acidosis often is subtle, and accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress. There may be associated hypothermia, hypotension, and resistant bradyarrhythmias with more marked acidosis. The patient and the patient's physician must be aware of the possible importance of such symptoms and the patient should be instructed to notify the physician immediately if they occur. Metformin should be withdrawn until the situation is clarified. Serum electrolytes, ketones, blood glucose, and if indicated, blood pH, lactate levels, and even blood metformin levels may be useful. Once a patient is stabilized on any dose level of Metformin, gastrointestinal symptoms, which are common during initiation of therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.
Levels of fasting venous plasma lactate above the upper limit of normal but less than 5 mmol/L in patients taking Metformin do not necessarily indicate impending lactic acidosis and may be explainable by other mechanisms, such as poorly controlled diabetes or obesity, vigorous physical activity, or technical problems in sample handling.
Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia).
Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking Metformin, the drug should be discontinued immediately and general supportive measures promptly instituted. Because metformin hydrochloride is dialyzable (with a clearance of up to 170 mL/min under good hemodynamic conditions), prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin. Such management often results in prompt reversal of symptoms and recovery.
Metformin hydrochloride tablets is indicated as an adjunct to diet and exercise to improve glycemic control in adults and children with type 2 diabetes mellitus. Metformin hydrochloride extended-release (XR) tablets is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Dosage & Administration
There is no fixed dosage regimen for the management of hyperglycemia in patients with type 2 diabetes with Metformin/Metformin extended-release (XR) tablets or any other pharmacologic agent. Dosage of Metformin/Metformin extended-release (XR) tablets must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily doses. The maximum recommended daily dose of Metformin tablets is 2550 mg in adults and 2000 mg in pediatric patients (10-16 years of age); the maximum recommended daily dose of Metformin tablets XR in adults is 2000 mg.
Metformin tablets should be given in divided doses with meals while Metformin tablets XR should generally be given once daily with the evening meal. Metformin/Metformin extended-release (XR) tablets should be started at a low dose, with gradual dose escalation, both to reduce gastrointestinal side effects and to permit identification of the minimum dose required for adequate glycemic control of the patient.
During treatment initiation and dose titration (see Recommended Dosing Schedule), fasting plasma glucose should be used to determine the therapeutic response to Metformin/Metformin extended-release (XR) tablets and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately 3 months. The therapeutic goal should be to decrease both fasting plasma glucose and glycosylated hemoglobin levels to normal or near normal by using the lowest effective dose of Metformin/Metformin extended-release (XR) tablets, either when used as monotherapy or in combination with sulfonylurea or insulin.
Monitoring of blood glucose and glycosylated hemoglobin will also permit detection of primary failure, i.e., inadequate lowering of blood glucose at the maximum recommended dose of medication, and secondary failure, i.e., loss of an adequate blood glucose lowering response after an initial period of effectiveness.
Short-term administration of Metformin/Metformin extended-release (XR) tablets may be sufficient during periods of transient loss of control in patients usually well-controlled on diet alone.
Metformin tablets XR tablets must be swallowed whole and never crushed or chewed. Occasionally, the inactive ingredients of Metformin tablets XR will be eliminated in the feces as a soft, hydrated mass.
Recommended Dosing Schedule
In general, clinically significant responses are not seen at doses below 1500 mg per day. However, a lower recommended starting dose and gradually increased dosage is advised to minimize gastrointestinal symptoms.
The usual starting dose of Metformin tablets (metformin hydrochloride) Tablets 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. Patients can also be titrated from 500 mg twice a day to 850 mg twice a day after 2 weeks. For those patients requiring additional glycemic control, Metformin tablets may be given to a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given 3 times a day with meals.
The usual starting dose of Metformin tablets XR (metformin hydrochloride) Extended-Release Tablets 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 Metformin tablets XR 2000 mg once daily, a trial of Metformin tablets XR 1000 mg twice daily should be considered. If higher doses of metformin are required, Metformin tablets should be used at total daily doses up to 2550 mg administered in divided daily doses, as described above.
In a randomized trial, patients currently treated with Metformin tablets were switched to Metformin tablets XR. Results of this trial suggest that patients receiving Metformin tablets treatment may be safely switched to Metformin tablets XR once daily at the same total daily dose, up to 2000 mg once daily. Following a switch from Metformin tablets to Metformin tablets XR, glycemic control should be closely monitored and dosage adjustments made accordingly
The usual starting dose of Metformin tablets 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. Safety and effectiveness of Metformin tablets XR in pediatric patients have not been established.
Transfer From Other Antidiabetic Therapy
When transferring patients from standard oral hypoglycemic agents other than chlorpropamide to Metformin/Metformin extended-release (XR) tablets, no transition period generally is necessary. When transferring patients from chlorpropamide, care should be exercised during the first 2 weeks because of the prolonged retention of chlorpropamide in the body, leading to overlapping drug effects and possible hypoglycemia.
Concomitant Metformin/Metformin extended-release (XR) tablets and Oral Sulfonylurea Therapy in Adult Patients
If patients have not responded to 4 weeks of the maximum dose of Metformin/Metformin extended-release (XR) tablets monotherapy, consideration should be given to gradual addition of an oral sulfonylurea while continuing Metformin/Metformin extended-release (XR) tablets at the maximum dose, even if prior primary or secondary failure to a sulfonylurea has occurred. Clinical and pharmacokinetic drug-drug interaction data are currently available only for metformin plus glyburide (glibenclamide).
With concomitant Metformin/Metformin extended-release (XR) tablets and sulfonylurea therapy, the desired control of blood glucose may be obtained by adjusting the dose of each drug. In a clinical trial of patients with type 2 diabetes and prior failure on glyburide, patients started on Metformin tablets 500 mg and glyburide 20 mg were titrated to 1000/20 mg, 1500/20 mg, 2000/20 mg, or 2500/20 mg of Metformin tablets and glyburide, respectively, to reach the goal of glycemic control as measured by FPG, HbA1c, and plasma glucose response However, attempts should be made to identify the minimum effective dose of each drug to achieve this goal. With concomitant Metformin/Metformin extended-release (XR) tablets and sulfonylurea therapy, the risk of hypoglycemia associated with sulfonylurea therapy continues and may be increased. Appropriate precautions should be taken. (See Package Insert of the respective sulfonylurea.)
If patients have not satisfactorily responded to 1 to 3 months of concomitant therapy with the maximum dose of Metformin/Metformin extended-release (XR) tablets and the maximum dose of an oral sulfonylurea, consider therapeutic alternatives including switching to insulin with or without Metformin/Metformin extended-release (XR) tablets.
Concomitant Metformin/Metformin extended-release (XR) tablets and Insulin Therapy in Adult Patients
The current insulin dose should be continued upon initiation of Metformin/Metformin extended-release (XR) tablets therapy. Metformin/Metformin extended-release (XR) tablets therapy should be initiated at 500 mg once daily in patients on insulin therapy. For patients not responding adequately, the dose of Metformin/Metformin extended-release (XR) tablets should be increased by 500 mg after approximately 1 week and by 500 mg every week thereafter until adequate glycemic control is achieved. The maximum recommended daily dose is 2500 mg for Metformin tablets and 2000 mg for Metformin tablets XR. It is recommended that the insulin dose be decreased by 10% to 25% when fasting plasma glucose concentrations decrease to less than 120 mg/dL in patients receiving concomitant insulin and Metformin/Metformin extended-release (XR) tablets. Further adjustment should be individualized based on glucose-lowering response.
Specific Patient Populations
Metformin/Metformin extended-release (XR) tablets are not recommended for use in pregnancy. Metformin tablets is not recommended in patients below the age of 10 years. Metformin tablets XR is not recommended in pediatric patients (below the age of 17 years).
The initial and maintenance dosing of Metformin/Metformin extended-release (XR) tablets should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment should be based on a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of Metformin/Metformin extended-release (XR) tablets. Monitoring of renal function is necessary to aid in prevention of lactic acidosis, particularly in the elderly.
Overdose of metformin hydrochloride has occurred, including ingestion of amounts greater than 50 grams. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin hydrochloride has been established. Lactic acidosis has been reported in approximately 32% of metformin overdose cases (see WARNINGS). Metformin is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected.
Metformin is contraindicated in patients with:
Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels â‰¥1.5 mg/dL [males], â‰¥1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia.
Known hypersensitivity to metformin hydrochloride.
Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin.
Metformin/Metformin extended-release (XR) tablets should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function.
Caution when used in patients with CHF especially in those with unstable or acute heart failure. Risk of lactic acid accumulation increases with the degree of renal impairment. May need to discontinue treatment in patients with stress-related states e. g. fever, trauma, infection or surgery. Metformin should be temporarily discontinued for 48 hr in patients undergoing radiologic studies involving intravascular admin of iodinated contrast materials. Elderly. Monitor renal function regularly. May impair ability to drive or operate machinery.
Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of vit B12. Chest discomfort, flushing, palpitation, chills, headache, lightheadedness, indigestion, abdominal discomfort. Potentially Fatal: Lactic acidosis in presence of renal failure and alcoholism.
Additive effect with sulphonylureas. Glycaemic control may be affected by diuretics, corticosteroids, phenothiazines, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, chlorpromazine and isoniazid. Metformin effects may be increased by ACE inhibitors, disopyramide, MAOIs. Cimetidine may increase the serum levels of metformin. Concurrent use with contrast agents may increase the risk of metformin-induced lactic acidosis. May decrease the anticoagulant effect of phenprocoumon, therefore routine anticoagulant monitoring is recommended. Potentially Fatal: Lactic acidosis with alcohol. Thrombocytopenia has been reported with ketotifen.
Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect that was not confirmed in controlled studies in women in the 1sttrimester.
Oral: Store at 20-25°C.
The exact Pharmacology of metformin is unclear but it appears to reduce glucose absorption from the GI tract, reduce gluconeogenesis and enhance insulin sensitivity by increasing peripheral glucose uptake and utilisation. Absorption: Slow and incomplete from the GI tract; reduced if taken with food. Distribution: Protein-binding: Negligible. Excretion: Urine.
A10BA02 - metformin; Belongs to the class of biguanides. Used in the treatment of diabetes.
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|BIGMET||Renata Limited||Metformin hydrochloride 500mg & 850mg||Tablet||100's each: 250.00 & 300.00 MRP|
|COMET 1G||Square Pharmaceuticals Ltd.||Metformin 1 gm||Tablet||6x5's: 210.60 MRP|
|COMET 500||Square Pharmaceuticals Ltd.||Metformin 500mg||Tablet||10x10's: 402.00 MRP|
|COMET 750||Square Pharmaceuticals Ltd.||Metformin 750mg||Tablet||6x10's: 270.60 MRP|
|COMET 850||Square Pharmaceuticals Ltd.||Metformin 850mg||Tablet||5x10's: 301.00 MRP|
|COMET XR||Square Pharmaceuticals Ltd.||Metformin 500mg||Tablet||5x10's: 301.00 MRP|
|COMET XR 1G||Square Pharmaceuticals Ltd.||Metformin 1 gm||Tablet||5x6's: 270.90 MRP|
|D-FO||Decent Pharma Laboratories Ltd.||Metformin hydrochloride 850mg||Tablet||30's: 75.00 MRP|
|DAOMIN||The Acme Laboratories Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x40's: 299.00 & 199.20 MRP|
|DEFORMIN||Zenith Pharmaceuticals Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||100's each: 150.00 & 300.00 MRP|
|DIA-M||Medimet Pharmaceuticals Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 55.00 & 125.00 MRP|
|DIA-M SR||Medimet Pharmaceuticals Ltd||Metformin hydrochloride 500mg||Tablet (sustained release)||50's: 100.00 MRP|
|DIAFRE||Mystic Pharmaceuticals Limited||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 150.00 MRP|
|ETFORM||Sandoz/Novartis||Metformin hydrochloride BP 500mg & 850mg||Tablet||500mg x 100's: MRP 200.00; 850mg x 50's: MRP 150.00|
|ETFORM 500||Sandoz/Novartis||Metformin hydrochloride BP 500mg||Tablet||10x10's, MRP 320.00|
|ETFORM 850||Sandoz/Novartis||Metformin hydrochloride BP 850mg||Tablet||5x10's, MRP 275.00|
|FORMET||Biopharma Laboratories Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 251.00 & 175.50 MRP|
|G-METFORMIN||Gonoshasthaya Pharmaceuticals Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||30's each: 48.00 & 75.00 MRP|
|G-PHASE||Edruc Limited||Metformin hydrochloride 850mg||Tablet||30's: 90.00 MRP|
|GLIMET-850||Millat Pharmaceuticals Ltd||Metformin hydrochloride 850mg||Tablet||30's: 120.00 MRP|
|GLUCOMET||Aristopharma Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 300.00 & 200.00 MRP|
|GLUCOMET 500 XR||Aristopharma Ltd.||Metformin hydrochloride 500mg||Tablet||50's: 250.00 MRP|
|GLUCOMET 750 XR||Aristopharma Ltd.||Metformin hydrochloride 500mg||Tablet||30's: 210.00 MRP|
|GLUNOR||Eskayef Bangladesh Ltd||Metformin hydrochloride BP 500mg & 850mg||Tablet||50's each, MRP: 100.00 & 150.00|
|GLUNOR XR||Eskayef Bangladesh Ltd||Metformin hydrochloride BP 500mg||Tablet (extended release)||50's MRP: 200.00|
|GLUPHAGE XR||Silva Pharmaceuticals Limited||Metformin hydrochloride 400mg||Tablet (extended release)||50's: 185.69 MRP|
|GLYMIN 500||Healthcare Pharmacuticals Ltd.||Metformin Hydrochloride BP 500mg||Tablet||50's MRP 150 Tk|
|GLYMIN 850||Healthcare Pharmacuticals Ltd.||Metformin Hydrochloride BP 850mg||Tablet||40's MRP 160 Tk|
|GLYMIN XR||Healthcare Pharmacuticals Ltd.||Metformin Hydrochloride BP 500mg||Tablet||50's MRP 250 Tk|
|GUAMIN||Ad-din pharmaceuticals Ltd.||Metformin hydrochloride 850mg||Tablet||50's: 150.00 MRP|
|HI-MET||Hudson Pharmaceuticals Ltd||Metformin hydrochloride 850mg||Tablet||100's: 300.00 MRP|
|INFO||Bristol Pharma Limited||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 100.00 & 150.00 MRP|
|INFORMAT LA||Beximco Pharmaceuticals Ltd||Metformin Hydrochloride BP 500mg||Tablet||100's: 500.00 MRP|
|INFORMET 500||Beximco Pharmaceuticals Ltd||Metformin Hydrochloride BP 500mg||Tablet||100's: 300.00 MRP|
|INFORMET 850||Beximco Pharmaceuticals Ltd||Metformin Hydrochloride BP 850mg||Tablet||60's: 270.00 MRP|
|INSIMET||IBN SINA Pharmaceutical Industry Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 300.00, 200.00 IP|
|KEMIN||Kemiko Pharmaceuticals Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 125.00 & 200.00 MRP|
|M-MIN||Sharif Pharmaceuticals Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x50's, 850mg x30's: 150.00 & 135.00 MRP|
|MEFOREX||Jayson Pharmaceuticals Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x50's, 850mg x30's: 55.00, 75.30 IP|
|MEFORIN||R A K Pharmaceuticals Pvt. Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 100.00 & 200.00 MRP|
|MEFORIN XR||R A K Pharmaceuticals Pvt. Ltd.||Metformin hydrochloride 500mg||Tablet (extended release)||30's: 150.00 MRP|
|MEGLU||Unimed & Unihealth Manufacturers Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||30's each: 90.00 & 120.00 MRP|
|MEGLU ER-500||Unimed & Unihealth Manufacturers Ltd.||Metformin hydrochloride 500mg||Tablet (extended release)||30's: 150.00 MRP|
|MET||Opsonin Pharma Limited||Metformin hydrochloride 500mg & 850mg||Tablet||30's each: 60.00 & 90.00 MRP|
|MET 500 XR||Opsonin Pharma Limited||Metformin hydrochloride 500mg||Tablet (extended release)||50's: 200.00 MRP|
|MET 750 XR||Opsonin Pharma Limited||Metformin hydrochloride 750mg||Tablet (extended release)||30's: 180.00 MRP|
|METARIN||Popular Pharmaceuticals Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||30's each: 75.29 & 120.62 MRP|
|METFAR||The White Horse Pharma||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 150.00 & 200.00 MRP|
|METFAR SR||The White Horse Pharma||Metformin hydrochloride 500mg||Tablet (sustained release)||30's: 120.00 MRP|
|METFAST ER 500||Aexim Pharmaceutical Ltd.||Metformin hydrochloride 500mg||Tablet (extended release)||50's: 200.00 MRP|
|METFEN||Doctors Chemical Works Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 250.00 & 175.00 MRP|
|METFO||Pacific Pharmaceuticals Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x50's:149.00; 850mg x30's & 100's: 148.00 & 496.00 MRP|
|METFO XR 500||Pacific Pharmaceuticals Ltd.||Metformin hydrochloride 500mg||Tablet (extended release)||30's: 180.00 MRP|
|METFORM||ACI Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 201.00 MRP|
|METFORM ER 1000||ACI Ltd.||Metformin hydrochloride 1,000mg||Tablet (extended release)||32's: 224.96 MRP|
|METIN||Supreme Pharmaceuticals Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x50's, 850mg x30's: 75.00 & 90.00 MRP|
|METLIFE||Silva Pharmaceuticals Limited||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 301.14 & 200.75 MRP|
|METMIN||Alco Pharma Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x50's, 850mg x100's: 100.00 & 300.00 MRP|
|METNIL||Medicon Laboratories Ltd||Metformin hydrochloride 500mg||Tablet||100's: 200.00 MRP|
|METOMIN||Somatec Pharmaceuticals Ltd.||Metformin hydrochloride 850mg||Tablet||50's: 125.50 MRP|
|METSA||Sanofi||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 299.99 & 250.00 MRP|
|Nobesit 500||Incepta Pharmaceuticals Limited||Metformin Hydrochloride BP 500mg||Tablet||15x4's:MRP 180 Tk|
|Nobesit 850||Incepta Pharmaceuticals Limited||Metformin Hydrochloride BP 850mg||Tablet||15x4's:MRP 270 Tk|
|Nobesit XR 500||Incepta Pharmaceuticals Limited||Metformin Hydrochloride BP 500mg||Tablet||10x5's:MRP 250 Tk|
|NV MET||Navana Pharmaceuticals Limited||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 150.00 & 200.00 MRP|
|NV MET-500 SR||Navana Pharmaceuticals Limited||Metformin hydrochloride 500mg||Tablet (sustained release)||50's: 200.00 MRP|
|OBEMET||Euro Pharma Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 200.00 MRP|
|OBID||Delta Pharma Limited||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x30's: 200.00 & 90.00 MRP|
|ORAMET||Drug International Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||100's each: 300.00 & 400.00 MRP|
|ORAMET-SR||Drug International Ltd||Metformin hydrochloride 500mg||Tablet (sustained release)||50's: 250.00 MRP|
|ORMIN||Orion Pharma Ltd.||Metformin hydrochloride 500mg & 850mg||Tablet||50's each: 100.50 & 150.50 MRP|
|P-MIN||Pharmadesh Laboratories Limited||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x30's: 250.00 & 105.30 MRP|
|PREFORM-850||Apex Pharmaceuticals Ltd.||Metformin hydrochloride 850mg||Tablet||100's: 250.00 MRP|
|PREFORM-SR||Apex Pharmaceuticals Ltd.||Metformin hydrochloride 500mg||Tablet (sustained release)||50's: 200.00 MRP|
|RUZMET||Amico Laboratories Ltd.||Metformin hydrochloride 500mg||Tablet||30's: 90.00 MRP|
|SUCOMET||Globe Pharmaceuticals Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||500mg x100's, 850mg x50's: 100.00 & 150.00 MRP|
|SUGAMET||General Pharmaceuticals Ltd||Metformin hydrochloride 500mg & 850mg||Tablet||100's each: 251.00 & 160.80 MRP|
Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you are over 80 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment) or coma; or heart, kidney, or liver disease.
Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover.
If you are having surgery, including dental surgery, any x-ray procedure in which dye is injected, or any major medical procedure, tell the doctor that you are taking metformin. You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Your doctor will tell you exactly when you should stop taking metformin and when you should start taking it again.
If you experience any of the following symptoms, stop taking metformin and call your doctor immediately: extreme tiredness, weakness, or discomfort; nausea; vomiting; stomach pain; decreased appetite; deep and rapid breathing or shortness of breath; dizziness; lightheadedness; fast or slow heartbeat; flushing of the skin; muscle pain; or feeling cold.
Tell your doctor if you regularly drink alcohol or sometimes drink large amounts of alcohol in a short time (binge drinking). Drinking alcohol increases your risk of developing lactic acidosis or may cause a decrease in blood sugar. Ask your doctor how much alcohol is safe to drink while you are taking metformin.
Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests to check your body's response to metformin. Talk to your doctor about the risk(s) of taking metformin.
Why is this medication prescribed?
Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood).
How should this medicine be used?
Metformin may come as a tablet, and an extended-release (long-acting) tablet or a liquid to take by mouth. The liquid is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow metformin extended-release tablets whole; do not split, chew, or crush them. Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1â€“2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.
Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor.
Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor for more information.
- tell your doctor if you are allergic to metformin, any of the ingredients of metformin liquid or tablets, or any other medications. Ask your check the manufacturer's patient information for a list of the ingredients.
- tell your doctor what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetazolamide; amiloride; angiotensin-converting enzyme inhibitors such as benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril; beta-blockers such as atenolol, labetalol, metoprolol, nadolol, and propranolol; calcium channel blockers such as amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimodipine, nisoldipine, and verapamil; cimetidine; digoxin; diuretics; furosemide; hormone replacement therapy; insulin or other medications for diabetes; isoniazid; medications for asthma and colds; medications for mental illness and nausea; medications for thyroid disease; morphine; niacin; oral contraceptives; oral steroids such as dexamethasone, methylprednisolone, and prednisone; phenytoin; procainamide; quinidine; quinine; ranitidine; topiramate; triamterene; trimethoprim; vancomycin; or zonisamide . Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had any medical condition, especially those mentioned in the IMPORTANT WARNING section.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking metformin, consult your doctor.
- tell your doctor if you eat less or exercise more than usual. This can affect your blood sugar. Your doctor will give you instructions if this happens.
What special dietary instructions should I follow?
Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet.
What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
What side effects can this medication cause?
This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms.
Metformin may cause side effects. Tell your doctor if any of these symptoms are severe, do not go away, go away and come back, or do not begin for some time after you begin taking metformin:
unpleasant metallic taste in mouth
flushing of the skin
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency treatment:
Some female laboratory animals given high doses of metformin developed non-cancerous polyps (abnormal growths of tissue) in the uterus (womb). It is not known if metformin increases the risk of polyps in humans. Talk to your doctor about the risks of taking this medication.
Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat, and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed.
In case of emergency/overdose
In case of overdose, consult your local doctor. If the victim has collapsed or is not breathing, consult local emergency medical services.Symptoms of overdose may include hypoglycemia symptoms as well as the following:
deep, rapid breathing
shortness of breath
abnormally fast or slow heartbeat
flushing of the skin
- muscle pain
- feeling cold
What other information should I know?
Your doctor will tell you how to check your response to this medication by measuring your blood sugar levels at home. Follow these instructions carefully.
If you are taking the extended-release tablets, you may notice something that looks like a tablet in your stool. This is just the empty tablet shell, and this does not mean that you did not get your complete dose of medication.
You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency. Do not let anyone else take your medication.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Ref: MedlinePlus, U.S. Natl. Library of Medicine
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.
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