Generic

Metformin Hydrochloride

Indications

Treatment of type 2 diabetes mellitus, especially in overweight patients, when nutrition and exercise alone are unable to provide optimal glycemic control.

• Metformin can be used alone or in conjunction with other oral antidiabetic drugs or insulin in adults.
• Metformin can be administered alone or in conjunction with insulin in children and adolescents as young as ten years old.

In overweight type 2 diabetes adult patients treated with metformin as first-line therapy following diet failure, there was a reduction in diabetic complications.

Pharmacology

Metformin is an antihyperglycemic medication of the biguanide class that is used to treat type 2 diabetes. Both baseline and postprandial plasma glucose levels are reduced. It has a different mode of action than sulfonylureas and does not cause hypoglycemia. Metformin enhances insulin sensitivity by increasing peripheral glucose uptake and utilization. It lowers hepatic glucose production, lowers intestinal glucose absorption, and lowers hepatic glucose production.

Dosage & Administration

Metformin Hydrochloride Dosage: Metformin Hydrochloride dosage should be tailored based on effectiveness and tolerance, while not exceeding the maximum suggested daily doses.

• Adults: Metformin is usually started at 500 mg twice a day or 850 mg once a day, with meals. Increases in dosage should be made in 500 mg weekly increments or 850 mg every two weeks, up to a maximum of 2000 mg per day, given in divided doses. Glucomin can be given at a maximum daily dose of 2550 mg per day to patients who need more glycemic control. Doses greater than 2000 mg may be tolerated better if taken three times a day with meals.
• Metformin 500 mg twice a day, with meals, is the usual starting dose for children. Increases in dosage should be done in 500 mg weekly increments up to a maximum of 2000 mg per day, given in divided doses.

Metformin extended-release tablet should be swallowed whole, without being crushed, chopped, or chewed.

• Adults should take 500 mg of Metformin XR once a day with their evening meal. Dose should be raised in 500 mg weekly increments up to a maximum of 2000 mg once day with the evening meal, or 1000 mg twice daily with supper as an option.
• Up to the maximum recommended daily dose, patients on Metformin instant release tablet may be switched to Metformin extended release tablet.
• Children have not been investigated with metformin extended release pill.
• Patients with an eGFR of less than 30 mL/min/1.73 m2 should not use Metformin. If the eGFR falls below 45 mL/min/1.73 m2, weigh the risks and benefits of counting.

Interactions

Carbonic anhydrase (Topiramate, Zonisamide) co-administration may raise the risk of lactic acidosis. Drugs that inhibit Metformin clearance (Ranolazine, Dolutegravir, Cimetidine) may cause Metformin buildup. Metformin’s effect on lactate metabolism can be amplified by alcohol.

Contraindications

• Hypersensitivity to the active ingredient or any excipient.
• Acute metabolic acidosis of any kind (such as lactic acidosis, diabetic ketoacidosis).
• Renal failure with a GFR of less than 30 mL/min.
• Dehydration, severe infection, and shock are examples of acute diseases that might affect renal function.
• Acute or chronic diseases, such as cardiac or respiratory failure, recent myocardial infarction, shock, hepatic insufficiency, acute alcohol intoxication, and alcoholism, can produce tissue hypoxia.

Side-Effects

Disorders of the circulatory and lymphatic systems: The following is unknown: Hemolytic anemia is a kind of anemia in which the red blood cells

Disorders of metabolism and nutrition: Lactic acidosis is a very unusual condition. During long-term metformin treatment, there is a decrease in vitamin B12 absorption along with a fall in serum levels. If a patient comes with megaloblastic anemia, such an etiology should be considered. In post-marketing experience, cases of peripheral neuropathy in patients with vitamin B12 insufficiency have been observed (frequency not known).

Taste disturbance is a common nervous system condition. The following is unknown: Encephalopathy

Gastrointestinal issues, such as nausea, vomiting, diarrhea, stomach pain, and loss of appetite, are extremely prevalent. These side effects are most common during the first few weeks of treatment and usually go away on their own.

Metformin should be taken in two or three daily doses during or after meals to prevent them. A gradual increase in dose may also help with gastrointestinal toleration.

Isolated cases of liver function test problems or hepatitis resolving after metformin cessation are extremely rare.

Disorders of the skin and subcutaneous tissue: Extremely uncommon: Reactions to the skin, including erythema, pruritus, urticaria.

Pregnancy

Uncontrolled diabetes (gestational or permanent) during pregnancy is linked to a higher risk of congenital malformations and perinatal mortality. When the patient intends to become pregnant, as well as when she is pregnant, Diabetes should not be treated with metformin; instead, insulin should be used to keep blood glucose levels as close to normal as possible, reducing the risk of foetal abnormalities.

Precautions

Metformin Hydrochloride is known to be eliminated in large amounts through the kidneys, and the danger of Metformin buildup and lactic acidosis increases as renal function declines. Metformin has been linked to a reduction in vitamin B12 levels. When combined with insulin or an insulin secretagogue, it raises the risk of hypoglycemia.

Therapeutic Class

Biguanides

Storage Conditions

Keep the temperature below 30°C and keep it away from light and moisture. Keep out of children’s reach.

Pharmaceutical Name

Opsonin Pharma Ltd.