Metfor PR 1000

Reduction in the risk or delay of onset of type 2 DM in adult, overwt patients w/ IGT &/or IFG, &/or increased HbA_1c who are at high risk for developing overt type 2 DM & still progressing towards type 2 DM despite implementation of intensive lifestyle change for 3-6 mth. Type 2 DM in adults, particularly in overwt patients, when dietary management & exercise alone does not result in adequate glycaemic control. Monotherapy or in combination w/ other oral antidiabetic agents or insulin.

Adult w/ normal renal function (GFR >90 mL/min) Reduction in the risk or delay of onset of type 2 DM Initially 1 tab of 500 mg once daily. After 10-15 days, adjust dose based on blood glucose measurements. Max: 4 tab (2,000 mg) once daily. Monotherapy & combination w/ oral antidiabetic agents Initially 1 tab of 500 mg once daily, may be increased in increments of 500 mg every 10-15 days up to max of 2,000 mg once daily. If glycaemic control is not achieved on 2,000 mg once daily, consider Metfor PR 1000 tab 1,000 mg bid. If glycaemic control is still not achieved, may be switched to standard metformin tab to a max dose of 3,000 mg daily. Patient already treated w/ metformin Initially equiv to daily dose of metformin IR tab. Transfer from another oral antidiabetic agent Discontinue other agent & initiate Metformin HCl PR tab as indicated. Combination w/ insulin Initially 500 mg once daily, adjust insulin based on blood glucose measurements. Patient already treated w/ metformin & insulin in combination therapy Dose of Metformin HCl SR 750 mg & 1,000 mg tab should be equiv to daily dose of metformin up to max of 1,500 mg or 2,000 mg, respectively, while adjust insulin dosage based on blood glucose measurements.

Should be taken with food: Taken with evening meal.

Hypersensitivity. Any type of acute metabolic acidosis (eg, lactic acidosis, diabetic ketoacidosis). Diabetic pre-coma. Disease which may cause tissue hypoxia (especially acute disease, or worsening of chronic disease) eg, decompensated heart failure, resp failure, recent MI, shock. Severe renal failure (GFR <30 mL/min). Acute conditions w/ potential to alter renal function eg, dehydration, severe infection, shock. Hepatic insufficiency, acute alcohol intoxication, alcoholism.

Temporarily discontinue in case of dehydration (severe diarrhoea or vomiting, fever or reduced fluid intake). Temporarily discontinue in the presence of conditions that alter renal function. Discontinue use prior to or at the time of intravascular administration of iodinated contrast agents & not to be restarted until at least 48 hr after, provided that renal function has been re-evaluated & found to be stable. Discontinue at the time of surgery under general, spinal or epidural anaesth. May be restarted no earlier than 48 hr following surgery or resumption of oral nutrition & provided that renal function has been re-evaluated & found to be stable. Risk of lactic acidosis. Risk of hypoxia & renal insufficiency in patients w/ heart failure. Regular monitoring of cardiac & renal function in patients w/ stable chronic heart failure. Contraindicated in patients w/ acute & unstable heart failure. Patient should continue the diet w/ regular distribution of carbohydrate intake during the day. Overwt patients should continue the energy-restricted diet. Assess GFR before treatment initiation & regularly thereafter. Regularly perform usual lab tests for diabetes monitoring. Caution in combination w/ insulin or other oral antidiabetics (eg, sulphonylureas or meglitinides). Impaired glycaemic control or diabetes should not be treated w/ metformin when patient plans to become pregnant & during pregnancy. Not recommended during breastfeeding. Not recommended in patients ≥75 yr. Not to be used in childn.

GI disorders eg, nausea, vomiting, diarrhoea, abdominal pain & loss of appetite. Taste disturbance.

Increased risk of lactic acidosis w/ alcohol; medicinal products that can adversely affect renal function (eg, NSAIDs, including selective COX II inhibitors, ACE inhibitors, AIIA & diuretics, especially loop diuretics). More frequent blood glucose monitoring may be required especially at the beginning of treatment w/ medicinal products w/ intrinsic hyperglycaemic activity [(eg, glucocorticoids (systemic & local routes) & sympathomimetics)]; May reduce efficacy w/ OCT1 inhibitors. May increase GI absorption & efficacy w/ OCT1 inducers. Increased plasma conc w/ OCT2 inhibitors (eg, cimetidine, dolutegravir, ranolazine, trimethoprim, vandetanib, isavuconazole). May alter efficacy & renal elimination w/ OCT1 & OCT2 inhibitors (eg, crizotinib, olaparib).

Antidiabetic Agents

A10BA02 - metformin ; Belongs to the class of biguanides. Used in the treatment of diabetes.

Rx