Metfor XR Dosage/Direction for Use

500 mg: Posology: Adults with normal renal function (GFR ≥90 mL/min): Risk reduction or delayed onset of type 2 diabetes: Metformin should only be used where thorough lifestyle modifications for 3 to 6 months have not caused sufficient glycemic control.
The therapy should be introduced with one tablet Metformin Hydrochloride Extended Release Tablets 500 mg once daily with the evening meal.
After 10 to 15 days, dose adjustment based on blood glucose measurements is advised (OGTT and/or FPG and/or HbA1C values to be within the normal range). Improvement in gastrointestinal tolerability may happen with gradual increase of dose. The maximum recommended dose is 4 tablets (2000 mg) once daily with the evening meal.
It is recommended to monitor regularly (probably every 3-6 months) the glycemic status (such as OGTT and/or FPG and/or HbA1c value) as well as the risk factors to assess if the treatment needs to be continued, modified, or discontinued.
A conclusion to re-evaluate therapy is also required if the patient consequently applies improvements to diet and/or exercise, or if alterations to the medical condition will allow increased lifestyle interferences to be possible.
Monotherapy in Type 2 diabetes mellitus and combination with other oral antidiabetic agents: The usual starting dose is one tablet of Metformin Hydrochloride Extended Release Tablets 500 mg once daily.
After 10 to 15 days the dose should be adjusted based on blood glucose measurements. Improvement in gastrointestinal tolerability may happen with gradual increase of dose. The maximum recommended dose is 4 tablets daily.
Increase in dosage should be made in increments of 500 mg every 10-15 days, up to a maximum of 2000 mg once daily with the evening meal. If control in glycemic activity is not achieved on Metformin Hydrochloride Extended Release Tablets 2000 mg once daily, Metformin Hydrochloride Extended Release Tablets 1000 mg twice daily should be contemplated, with both doses given with food. If glycemic control is still not reached, patients may be changed to standard metformin tablets with a maximum dose of 3000 mg daily.
In patients who started to use metformin tablets, the starting dose of Metformin Hydrochloride Extended Release Tablets should be equivalent to the daily dose of metformin immediate release tablets. In patients who started to use metformin at a dose above 2000 mg daily, switching to Metformin Hydrochloride Extended Release Tablets is not advised.
If transfer from another oral antidiabetic agent is anticipated: discontinue the other agent and initiate Metformin Hydrochloride Extended Release Tablets at the dose indicated previously.
Metformin Hydrochloride Extended Release Tablets 750 mg and 1000 mg are intended for patients who are already treated with metformin tablets (extended or immediate release).
The dose of Metformin Hydrochloride Extended Release Tablets 750 mg or 1000 mg should be equivalent to the daily dose of metformin tablets (extended or immediate release), up to a maximum dose of 1500 mg or 2000 mg respectively, given with the evening meal.
Combination with insulin: Metformin and insulin may be used concomitantly to achieve better blood glucose control. The usual starting dose of Metformin Hydrochloride Extended Release is one 500 mg tablet once daily, while insulin dosage is adjusted based on blood glucose measurements.
For patients already treated with metformin and insulin concomitantly, the dose of Metformin Hydrochloride Extended Release Tablets 750 mg or 1000 mg should be equivalent to the daily dose of metformin tablets maximum of 1500 mg or 2000 mg respectively, given with the evening meal, while insulin dosage is adjusted based on blood glucose measurements.
Elderly: Due to the potential for decreased renal function, the metformin dosage should be modified based on renal function. Regular assessment of renal function is required. Benefit in the risk reduction or delayed onset of type 2 diabetes mellitus has not been proven in patients 75 years and older and metformin initiation is therefore not advised in these patients.
Renal impairment: A GFR should be evaluated before initiation of treatment with metformin containing products and at least annually subsequently. In patients with an increased risk of further progression of renal impairment and in the elderly, renal function should be reviewed more often (every 3-6 months). (See table.)

Click on icon to see table/diagram/image

Pediatric population: In the absence of sufficient data, Metformin Hydrochloride Extended Release Tablets should not be used in children.
750 mg: Extended-Release Tablet: Adult Dose: Monotherapy and combination with other oral hypoglycemic agents: The usual starting dose is 750 mg given with evening meals. Maximum dose of up to 1500 mg given with evening meals. After 10 to 15 days, it is recommended to check if the dose given to the patient is adequate on the basis of blood glucose measurement.
Combination with Insulin: For patients treated with combination therapy of metformin and insulin, metformin dose 750 mg with evening meals, up to a maximum dose of 1500 mg given with evening meals. Insulin dosage is adjusted on the basis of blood glucose measurement of the patient.