Formetin, tablets 850 mg 60 pcs

Metformin inhibits gluconeogenesis in liver, decreases glucose absorption from intestine, increases peripheral glucose utilization, and increases tissue sensitivity to insulin. At the same time it has no effect on insulin secretion by beta-cells of the pancreas and does not cause hypoglycemic reactions. It reduces the level of triglycerides and low-density lipoproteins in the blood. Stabilizes or reduces body weight. Has a fibrinolytic effect due to inhibition of tissue-type plasminogen activator inhibitor.< br>

Pharmacokinetics.
After oral administration metformin is slowly absorbed from the gastrointestinal tract. Bioavailability after a standard dose is 50-60%. Maximum plasma concentration is reached 2.5 hours after oral administration. It is practically not bound to plasma proteins. It accumulates in salivary glands, muscles, liver and kidneys. It is excreted unchanged by the kidneys. The elimination half-life is 1.5-4.5 hours. Cumulation of the preparation is possible in patients with impaired renal function.

Indications

Type 2 diabetes mellitus when diet therapy is ineffective (especially in obese patients).

Active ingredient

Composition

How to take, the dosage

The dose of the drug is set by the doctor individually, depending on the level of glucose in the blood.
Take without chewing during or after a meal, with plenty of water. The initial dose is 0.5 g 1-2 times a day or 0.85 g once a day, the dose is gradually (once a week) increased to 2-3 g a day. Maximal daily dose is 3 g.
In elderly patients the daily dose should not exceed 1 g. Because of increased risk of lactoacidosis in patients with severe metabolic disorders the drug dose should be reduced.

Interaction

Concomitant use with sulfonylurea derivatives, acarbose, insulin, nonsteroidal anti-inflammatory drugs, monoamine oxidase inhibitors, oxytetracycline, angiotensin-converting enzyme inhibitors, clofibrate derivatives, cyclophosphamide, (3-adrenoblockers may increase the hypoglycemic effect of metformin.
Concomitant use with glucocorticosteroids, oral contraceptives, epinephrine, sympathomimetics, glucagon, thyroid hormones, thiazide and “loop” diuretics, phenothiazine derivatives, nicotinic acid derivatives may reduce the hypoglycemic effect of metformin.
Cimetidine slows metformin excretion, which increases the risk of lactoacidosis.
Metformin may weaken the effect of anticoagulants (coumarin derivatives). If alcohol is taken at the same time, lactoacidosis may develop. Nifedipine increases absorption, maximum concentration, slows metformin excretion.
Cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, vancomycin) that are secreted in the tubules compete for tubule transport systems and may increase the maximum drug concentration by 60% with long-term therapy.

Special Instructions

Key kidney function should be monitored during treatment. At least twice a year, as well as in case of myalgia, plasma lactate content should be determined.
It is possible to use Formetin in combination with sulfonylurea derivatives. In this case particularly careful control of blood glucose levels is necessary.

Impact on the ability to drive vehicles and operate machinery:
When used in monotherapy Formetine does not affect the ability to drive and operate machinery.
When combining Formetin with other hypoglycemic agents (sulfonylurea derivatives, insulin, etc.) the development of hypoglycemic states is possible with which the ability to drive motor transport and to perform other potentially dangerous activities that require increased attention and quick psychomotor reactions is impaired.

Contraindications

Side effects

Digestive system disorders: nausea, vomiting, “metallic” taste in the mouth, lack of appetite, diarrhea, flatulence, abdominal pain.
Metabolism: in rare cases lactoacidosis (requires discontinuation of treatment); with long-term treatment – hypovitaminosis B12 (malabsorption).
Blood organs: in some cases – megaloblastic anemia.
Endocrine system: hypoglycemia (when used in inadequate doses).
Allergic reactions: skin rash.

Overdose

In case of metformin overdose, lactoacidosis with fatal outcome is possible. The cause of lactocidosis may also be cumulation of the drug due to renal dysfunction. Early symptoms of lactocidosis are general weakness, nausea, vomiting, diarrhea, decreased body temperature, abdominal pain, muscle pain, decreased blood pressure, reflex bradyarrhythmia, later there may be rapid breathing, dizziness, loss of consciousness and development of coma. Treatment: If signs of lactoacidosis appear, treatment with metformin should be stopped immediately, the patient should be hospitalized urgently and the lactate concentration should be determined to confirm the diagnosis. The most effective measure for elimination of lactate and metformin from the body is hemodialysis. Symptomatic treatment is also carried out.

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