Metformin, 1000 mg 60 pcs
€5.79 €5.15
Pharmacotherapeutic group: Hypoglycemic drug of oral biguanide group.
ATX code: A10BA02
Pharmacological properties
.Pharmacodynamics
Metformin reduces hyperglycemia without leading to hypoglycemia. Unlike sulfonylurea derivatives, it does not stimulate insulin secretion and has no hypoglycemic effect in healthy individuals. Increases the sensitivity of peripheral receptors to insulin and glucose utilization by cells. Inhibits gluconeogenesis in the liver, delays carbohydrate absorption in the intestine. Stimulates glycogen synthesis by activating glycogen synthase. Increases the transport capacity of all types of membrane glucose transporters.
In addition, it has favorable effects on lipid metabolism: it reduces the levels of total cholesterol, low-density lipoproteins and triglycerides.
By taking metformin, a patient’s body weight either remains stable or decreases moderately.
Pharmacokinetics
Absorption<
Metformin is rapidly absorbed in the gastrointestinal tract (GIT). Absolute bioavailability is 50-60%. Maximum concentration (Cmax) in blood plasma is approximately 2 µg/ml. Time to reach Cmax is 2.5 h. Absorption of metformin is decreased and delayed with concomitant food intake.
Distribution
Metformin is rapidly distributed in tissues, almost does not bind to plasma proteins.
Metabolism and excretion
It is metabolized to a very low degree and excreted by the kidneys. Metformin clearance in healthy subjects is 400 ml/min (4 times greater than creatinine clearance), indicating the presence of active tubular secretion. The elimination half-life (T1/2) is about 6.5 h.
Pharmacokinetics in special groups of patients
In patients with renal impairment the T1/2 increases, there is a risk of metformin cumulation in the body.
Indications
Type 2 diabetes mellitus, especially in obese patients, when diet therapy and physical activity are ineffective:
- in adults as monotherapy or in combination with other oral hypoglycemic drugs, or with insulin;
- in children from 10 years of age as monotherapy or in combination with insulin.
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Active ingredient
Metformin
Composition
Active ingredient: metformin hydrochloride 1000.0 mg; excipients: potato starch 80.0 mg, lactose monohydrate 60.0 mg, povidone-CZO 36.0 mg, magnesium stearate 24.0 mg; coating: film coating (polyvinyl alcohol 14.4 mg, titanium dioxide 9.0 mg, macrogol 7.3 mg, talc 5.3 mg) 36.0 mg.
How to take, the dosage
The drug Metformin is taken orally, during or immediately after a meal, without chewing, with plenty of water.
Adults
Monotherapy and combination therapy in combination with other oral hypoglycemic agents
- The usual starting dose is 500 mg or 850 mg 2-3 times daily after or with a meal. Further gradual dose increases are possible depending on blood glucose concentrations.
- The maintenance dose of the drug is usually 1500-2000 mg/day. To reduce gastrointestinal side effects, the daily dose should be divided into 2-3 doses. The maximum dose is 3000 mg/day divided into 3 doses.
- Slow dose increases may improve gastrointestinal tolerance.
- Patients taking metformin at doses of 2000-3000 mg/day may be switched to taking the drug at a dose of 1000 mg. The maximum recommended dose is 3000 mg/day divided into 3 doses.
If a switch from another hypoglycemic drug is planned: Stop taking another hypoglycemic drug and start Metformin at the dose stated above.
Combination with insulin
To achieve better blood glucose control, metformin and insulin can be used as combination therapy. The usual starting dose of Metformin in doses of 500 mg or 850 mg is one tablet 2-3 times a day, Metformin in doses of 1000 mg one tablet once a day, while the dose of insulin is adjusted based on blood glucose concentration.
Children and adolescents
From the age of 10, the drug may be used both in monotherapy and in combination with insulin. The usual starting dose is 500 mg or 850 mg once daily after or with a meal. The dose should be adjusted after 10-15 days on the basis of blood glucose concentrations. The maximum daily dose is 2000 mg divided into 2-3 doses.
Elderly patients
Because of the possible decrease of renal function, the dose of Metformin must be adjusted with regular monitoring of renal function parameters (determine plasma creatinine concentration at least 2-4 times per year).
Patients with impaired renal function
The dose of Metformin is adjusted based on renal function assessment, which should be performed regularly (see “Cautionary Note”).
Duration of treatment
The duration of use of Metformin is determined by the physician.
Prescribing discontinuation of the drug without a physician’s direction is not recommended.
Interaction
Contraindicated combinations
Iodine-containing radiopaque agents:In a background of functional renal insufficiency in patients with diabetes mellitus, radiological examination with iodine-containing radiopaque contrast agents may cause the development of lactoacidosis. Metformin treatment should be discontinued depending on renal function 48 hours before or at the time of radiological study with iodine-containing radiopaque agents and not resumed until 48 hours after, provided that renal function has been found normal during the examination.
Unrecommended combinations
Alcohol:In acute alcohol intoxication, there is an increased risk of lactoacidosis, especially in cases of malnutrition; compliance with a low-calorie diet; in cases of hepatic insufficiency. Alcohol and medicinal products containing ethanol should be avoided while taking the drug.
Combinations requiring use with caution
Danazole: concomitant administration of danazol is not recommended to avoid the hyperglycemic effects of the latter; if treatment with danazol is necessary and after discontinuation of the latter, correction of the metformin dose under control of blood glucose concentrations is required.
Chlorpromazine when taken in high doses (100 mg/day) increases blood glucose concentration, reducing insulin release. During treatment with neuroleptics and after discontinuation of their use metformin dose adjustment is required with monitoring of blood glucose concentrations.
Glucocorticosteroids (GCS) of systemic and local action decrease glucose tolerance and increase blood glucose concentration, sometimes causing ketosis. During treatment with GCS and after discontinuation of GCS, metformin dose adjustment is required under control of blood glucose concentration.
Diuretics:Concomitant use of “loop” diuretics may lead to lactoacidosis due to possible functional renal failure. Metformin should not be taken if the CK is below 60 mL/min.
Beta2-adrenomimetics administered parenterally increase blood glucose concentration due to beta-adrenoreceptor stimulation. In this case it is necessary to control blood glucose concentration. If necessary insulin administration is recommended.
When concomitant use of the above drugs may require more frequent monitoring of blood glucose, especially at the beginning of treatment. If necessary, the dose of metformin may be adjusted during treatment and after discontinuation.
Angiotensin-converting enzyme (ACE) inhibitors and other hypotensive drugs may decrease blood glucose concentrations. The dose of metformin should be adjusted if necessary.
Concomitant use of metformin with sulfonylurea derivatives, insulin, acarbose, salicylates may cause hypoglycemia.
Nifedipine increases absorption and Cmax of metformin.
Cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, and vancomycin) that are secreted in the renal tubules compete with metformin for tubular transport systems and may increase its Cmax.
Special Instructions
Lactoacidosis
Lactoacidosis is a rare but serious (high mortality if not treated urgently) complication that can occur due to metformin cumulation. Cases of lactoacidosis when taking metformin have occurred mainly in patients with diabetes mellitus with severe renal insufficiency.
The risk of lactoacidosis should be considered if nonspecific signs, such as muscle cramps accompanied by dyspeptic symptoms, abdominal pain, and marked asthenia, are present. Lactoacidosis is characterized by acidotic dyspnea, abdominal pain, and hypothermia, followed by coma. Diagnostic laboratory indicators are decreased blood pH (less than 7.25), plasma lactate content over 5 mmol/l, elevated anion gap and lactate/pyruvate ratio.
If metabolic acidosis is suspected, discontinue the drug and see a physician immediately.
Surgical surgeries
The use of metformin should be discontinued 48 hours before elective surgical procedures and may be continued no earlier than 48 hours after, provided that renal function has been found to be normal during examination.
The drug Metformin should be changed to another hypoglycemic drug (e.g., insulin) 48 hours before an IV radiology exam and continued for another 48 hours after that exam.
Renal function
Because metformin is excreted by the kidneys, CK should be determined before treatment and regularly thereafter: at least once a year in patients with normal renal function, and 2-4 times a year in elderly patients, and in patients with CK at the lower end of normal.
Particular caution should be exercised if renal function may be impaired in elderly patients, if hypotensive drugs, diuretics, or nonsteroidal anti-inflammatory drugs are used concomitantly.
Application in children and adolescents
The diagnosis of type 2 diabetes must be confirmed before starting treatment with metformin.
In 1-year clinical trials, metformin has not been shown to affect growth and puberty. However, because of the lack of long-term data, close monitoring of the subsequent effects of metformin on these parameters in children, especially during puberty, is recommended. The most careful monitoring is necessary in children aged 10-12 years.
Other precautions
Patients are advised to continue on a diet with an even carbohydrate intake throughout the day. Patients who are overweight are recommended to continue on a hypocaloric diet (but at least 1000 kcal/day).
It is recommended that regular standard laboratory tests be performed to control diabetes.
The drug is not recommended if there is a risk of dehydration.
Metformin does not cause hypoglycemia during monotherapy, but caution is recommended when using it in combination with insulin or other hypoglycemic agents (e.g., sulfonylurea derivatives, repaglinide). In case of concomitant treatment it is necessary to control blood glucose concentration carefully.
Influence on driving and operating machinery
Monotherapy with the drug does not cause hypoglycemia and therefore does not affect driving and operating machinery. Patients should be cautioned about the risk of hypoglycemia when using metformin in combination with other hypoglycemic drugs (sulfonylurea derivatives, insulin, repaglinide, etc.), which impair the ability to drive vehicles and engage in other potentially dangerous activities that require increased alertness and quick psychomotor reactions.
Synopsis
Dosage 1000 mg: film-coated tablets, white or almost white, oblong, biconvex with a ridge on one side.
Contraindications
- High sensitivity to metformin and/or any excipient of the drug;
- diabetic ketoacidosis, diabetic precoma, coma;
- renal insufficiency (creatinine clearance (CK) less than 60 ml/min);
- disordered liver function;
- clinical manifestations of acute and chronic diseases that may lead to tissue hypoxia (including cardiac or respiratory failure, acute myocardial infarction);
- application less than 48 hours before and within 48 hours after radioisotopic or radiological studies with iodine-containing contrast agent;
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
- chronic alcoholism, acute alcohol poisoning;
- hypocaloric diet (less than 1000 kcal/d);
- lactoacidosis (including anamnesis);
- acute conditions with risk of renal dysfunction: dehydration (with diarrhea, vomiting), severe infectious diseases, shock;
- extensive surgical operations and trauma when insulin therapy is indicated (see
- pregnancy
- children under 10 years of age.
Cautions
The drug should be used in persons over 60 years of age who have heavy physical work because of increased risk of lactoacidosis; during breastfeeding.
Side effects
The frequency of side effects of the drug is rated as follows: very frequently: > 1/10; frequently: 1/10-1/100; infrequently: 1/100-1/1000; rarely: 1/1000-1/10000; very rarely: < 1/10000.
Metabolic and nutritional disorders
Very rare: lactoacidosis (see section “Special Precautions”).
Long-term use of metformin may result in decreased absorption of vitamin B12. If megaloblastic anemia is detected, the possibility of this etiology should be considered.
Nervous system disorders
Often: impaired taste.
Gastrointestinal disorders
Very common: nausea vomiting diarrhea lack of appetite abdominal pain.
These side effects often occur during the initial period of treatment and in most cases go away spontaneously when continued. To reduce side effects, it is recommended that the drug be taken with or after meals. Slowly increasing the dose may improve gastrointestinal tolerance.
Hepatic and biliary tract disorders
Very rare: impaired liver function and hepatitis. After withdrawal of metformin, these adverse events disappear completely.
Skin and subcutaneous tissue disorders
Very rare: skin reactions such as erythema pruritus rash.
Published post-marketing data and controlled clinical studies in a limited pediatric population in the 10-16 year age group show that side effects in children are similar in nature and severity to those in adult patients.
Overdose
Symptoms: when using metformin at a dose of 85 g (42.5 times the maximum daily dose) hypoglycemia was not observed, but the development of lactoacidosis was noted. Significant overdose of metformin or associated risk factors may lead to the development of lactoacidosis (see “Cautionary Note”). Treatment: in case of signs of lactocidosis, the drug treatment should be stopped immediately, the patient should be urgently hospitalized and, after determining the lactate concentration, the diagnosis should be specified. The most effective measure for lactate and metformin elimination from the body is hemodialysis. Symptomatic treatment is also carried out.
Pregnancy use
Decompensated diabetes mellitus during pregnancy is associated with an increased risk of birth defects and perinatal mortality.
Limited data suggest that metformin administration in pregnant women does not increase the risk of birth defects in children.
If pregnancy is planned or if pregnancy occurs while taking metformin for prediabetes or type 2 diabetes, the drug should be withdrawn and insulin therapy should be prescribed. Plasma glucose levels should be maintained as close to normal as possible to reduce the risk of fetal malformations.
Metformin passes into breast milk. No adverse effects have been observed in infants during breastfeeding while taking metformin. However, due to the limited data, it is not recommended to use the drug during breastfeeding. The decision to discontinue breastfeeding should be made taking into account the benefits of breastfeeding and the potential risk of side effects in the baby.
Similarities
Siofor 500, Siofor 850, Metformin-Teva, Siofor 1000, Glucofage Long, Formetin, Metformin, Merifatin
Weight | 0.135 kg |
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Shelf life | 2 years. Do not use after the expiration date. |
Conditions of storage | Store in a dry, light-protected place at a temperature not exceeding 25 °С. Keep out of reach of children. |
Manufacturer | Rapharma AO, Russia |
Medication form | pills |
Brand | Rapharma AO |
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