Metformin, 60 pcs., 850 mg, film-coated tablets

Metformin Pharmland 500 mg and 850 mg No. 30, tablets

The effect of metformin is enhanced by NSAIDs, MAO inhibitors, oxytetracycline, ACE inhibitors, clofibrate derivatives, cyclophosphamide, beta-blockers. When metformin is used together with sulfonylurea derivatives, insulin, acarbose and salicylates, the hypoglycemic effect may be potentiated. Compatible with sulfonylurea derivatives and insulin. Nifedipine increases absorption, Cmax, and prolongs the elimination of metformin.

The effect of metformin is weakened by phenothiazines, thyroid hormones, estrogens, oral contraceptives, phenytoin, nicotinic acid, calcium antagonists, isoniazid. Therefore, more frequent monitoring of blood glucose levels is necessary in patients receiving these drugs, especially at the beginning of treatment. If necessary, the dose of the drug is adjusted both during such treatment and after its cessation. The simultaneous use of guar gum or cholestyramine interferes with the absorption of the drug and reduces its effect.

With simultaneous use of the drug metformin with danazol, a hyperglycemic effect may develop (this combination is not recommended). When using the drug metformin and chlorpromazine together, it should be taken into account that the antipsychotic, when used in high doses, reduces the release of insulin and increases the level of glucose in the blood (this may require dose adjustment of metformin under the control of blood glucose levels).

With simultaneous injections of beta 2-sympathomimetics, the hypoglycemic effect of metformin may be weakened (it is necessary to monitor blood glucose levels and, if necessary, prescribe insulin). The effect of metformin is weakened by thiazide and other diuretics. Furosemide increases the Cmax of metformin by 22%. Metformin reduces Cmax and T1/2 of furosemide by 31% and 42.3%, respectively.

The simultaneous use of loop diuretics and metformin can lead to lactic acidosis due to the possible development of functional renal failure. When administered together, GCS (for systemic and local use) affect the effectiveness of metformin, reducing glucose tolerance and increasing plasma glucose levels, in some cases causing ketosis (if it is necessary to use such a combination, a dose adjustment of metformin is required to control blood glucose levels) . Drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene and vancomycin) secreted in the tubules compete for tubular transport systems and with long-term therapy can increase Cmax by 60%. The use of iodine-containing radiocontrast agents for radiological examination while using metformin can lead to the development of lactic acidosis due to functional renal failure.

Cimetidine slows down the elimination of metformin and increases the risk of developing lactic acidosis.

Metformin weakens the effect of indirect anticoagulants (coumarin derivatives).

While using the drug metformin, you should not drink alcohol or ethanol-containing drugs, as this increases the risk of developing lactic acidosis, especially when fasting or following a low-calorie diet.

Buy Metformin Canon film-coated tablets 850 mg No. 60 in pharmacies

Instructions for use

Metformin tablet p.o 850 mg No. 60

Dosage forms

tablets 850 mg Synonyms Bagomet Vero-Metformin Gliminfor Gliformin Glucophage Glucophage Long Diaformin OD Metfogamma 1000

Metformin

Siofor 1000

Formetin Group Antidiabetic agents - biguanides International nonproprietary name Metformin Composition Active substance - metformin hydrochloride. Manufacturers Kanonpharma Production (Russia) Pharmacological action Hypoglycemic. Reduces the concentration of glucose in the blood and the level of glycosylated hemoglobin, increases glucose tolerance. Reduces intestinal absorption of glucose, its production in the liver, potentiates sensitivity to insulin in peripheral tissues. Does not alter insulin secretion by beta cells of the pancreatic islets. Normalizes the lipid profile of blood plasma in patients with non-insulin-dependent diabetes mellitus: it reduces the content of triglycerides, cholesterol and LDL and does not change the levels of lipoproteins of other densities. Stabilizes or reduces body weight. Rapidly absorbed from the gastrointestinal tract. The maximum concentration is reached after approximately 2 hours. Absorption from the gastrointestinal tract ends after 6 hours and the concentration in the blood begins to gradually decrease. Can accumulate in the salivary glands, liver and kidneys. It is excreted unchanged by the kidneys. The half-life is 6.2 hours (plasma) and 17.6 hours (blood), because accumulates in erythrocytes. Side effects At the beginning of the course of treatment - anorexia, diarrhea, nausea, vomiting, flatulence, abdominal pain (reduced when taken with meals); metallic taste; megaloblastic anemia; lactic acidosis (respiratory disturbances, weakness, drowsiness, hypotension, reflex bradyarrhythmia, abdominal pain, myalgia, hypothermia), hypoglycemia; rashes and dermatitis. Indications for use Diabetes mellitus type 2 with ineffective correction of hyperglycemia by diet therapy, incl. in combination with sulfonylureas; type 1 diabetes mellitus as an adjunct to insulin therapy. Contraindications Hypersensitivity, kidney disease or renal failure, severe liver disorders, cardiac and respiratory failure, acute phase of myocardial infarction, infectious diseases, major operations and injuries, chronic alcoholism, acute or chronic metabolic acidosis, including diabetic ketoacidosis with or without coma, conducting research using radioactive isotopes of iodine, pregnancy, breastfeeding. Restrictions on use: Children and the elderly (over 65 years of age). Directions for use and dosage : Orally, during or immediately after meals. Monotherapy and combination therapy with other oral hypoglycemic agents. The initial dose is 500-1000 mg 1 time per day in the evening. After 7-15 days, if there are no adverse effects from the gastrointestinal tract, 500-1000 mg is prescribed 2 times a day in the morning and evening. A further gradual increase in the dose is possible depending on the concentration of glucose in the blood. Overdose Symptoms: lactic acidosis. Treatment: hemodialysis, symptomatic therapy. Interaction Phenothiazines, corticosteroids, thyroid hormones, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium antagonists, isoniazid, thiazide and other diuretics weaken the effect. Insulin, sulfonylurea derivatives, acarbose, NSAIDs, MAO inhibitors, oxytetracycline, ACE inhibitors, clofibrate derivatives, cyclophosphamide, beta-blockers enhance the effect. Furosemide increases the maximum concentration. Nifedipine increases absorption, maximum concentration, and prolongs elimination. Amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene and vancomycin during long-term therapy can increase the maximum concentration by 60%. Incompatible with alcohol. Special instructions It is necessary to constantly monitor renal function, glomerular filtration, and blood glucose levels. Vitamin B12 levels should be determined once a year. When transferring a patient to metformin, it is prescribed immediately after discontinuation of the previous drug, with the exception of replacing chlorpropamide. It should not be used before surgical operations and within 2 days after them, as well as within 2 days before and after diagnostic studies. Should not be prescribed to people performing heavy physical work. Storage conditions List B. In a dry place, protected from light.

Metformin

Lactic acidosis

Lactic acidosis is a rare but serious (high mortality unless promptly treated) complication that may occur due to accumulation of metformin. Cases of lactic acidosis when taking metformin occurred mainly in patients with diabetes mellitus with severe renal failure. Other associated risk factors should be taken into account, such as decompensated diabetes mellitus, ketosis, prolonged fasting, alcoholism, liver failure, any condition associated with severe hypoxia and simultaneous use of drugs that can cause the development of lactic acidosis (see section “Interaction with other drugs”) "). This may help reduce the incidence of lactic acidosis. The risk of developing lactic acidosis should be taken into account when nonspecific signs appear, such as muscle cramps accompanied by dyspeptic disorders, abdominal pain and severe asthenia. Lactic acidosis is characterized by acidotic shortness of breath, abdominal pain and hypothermia followed by coma. Diagnostic laboratory parameters are a decrease in blood pH (less than 7.35), lactate content in the blood plasma over 5 mmol/l, increased anion gap and lactate/pyruvate ratio. If metabolic acidosis is suspected, stop taking the drug and consult a doctor immediately.

Surgical operations

Metformin should be discontinued during surgery under general, spinal or epidural anesthesia. Metformin therapy can be continued no earlier than 48 hours after surgery or resumption of food intake, provided that renal function has been examined and found to be normal.

Kidney function

Since metformin is excreted by the kidneys, before starting treatment and regularly thereafter, it is necessary to determine the clearance of creatinan:

- At least once a year in patients with normal renal function;

- Every 3-6 months in patients with creatinine clearance 45-59 ml/min.

- Every 3 months in patients with creatinine clearance 30-44 ml/min.

In case of creatinine clearance less than 30 ml/min, the use of the drug is contraindicated.

Particular caution should be exercised in case of possible impaired renal function in elderly patients, with dehydration (chronic or severe diarrhea, repeated bouts of vomiting), and with the simultaneous use of antihypertensive drugs, diuretics or non-steroidal anti-inflammatory drugs.

Heart failure

Patients with heart failure have a higher risk of developing hypoxia and renal failure. Patients with chronic heart failure should have their cardiac renal function monitored regularly while taking metformin.

Taking metformin in heart failure with unstable hemodynamic parameters is contraindicated.

Children and teenagers

The diagnosis of type 2 diabetes mellitus must be confirmed before starting treatment with metformin.

In clinical studies lasting 1 year, metformin was shown to have no effect on growth and puberty. However, due to the lack of long-term data, careful monitoring of the subsequent effects of metformin on these parameters in children, especially during puberty, is recommended. The most careful monitoring is necessary for children aged 10-12 years.

The use of iodine-containing radiocontrast agents

Intravascular administration of iodinated radiocontrast agents can lead to the development of renal failure and accumulation of metformin, which increases the risk of developing lactic acidosis. Metformin should be discontinued, depending on renal function, 48 hours before or during an X-ray examination using iodinated contrast agents, and not resumed until 48 hours after it, provided that during the examination, renal function was found to be normal.

Other precautions:

- Patients are advised to continue to follow a diet with even carbohydrate intake throughout the day. Overweight patients are recommended to continue to follow a hypocaloric diet (but not less than 1000 kcal/day).

— It is recommended that routine laboratory tests be performed regularly to monitor diabetes mellitus.

— Metformin in monotherapy does not cause hypoglycemia, however, it is recommended to exercise caution when using it in combination with insulin or other hypoglycemic agents (for example, sulfonylurea derivatives, repaglinide, etc.).

The use of Metformin is recommended for the prevention of type 2 diabetes mellitus in persons with prediabetes and additional risk factors for the development of overt type 2 diabetes mellitus, such as:

— Age less than 60 years;

— Body mass index (BMI) ≥ 30kg/m:;

- History of gestational diabetes mellitus;

— Family history of diabetes mellitus in first-degree relatives;

- Increased concentration of HDL cholesterol;

- arterial hypertension.

— Metformin did not affect the fertility of male and female rats when administered at doses three times the maximum recommended daily dose for humans.