Metformin 500mg drug pharm treatment for diabetes (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Metformin HCl

Ingredient

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Composition information	Content
Metformin HCl	500mg

Uses

indications

Metformin drugs are indicated in the following cases:

Treatment of diabetes does not depend on insulin (type II): Single therapy, when unable to treat blood glucose with a simple diet. Enough.

ATC code: A10BA02.

Metformin is a Biguanid -group anti -diabetes drug, which has a mechanism of action from anti -diabetes drugs Sulfonylure. Unlike sulfonylure, Metformin does not stimulate the release of insulin from the pancreatic beta cells. The drug has no hypoglycemic effect in humans without diabetes. In people with diabetes, metformin reduces hyperglycemia but does not cause hypoglycemia (except for fasting or coordinating medications in effect). Therefore, both BiguanID and Sulfonylure were previously considered hypoglycemic drugs, but actually Biguanid (such as Metformin) must be considered as an anti -hypertension suitable for new cases. metformin reduces glucose levels in plasma, when hungry and after meals, in patients with type II diabetes (regardless of insulin). The mechanism of the peripheral effect of Metformin is to increase the use of glucose in the cell, improve insulin links to the receptor and perhaps both the effect of the receptor, the synthesis of glucose synthesis in the liver and reducing the absorption of glucose in the intestine. In addition to anti -diabetic effects, metformin has partly good on lipoprotein metabolism, often disorders in people with diabetes without insulin. Contrary to the sulfonylure, the weight of the person treated with metformin tends to be stable or may decrease slightly.

Metformin monoma can be effective for patients who do not respond or only partially respond to sulfonylure or those who no longer respond to sulfonylure. In these patients, if with single -treatment metformin, blood sugar is still not controlled as required, coordination of metformin with a sulfonylure may have a synergistic effect, because both drugs improve glucose tolerance with different mechanisms but complement each other.

pharmacokinetics

metformin absorbing slowly and incomplete. Absolute bioavailability of 500mg of Metformin oral oral at approximately 50 - 60%. There is no proportion to the dose when increasing the dose, due to reduced absorption. Food reduces the level of absorption and slows the absorption of metformin. Metformin is associated with negligible plasma protein.

Metformin has a large distribution (63-276L) in the tissue and fluid. The drug is also distributed in red blood cells.

metformin is not metabolized in the liver and does not excrete through bile. Excretion in the renal tubules is the main elimination of metformin. After drinking, about 90% of the absorbing drugs are eliminated through the kidneys within the first 24 hours in non -metabolic form. Selling waste time in plasma is 1.5 - 4.5 hours.

There may be risk of accumulating drugs in the case of impaired renal function. Metformin clearance through renal decreased in patients with renal impairment and elderly.

Before taking Metformin 500mg drug pharm treatment for diabetes (10 blisters x 10 tablets)

How to use

Take oral use. Swallow the pill, drink after meals. Do not chew.

Dosage

Adults: The starting dose for patients who are not using metformin is 500mg or 850mg, 1 time/day. If the patient does not have a harmful reaction to the gastrointestinal tract and need to increase the dose, an additional 500mg or 850mg can be used after each treatment period from 1 to 2 weeks. The dose of Metformin should be considered for adjustment on each specific patient based on the patient's effectiveness and tolerance and does not exceed the maximum recommended dose of 2000 mg/day.

Elderly: Kidney function may be impaired in the elderly, the dose of metformin must be adjusted according to the kidney function. Regular monitoring and evaluation of kidney function is necessary when treating with Metformin.

Children and adolescents: It is not recommended to use 850mg.

Patients with renal impairment: Assess the kidney function before the beginning of treatment with Metformin and periodic assessment.

Contraindicated Metformin in patients with EGFR is less than 30ml/min/1.73m2.

It is not recommended to start treatment with Metformin in patients with EGFR in the range of 30-45ml/minute/1.73m2.

In patients using Metformin and having EGFR drops below 45ml/min/1.73m2, assessing risks - benefits when continuing treatment.

Stop using metformin if the patient has EGFR drops below 30ml/minute/1.73m2 (see the contraindication, warning and cautious section).

Stop using metformin when performing an image diagnostic test used to use contrast drugs containing iodine.

In patients with EGFR in the range of 30-60ml/min/1.73m2, in patients with a history of liver disease, alcoholism or heart failure or on patients, they will use optical bumper containing iodine through artery lines, stop metformin before or at the time of testing testing testing tests using iodine containing iodine. Reassessment of the EGFR after a 48 -hour screening use Metformin if the kidney function stabilizes (see the warning and caution).

Other drug combination

Sulfonylure oral: Use single Metformin for 4 weeks inefficient. When treated in combination with the maximum dose of both drugs, the patient does not respond for 1-3 months, it is often necessary to stop treating with anti-diabetes and start taking insulin.

insulin: Metformin can be combined with insulin to achieve better blood sugar control. The usual starting dose of Metformin is 1 tablet of 500mg or 850mg, 2-3 times a day, and the dose of insulin is adjusted depending on blood sugar.

What to do when overdose? Hypoglycemia is notified at about 10% of cases after taking the amount exceeding 50g of metformin hydrochloride; Lactic acid contamination occurs at about 32% of the shift.

Overdose:

Because metformin is eliminated by a separation (with a clearance of up to 170ml/min in the condition of good hemorrhage), it is recommended that the hemolytic refinement immediately to address acid infection and stagnant removal; With this care often all symptoms and fast recovery.

Monitor patients, symptomatic treatment.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double doses to compensate for missed dose.

Side Effects

When using the drug often has unwanted effects (ADR) such as:

The most common unwanted effect is digestive. These effects are associated with the dose, and often occur at the beginning of treatment, but often temporary and can be reduced when taking the drug during meals. If the symptoms still exist, stop treatment immediately and notify the doctor.

Common (ADR> 1/100):

digestive: anorexia, nausea, vomiting, diarrhea, epigastric, constipation, heartburn. (1/1000 Hematology: Dehydration of blood products, anemia, hemolytic anemia, marrow failure, thrombocytopenia, granulocytosis. If this happens, immediately stop treatment and report immediately to the treating doctor.

Instructions on how to handle ADR:

It is possible to avoid gastrointestinal ADR if you take Metformin at meals and increase the dose gradually. However, there is a hypoglycemia of blood glucose when there is a combination of other favorable factors (such as sulfonylure, alcohol). Vitamin B12 treatment has good results. lactic.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Metformin 500 mg drug is contraindicated in the following cases:

Patients with severe renal impairment (EGFR below 30ml/min/1.73m2). insulin). Blood. Metformin temporarily stopped for patients with X -ray projections with iodine contrast substances that use these substances that can affect renal function.

Be cautious when using

Please see more information about the drug in the instruction sheet of the use of the drug attached.

Need to be very cautious when taking drugs for patients in the following cases:

Lactic acidosis

The surveillance process records lactic acidosis related to metformin, including death, heat reduction, hypotension, prolonged slow arrhythmia. The onset of lactic acidic acidosis related to Metformin is often not easy to detect, accompanied by typical symptoms such as discomfort, muscle pain, respiratory failure, drowsiness and abdominal pain. Lactic acidic acidosis associated with metformin is characterized by increased lactate levels in the blood (> 5mmol/l), anion space (no evidence of keto urine or blood keto), increasing lactate/pyruvate ratio and plasma metformin levels in general increases> 5µg/ml.

Risk factors of lactic acidic acidosis related to Metformin include renal failure, simultaneous use with certain drugs (for example, carbonic inhibitors such as Topiramat), from 65 years of age and older, performing screens using contrast drugs, surgery and performing other tricks, reducing inhaled oxygen (eg acute congestion), drinking a lot of alcohol and liver failure.

Measures to minimize the risk and management of lactic acidic acidosis related to metformin in a group of high -risk patients are detailed in the instruction sheet of drug use (Dosage and usage, contraindications, warning and caution, drug interaction and drug use on special objects).

If there is suspicion of lactic acidosis related to Metformin, should stop using, quickly take patients to the hospital and take treatment measures. In patients who have been treated with metformin, have been diagnosed with lactic acidosis or doubts that are likely to have lactic acidosis, quickly recommend filtering to adjust acidosis and remove the accumulated metformin part (metformin hydrochloride can be separated with 170ml/minute clearance under good dynamics). Dialysis can reverse symptoms and recovery.

Instructions for patients and family members about acidic symptoms and if these symptoms occur. Need to stop the drug and report these symptoms to the doctor.

For each factor that increases the risk of lactic acidosis related to metformin, recommendations to help minimize the risk and handle lactic acidosis related to metformin, specifically as follows:

Renal failure: Lactic acidosis related to metformin during monitoring occurs mainly in patients with severe renal impairment. The risk of metformin accumulation and lactic acidosis increases according to the severity of renal failure because metformin is excreted mainly through the kidneys. Clinical recommendations based on the patient's kidney function include (see the dose and usage section, clinical pharmacology):

Before the beginning of treatment with Metformin should estimate the level of glomerular filtration (EGFR) of the patient. ml/minute/1.73m2. The regimen.

Medicine interaction: Concomitant use of metformin with some drugs may increase the risk of lactic acidosis: Patients with impaired renal function leads to significant hemodynamic changes, affecting acid-base balance or increasing metformin accumulation (see drug interaction). Therefore, most need to monitor patients more often.

Patients aged 65 and older: The risk of lactic acidosis is related to Metformin increases with the age of the patient because the elderly patients are likely to have liver failure, kidney failure, heart failure than younger patients. Need to evaluate kidney function more often for older patients.

Perform diagnostic tests using contrast drugs: Injecting contrast drugs into the intravascular disease in patients who are being treated metformin can lead to impaired renal function and cause lactic acidosis. Stop using Metformin before or at the time of performing screens using iodine containing iodine in patients with EGFR is in the range of 30-60ml/min/1.73m2, patients with a history of liver failure, alcoholism, heart failure or patients who will use optical bumper containing iodine in artery. Reassess EGFR 48H after screening and reuse Metformin if the kidney function is stable.

Surgery or other procedures: food storage and fluid during surgery or performing other procedures may increase the risk of decreased volume, hypotension and kidney failure. Metformin should be temporarily stopped temporarily when the patient has a limited amount of food and deposits.

Inhalation oxygen reduction: The monitoring process has recorded a number of lactic acidosis related to metformin occurring in acute congestive heart failure (especially when accompanied by reduced osical and oxygen reduction). Cardiovascular collapse (shock), acute myocardial infarction, bacterial infection and other diseases related to hypoxemia are associated with lactic acidosis and may also cause nitrogen nitrogen before the kidneys. When these events occur, stop Metformin.

Alcohol: Alcohol has the potential to affect the impact of metformin on lactate metabolism and thereby increases the risk of lactic acidosis. Warning patients do not drink alcohol when using Metformin.

Hepatic failure: Patients with hepatic impairment may progress to lactic acidosis related to metformin due to lactate excretion reduction leading to increased lactate levels in the blood. Therefore, avoid using Metformin in patients who have been diagnosed with liver disease through testing or clinical evidence.

The effect of the drug on the ability to drive and operate machinery

Metformin single treatment does not lower blood sugar and therefore does not affect the ability to drive or use machines.

When metformin is used in combination with other diabetes medications (such as sulfonylure, insulin, glinides), can cause hypoglycemia with symptoms: fatigue, dizziness, sweating, heartbeat, eye -catching or poor concentration. Therefore, in this case, you should not drive or operate machinery.

Using drugs for women during pregnancy and lactation

Pregnancy: Metformin is contraindicated for pregnant women. And must treat diabetes with insulin.

Demonstrate period: There is no documentation of using metformin for nursing mothers or determine
The amount of drug excreted in breast milk. It is necessary to consider whether to stop breastfeeding or stop taking the drug, based on the importance of the mother's importance to the mother.

Interactive drug

Active reduction: drugs that can cause hyperglycemia such as diuretics, corticosteroids, phenothiazine, thyroid preparations, estrogen, conception drugs, phenytoin, nicotine acid, drugs like sympathetic neurological neurons, medications of calcium channel, ISONIAZID, TETRASASIAC Salbutamol, Terbutalin, diuretics, Danazol or Clopromazin and the same groups, can lead to reducing blood glucose control. Recommendations to monitor blood sugar and consider adjusting the dose of metformin.

Increased effect: Furosemid increases the maximum concentration of Metformin in plasma and in the blood, without changing Metformin's kidney clearance coefficient in the study using a single dose.

Increased toxicity: Cationic drugs (for example, amilorid, digoxin, morphin, process, quinidin, ranitidin, triamteren, trimethoprim and vanomycin) are excreted by excretion through the renal tubules that can interact with Metformin by competing with normal transportation systems in the kidney tubes.

cimetidine increases the peak concentration of Metformin in plasma and total blood, thus avoiding the combination of metformin with cimetidine.

Interaction with alcohol: avoid or limit drinking alcohol (lactic acid infection rate may increase; may cause hypoglycemia).

Storage

To be out of reach of children.

Store in a dry place, the temperature does not exceed 30 ° C, avoiding light.

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