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Starting Dose Of Metformin

Metformin Hcl Flashcards | Quizlet

Metformin Hcl Flashcards | Quizlet

adjunct to diet to lower blood glucose in patients with non-insulin dependent diabetes mellitus. one 500mg tablet given twice a day with meals or one 850 mg tablet given with the morning meal adding one 500mg tablet every week or one 850 mg tablet every other week until the optimum response is seen Can patients be switched from metformin to XR? Metformin can be used concomitatly with___ when a sulfonylurea when diet and metformin or sulfonylurea alone do not result in adequate glycemic control Transition period needed when transferring patients from most other oral hypoglycemic agents only for chlorpropamide bc of its longer half life. Take care in first two weeks decreases intestinal absorption, suppresses hepatic gluconeogenesis and improves insulin sensitivity. what must be present for metformin to be effective its a dual hydrophylic polymer matrix system. Fluid from the gi tract enters the tablet and hydrates polymers causing them to swell. Drug is released by diffusion through a gel matrix independent of pH. furosemide, cimetidine, nifedipine, and alcohol furosemide, cimetidine, and nifedipine do what to metformin potentiate the effect of metformin on lactate metabolism impaired renal funciton or hepatic function. radiologic studies involving parenteral admin of iodinated contrast material because of effects on renal function. Acute of chronic metabolic acidosis including diabetic ketoacidosis Continue reading >>

Pioglitazone/metformin

Pioglitazone/metformin

Pioglitazone/metformin (also known by the brand names Actoplus Met, Piomet and Politor) is combination of two oral diabetes medications pioglitazone and metformin. The two oral antihyperglycemic agents with different mechanisms of action are used to improve glycemic control in patients with diabetes mellitus type 2. Mechanisms[edit] Pioglitazone is a member of the thiazolidinedione class, it decreases insulin resistance in the periphery and in the liver resulting in increased insulin dependent glucose disposal and decreased hepatic glucose output. Metformin is a member of the biguanide class, improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Indication[edit] Pioglitazone/metformin is indicated as an adjunct to diet and exercise: To improve glycemic control in patients with type 2 diabetes, or For patients who are already treated with a separate combination of pioglitazone and metformin, For patients whose diabetes is not adequately controlled with metformin alone, or For patients who have initially responded to pioglitazone alone and require additional glycemic control. Dosage and administration[edit] Recommended dose[edit] Use of antihyperglycemic agents in the management of type 2 diabetes should be individualized on the basis of effectiveness and tolerability. Pioglitazone/metformin should be given with meals; the initial starting dose is either the 15 mg/500 mg or 15 mg/850 mg tablet strength once or twice daily, and gradually titrated after assessing adequacy of therapeutic response, while not exceeding the maximum recommend Continue reading >>

Reducing Metformin Dosage

Reducing Metformin Dosage

Days ago I took myself completely off of my oral medication, Amaryl. I noticed a difference immediately starting the very next day because I was no longer getting Hypos. Since then, ALL of my blood glucose numbers have been tightly packed together, mostly in the 70s and 80s mg/dL. I am no longer getting huge swings in my blood glucose numbers. I am very pleased with my numbers. I did notice one change however, my weight loss has been accelerated since off the Amaryl. I knew that Amaryl could cause weight gain, although I never expected such a sudden drastic weight loss in the days since discontinuing this medication. I needed to lose more weight anyway, so I'm not complaining. Well, a couple of days ago I decided to also discontinue my evening Metformin of 500 mg. Since discontinuing Amaryl, my morning fasting numbers have been nearly always in the 70s mg/dL, so I felt safe to also discontinue my evening Metformin. I am still taking my morning Metformin 500 mg, which I believe is the lowest dosage possible. I haven't noticed any difference at all with any of my blood glucose numbers since discontinuing the evening Metformin. ALL my numbers are on the low side still, in the 70s or 80s mg/dL, and I no longer get any Hypos. I never, ever get any high blood glucose numbers. My question is, does it take a while for Metformin to work its way out of a person's system? Moderator Type1 - Minimed 640G - Enlite CGM I was told that it takes about 3 weeks for Metformin to really kick in, so it wouldn't surprise me if its effect could hang around for some weeks... don't know for certain though. I guess if you just keep a really close eye on your BG you should see if things start to go pearshaped. sounds reasonable to me since it takes a "little while" to start working in one's syste Continue reading >>

Glucophage Sr 500mg, 750mg And 1000mg Prolonged Release Tablets

Glucophage Sr 500mg, 750mg And 1000mg Prolonged Release Tablets

500 mg: One prolonged release tablet contains 500mg metformin hydrochloride corresponding to 390 mg metformin base. 750 mg: One prolonged release tablet contains 750 mg metformin hydrochloride corresponding to 585 mg metformin base. 1000 mg: One prolonged release tablet contains 1000 mg metformin hydrochloride corresponding to 780 mg metformin base. For the full list of excipients, see section 6.1. Prolonged release tablet. 500 mg: White to off-white, round, biconvex tablet, debossed on one side with '500'. 750 mg: White capsule-shaped, biconvex tablet, debossed on one side with '750' and on the other side with 'Merck'. 1000 mg: White to off-white capsule-shaped, biconvex tablet, debossed on one side with '1000' and on the other side with 'MERCK'. • Reduction in the risk or delay of the onset of type 2 diabetes mellitus in adult, overweight patients with IGT* and/or IFG*, and/or increased HbA1C who are: - at high risk for developing overt type 2 diabetes mellitus (see section 5.1) and - still progressing towards type 2 diabetes mellitus despite implementation of intensive lifestyle change for 3 to 6 months Treatment with Glucophage SR must be based on a risk score incorporating appropriate measures of glycaemic control and including evidence of high cardiovascular risk (see section 5.1). Lifestyle modifications should be continued when metformin is initiated, unless the patient is unable to do so because of medical reasons. *IGT: Impaired Glucose Tolerance; IFG: Impaired Fasting Glucose • Treatment of type 2 diabetes mellitus in adults, particularly in overweight patients, when dietary management and exercise alone does not result in adequate glycaemic control. Glucophage SR may be used as monotherapy or in combination with other oral antidiabetic agents, or with in Continue reading >>

Dosing & Administration

Dosing & Administration

Warnings and Precautions Pancreatitis: There have been post-marketing reports of acute pancreatitis in patients taking saxagliptin, and in the SAVOR cardiovascular outcomes trial. Observe for pancreatitis. If pancreatitis is suspected, discontinue KOMBIGLYZE XR. Heart Failure: In the SAVOR cardiovascular outcomes trial, more patients treated with saxagliptin were hospitalized for heart failure compared to placebo. Patients with a prior history of heart failure or renal impairment had a higher risk for hospitalization for heart failure. Consider the risks and benefits of KOMBIGLYZE XR in patients who have known risk factors for heart failure. Monitor for signs and symptoms. If heart failure develops, consider discontinuation of KOMBIGLYZE XR. Vitamin B12 Deficiency: Metformin may lower vitamin B12 levels. Measure hematological parameters annually. Hypoglycemia: When saxagliptin was used in combination with a sulfonylurea or with insulin, the incidence of confirmed hypoglycemia was increased over that of placebo. Consider lowering the dose of these agents when coadministered with KOMBIGLYZE XR. Hypoglycemia could occur when caloric intake is deficient, strenuous exercise is not compensated by caloric supplementation, or when KOMBIGLYZE XR is used with other glucose-lowering agents or ethanol. Hypersensitivity: Serious reactions have been reported in patients treated with saxagliptin, including anaphylaxis, angioedema, and exfoliative skin conditions. Onset of these reactions occurred within the first 3 months after initiation of treatment with saxagliptin, with some reports occurring after the first dose. If a serious hypersensitivity reaction is suspected, discontinue KOMBIGLYZE XR. Use caution in patients with a history of angioedema to another DPP-4 inhibitor. Severe a Continue reading >>

Glucophage

Glucophage

GLUCOPHAGE® (metformin hydrochloride) Tablets GLUCOPHAGE® XR (metformin hydrochloride) Extended-Release Tablets DESCRIPTION GLUCOPHAGE® (metformin hydrochloride) Tablets and GLUCOPHAGE® XR (metformin hydrochloride) Extended-Release Tablets are oral antihyperglycemic drugs used in the management of type 2 diabetes. Metformin hydrochloride (N,N-dimethylimidodicarbonimidic diamide hydrochloride) is not chemically or pharmacologically related to any other classes of oral antihyperglycemic agents. The structural formula is as shown: Metformin hydrochloride is a white to off-white crystalline compound with a molecular formula of C4H11N5 HCl and a molecular weight of 165.63. Metformin hydrochloride is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pK of metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68. GLUCOPHAGE tablets contain 500 mg, 850 mg, or 1000 mg of metformin hydrochloride. Each tablet contains the inactive ingredients povidone and magnesium stearate. In addition, the coating for the 500 mg and 850 mg tablets contains hypromellose and the coating for the 1000 mg tablet contains hypromellose and polyethylene glycol. GLUCOPHAGE XR contains 500 mg or 750 mg of metformin hydrochloride as the active ingredient. GLUCOPHAGE XR 500 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, microcrystalline cellulose, and magnesium stearate. GLUCOPHAGE XR 750 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, and magnesium stearate. System Components And Performance GLUCOPHAGE XR comprises a dual hydrophilic polymer matrix system. Metformin hydrochloride is combined with a drug release controlling polymer to form an “inne Continue reading >>

Metformin Extended-release (metformin Hydrochloride) - Indications And Dosage

Metformin Extended-release (metformin Hydrochloride) - Indications And Dosage

INDICATIONS AND USAGE Metformin hydrochloride extended-release tablets, as monotherapy, are indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes. Metformin hydrochloride extended-release tablets are indicated in patients 17 years of age and older. Metformin hydrochloride extended-release tablets may be used concomitantly with a sulfonylurea or insulin to improve glycemic control in adults (17 years of age and older). DOSAGE AND ADMINISTRATION There is no fixed dosage regimen for the management of hyperglycemia in patients with type 2 diabetes with metformin hydrochloride extended-release tablets or any other pharmacologic agent. Dosage of metformin hydrochloride extended-release tablets must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily dose. The maximum recommended daily dose of metformin hydrochloride extended-release tablets in adults is 2000 mg. Metformin hydrochloride extended-release tablets should generally be given once daily with the evening meal. Metformin hydrochloride extended-release tablets should be started at a low dose, with gradual dose escalation, both to reduce gastrointestinal side effects and to permit identification of the minimum dose required for adequate glycemic control of the patient. During treatment initiation and dose titration (see Recommended Dosing Schedule), fasting plasma glucose should be used to determine the therapeutic response to metformin hydrochloride extended-release tablets and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately three months. The therapeutic goal should be to decrease both fasting plasma glucose and gl Continue reading >>

Metformin, Oral Tablet

Metformin, Oral Tablet

Metformin oral tablet is available as both a generic and brand-name drug. Brand names: Glucophage, Glucophage XR, Fortamet, and Glumetza. Metformin is also available as an oral solution but only in the brand-name drug Riomet. Metformin is used to treat high blood sugar levels caused by type 2 diabetes. FDA warning: Lactic acidosis warning This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects. Lactic acidosis is a rare but serious side effect of this drug. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital. Lactic acidosis is fatal in about half of people who develop it. You should stop taking this drug and call your doctor right away or go to the emergency room if you have signs of lactic acidosis. Symptoms include tiredness, weakness, unusual muscle pain, trouble breathing, unusual sleepiness, stomach pains, nausea (or vomiting), dizziness (or lightheadedness), and slow or irregular heart rate. Alcohol use warning: You shouldn’t drink alcohol while taking this drug. Alcohol can affect your blood sugar levels unpredictably and increase your risk of lactic acidosis. Kidney problems warning: If you have moderate to severe kidney problems, you have a higher risk of lactic acidosis. You shouldn’t take this drug. Liver problems warning: Liver disease is a risk factor for lactic acidosis. You shouldn’t take this drug if you have liver problems. Metformin oral tablet is a prescription drug that’s available as the brand name drugs Glucophage, Glucophage XR, Fortamet, and Glumetza. Glucophage is an immediate-release tablet. All of the other brands are extended-r Continue reading >>

Metformin Dosage

Metformin Dosage

Metformin Dosage There have been no human studies to identify the optimal dose of metformin that is needed to duplicate the beneficial gene expression effects that are described in the June 2003 issue of Life Extension magazine. For people who want to derive the many proven health benefits of metformin, it might be prudent to follow the dosage schedule used by Type II diabetics. According to the Physician's Desk Reference, the starting dose should be 500 mg of metformin twice a day. (An alternative option is 850 mg of metformin once a day). After one week, increase the dose of metformin to 1000 mg as the first dose of the day and 500 mg as the second dose. After another week, increase to 1000 mg of metformin two times a day. The maximum safe dose described in the Physician's Desk Reference is 2550 mg a day (which should be taken as 850 mg three times a day). According to the Physician's Desk Reference, clinically significant responses in Type II diabetics are not seen at doses below 1500 mg a day of metformin. Anti-aging doctors, on the other hand, have recommended doses as low as 500 mg twice a day to healthy non-diabetics who are seeking to obtain metformin's other proven benefits such as enhancing insulin sensitivity and reducing excess levels of insulin, glucose, cholesterol and triglycerides in the blood. It could be the dosage range is highly individualistic in healthy people, meaning some may benefit from 500 mg twice a day, while others may need 1000 mg twice a day for optimal effects. Blood tests to ascertain if the dose of metformin you are taking is improving glucose/insulin metabolism would be: Hemoglobin A1c Fasting insulin CBC/Chemistry panel that includes glucose, cholesterol triglycerides and indicators of liver and kidney function A hemoglobin A1c test Continue reading >>

About Metformin

About Metformin

Metformin is a medicine used to treat type 2 diabetes and sometimes polycystic ovary syndrome (PCOS). Type 2 diabetes is an illness where the body doesn't make enough insulin, or the insulin that it makes doesn't work properly. This can cause high blood sugar levels (hyperglycemia). PCOS is a condition that affects how the ovaries work. Metformin lowers your blood sugar levels by improving the way your body handles insulin. It's usually prescribed for diabetes when diet and exercise alone have not been enough to control your blood sugar levels. For women with PCOS, metformin stimulates ovulation even if they don't have diabetes. It does this by lowering insulin and blood sugar levels. Metformin is available on prescription as tablets and as a liquid that you drink. Key facts Metformin works by reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin. Insulin is the hormone that controls the level of sugar in your blood. It's best to take metformin with a meal to reduce the side effects. The most common side effects are feeling sick, vomiting, diarrhoea, stomach ache and going off your food. Metformin does not cause weight gain (unlike some other diabetes medicines). Metformin may also be called by the brand names Bolamyn, Diagemet, Glucient, Glucophage, and Metabet. Who can and can't take metformin Metformin can be taken by adults. It can also be taken by children from 10 years of age on the advice of a doctor. Metformin isn't suitable for some people. Tell your doctor before starting the medicine if you: have had an allergic reaction to metformin or other medicines in the past have uncontrolled diabetes have liver or kidney problems have a severe infection are being treated for heart failure or you have recentl Continue reading >>

Proper Use

Proper Use

Drug information provided by: Micromedex This medicine usually comes with a patient information insert. Read the information carefully and make sure you understand it before taking this medicine. If you have any questions, ask your doctor. Carefully follow the special meal plan your doctor gave you. This is a very important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed. Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment. Swallow the extended-release tablet whole with a full glass of water. Do not crush, break, or chew it. While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way. You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the Continue reading >>

Metformin Dosage 250mg Is Too Low?

Metformin Dosage 250mg Is Too Low?

Friend Thin super-active but rising FBG; Mom T2 I felt nothing after one week on 250mg glucostage. Maybe the dosage is too low and too soon to share experience. I read someone saying met needs at least 1000mg to start working, is it true? I am considering raising it to 850mg XR after 90days, when I will do a blood testing At first metformin 500 mg worked but eventually needed more and that is when i couldnt handle the side effects. Also you have to eat low carb with it to work good D.D. Family Getting much harder to control A lot depends on what your eating. Met can not counter act what carbs do. Also it could take 6 weeks to fully work most likely they started you low dose to prevent stomach issues. I started 500mg for first week and then upped to 1000mg. As furball says the initial lower dose is so your body adjusts. 250 does sound a bit low though. I am also taking 2.5mg of glipizide once a day. Friend Thin super-active but rising FBG; Mom T2 I work hard to persuade dr. for even 250mg dosage because in their book the patient is normal unless FBG is 7+ or HBA1c is 6.5%+ After 3 months, I will have the battle to get 850mg XR ... I truely believe Met needs more dosage to work.. 250mg, which is too low, is wasting my kidney and my time.... D.D. Family Getting much harder to control Friend Thin super-active but rising FBG; Mom T2 it's like eating much salt while I am not a salty dinner fan... Met is dumped by my kidney, right? My lovely organ should not "in vain" function, my opinion... D.D. Family Getting much harder to control Met works in the liver and reduces insulin resistance and you been on it only one week it's not like a pancreas stimulating med. D.D. Family diabetic since 1997, on insulin 2000 When I first started metformin, I had to raise it to 2550 mg before Continue reading >>

Safe Prescribing Of Metformin In Diabetes

Safe Prescribing Of Metformin In Diabetes

Metformin is the first-line pharmacological therapy for type 2 diabetes. It is the only glucose-lowering oral drug that has been shown to reduce mortality in patients with diabetes. The most common adverse effect is gastrointestinal upset. Starting at a low dose and increasing it slowly reduces this risk. Taking metformin with food also helps. Numerous contraindications to the use of metformin are listed in the product information, including reduced renal function. Strict adherence to these recommendations may deny a valuable drug to many patients. Introduction Metformin lowers both fasting and postprandial blood glucose. It reduces hepatic glucose output 1 and increases peripheral glucose uptake, and may delay intestinal glucose absorption. Its use is not associated with weight gain and hypoglycaemia is extremely rare when metformin is used on its own. It lowers triglyceride concentrations and has small but beneficial effects on total and high-density lipoprotein cholesterol. In the UK Prospective Diabetes Study metformin reduced diabetes-related and all-cause mortality, and reduced the risk of myocardial infarction in obese patients with type 2 diabetes when used as first-line therapy. It also reduced the risk of microvascular complications, but was no more effective than insulin or sulfonylureas. 2 A retrospective cohort study from the USA found a lower rate of hospitalisations for myocardial infarction and stroke and a reduced death rate when metformin was used first-line in type 2 diabetes in comparison with a sulfonylurea. 3 Metformin is effective when used with other glucose-lowering drugs. A standard-release (3000 mg/day maximum dose) and an extended-release preparation of metformin (2000 mg/day maximum dose) are available. The extended-release preparation can b Continue reading >>

"low Dose" Metformin Improves Hyperglycemia Better Than Acarbose In Type 2 Diabetics

Rev Diabet Stud. 2004 Summer; 1(2): 8994. Published online 2004 Aug 10. doi: 10.1900/RDS.2004.1.89 "Low Dose" Metformin Improves Hyperglycemia Better Than Acarbose in Type 2 Diabetics 1Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan 2Department of Internal Medicine, Hamamatsu Red Cross Hospital, Hamamatsu, 430-0907, Japan 3Department of Internal Medicine, Tokyo Denryoku Hospital, Tokyo, 160-0016, Japan Address correspondence to: Akira Shimada, e-mail: [email protected] Copyright 2004, SBDR - Society for Biomedical Diabetes Research This article has been cited by other articles in PMC. OBJECTIVES: "High dose" metformin therapy (2,550 mg/day) is reported to improve glycemic control in type 2 diabetic patients with obesity (body mass index (BMI) 30). Some have reported that metformin therapy, even in low doses (500-750 mg/day), improves glycemic control in non-obese type 2 diabetic patients (BMI approximately 25). However, it is unclear whether "low dose" metformin improves glycemic control better than acarbose in non-obese type 2 diabetic patients, which has been shown to improve glycemic control in type 2 diabetes with obesity. METHODS: We randomly divided 22 non-obese type 2 diabetic patients (mean BMI approximately 25) into two groups (A = 11, B = 11). Group A was treated with "low dose" metformin (500-750 mg/day) for 3 months, and switched to acarbose (150-300 mg/day) for another 3 months. Group B was treated with acarbose first, and then switched to "low dose" metformin. RESULTS: "Low dose" metformin significantly decreased the fasting plasma glucose (FPG) and HbA1c level in both groups A and B, whereas acarbose decreased HbA1c levels in group B but not in group A. Overall, "low dose" met Continue reading >>

Metformin

Metformin

Adult Dosing . Dosage forms: TAB: 500 mg, 850 mg, 1000 mg; ER TAB: 500 mg, 750 mg, 1000 mg diabetes mellitus, type 2 [immediate-release form] Dose: 850-1000 mg PO bid; Start: 850 mg PO qd or 500 mg PO bid, incr. 500 mg qwk or 850 mg q2wk; Max: 2550 mg/day; Info: give w/ meals; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn [extended-release form] Dose: 1000-2000 mg ER PO qpm; Start: 500 mg ER PO qpm, incr. 500 mg/day qwk; Max: 2000 mg/day ER; Alt: 1000 mg ER PO bid; Info: may add 500 mg regular form if inadequate response; give w/ meals; do not cut/crush/chew ER tab; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn *polycystic ovary syndrome [immediate-release form] Dose: 500 mg PO tid; Max: 2550 mg/day; Alt: 850-1000 mg PO bid; Info: may incr. dose if inadequate response; give w/ meals; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn [extended-release form] Dose: 1500-2000 mg ER PO qpm; Info: give w/ meals; do not cut/crush/chew ER tab; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn renal dosing [see below] eGFR 30-45: avoid use; eGFR <30: contraindicated hepatic dosing [see below] hepatic impairment: avoid use Continue reading >>

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