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Contraindications Of Metformin Tablets

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 >>

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 >>

Fortamet

Fortamet

FORTAMET® (metformin hydrochloride) Extended-Release Tablets DESCRIPTION FORTAMET® (metformin hydrochloride) Extended-Release Tablets contain an oral antihyperglycemic drug used in the management of type 2 diabetes. Metformin hydrochloride (N, Ndimethylimidodicarbonimidic diamide hydrochloride) is a member of the biguanide class of oral antihyperglycemics and is not chemically or pharmacologically related to any other class of oral antihyperglycemic agents. The empirical formula of metformin hydrochloride is C4H11N5•HCl and its molecular weight is 165.63. Its structural formula is: Metformin hydrochloride is a white to off-white crystalline powder that is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pKa of metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68. FORTAMET® Extended-Release Tablets are designed for once-a-day oral administration and deliver 500 mg or 1000 mg of metformin hydrochloride. In addition to the active ingredient metformin hydrochloride, each tablet contains the following inactive ingredients: candellila wax, cellulose acetate, hypromellose, magnesium stearate, polyethylene glycols (PEG 400, PEG 8000), polysorbate 80, povidone, sodium lauryl sulfate, synthetic black iron oxides, titanium dioxide, and triacetin. FORTAMET® meets USP Dissolution Test 5. System Components And Performance FORTAMET® was developed as an extended-release formulation of metformin hydrochloride and designed for once-a-day oral administration using the patented single-composition osmotic technology (SCOT™). The tablet is similar in appearance to other film-coated oral administered tablets but it consists of an osmotically active core formulation that is surrounded by a semipermeable membra Continue reading >>

Tips From Other Journals - American Family Physician

Tips From Other Journals - American Family Physician

Am Fam Physician.1998Feb1;57(3):536-537. In 1995, biguanide metformin was approved by the U.S. Food and Drug Administration for use in the treatment of type 2 diabetes. Use of biguanide phenformin in the 1970s led to its subsequent withdrawal from the market in many countries because of a high incidence of lactic acidosis in patients with renal impairment, hepatic dysfunction or cardiac disease. Sulkin and associates studied the prevalence of conditions currently regarded as contraindications or cautions to the use of metformin in patients receiving this agent. The authors identified the following potential contraindications or cautions to metformin therapy: (1) renal impairment, defined as a plasma creatinine level greater than 1.4 mg per dL (120 mol per L) or dipstick-positive proteinuria, (2) cardiac failure, (3) chronic hepatic dysfunction, (4) significant chronic pulmonary disease, (5) coronary artery disease, (6) peripheral vascular disease, and (7) miscellaneous conditions (intercurrent illnesses, acute trauma or major surgical procedures, and metastatic malignancy). The authors reviewed the medical records of 89 patients receiving metformin to identify the prevalence of potential contraindications to the use of the drug. These patients were seen at a university hospital diabetes clinic in the United Kingdom. The authors found that over one half of the patients had conditions regarded as cautions or contraindications to the use of metformin, eight of the patients had two conditions, five patients had three conditions and one patient had four conditions. The most common conditions were peripheral vascular disease (22 patients), ischemic heart disease (20 patients) and proteinuria (14 patients). Two of the patients had a significant degree of renal impairment. The Continue reading >>

Metformin

Metformin

Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have kidney disease. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. Also, tell your doctor if you plan to have any x-ray procedure in which dye is injected, especially if you drink or have ever drunk large amounts of alcohol or have or have had liver disease or heart failure. You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Your doctor will tell you exactly when you should stop taking metformin and when you should start taking it again. If you experience any of the following symptoms, stop taking metformin and call your doctor immediately: extreme tiredness, weakness, or discomfort; nausea; vomiting; stomach pain; decreased appetite; deep and rapid breathing or shortness of breath; dizzi Continue reading >>

Glucophage, Glucophage Xr (metformin) Dosing, Indications, Interactions, Adverse Effects, And More

Glucophage, Glucophage Xr (metformin) Dosing, Indications, Interactions, Adverse Effects, And More

Initial: 500 mg PO q12hr or 850 mg PO qDay with meals; increase q2Weeks Maintenance: 1500-2550 mg/day PO divided q8-12hr with meal Glucophage XR: 500 mg PO qDay with dinner; titrate by 500 mg/day qWeek; not to exceed 2000 mg/day Fortamet: 500-1000 mg PO qDay; titrate by 500 mg/day qWeek; not to exceed 2500 mg/day Glumetza: 1000 mg PO qDay; titrate by 500 mg/day qWeek; not to exceed 2000 mg/day Hepatic impairment: Avoid use; risk of lactic acidosis eGFR 30-45 mL/min/1.73 m: Not recommended to initiate treatment Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly) If eGFR falls below 45mL/min/1.73 m while taking metformin, risks and benefits of continuing therapy should be evaluated If eGFR falls below 30 mL/min/1.73 m: while taking metformin, discontinue the drug Orphan designation for treatment of pediatric polycystic ovary syndrome EffRx Pharmaceuticals SA; Wolleraustrass 41 B; 8807 Freienbach (SZ); SWITZERLAND Orphan designation for treatment of progressive myoclonus epilepsy type 2 (Lafora disease) Consorcio Centro de Investigacin Biomdica en Red, M.P. (CIBER); Monforte de Lemos, 3-5 Pabellon 11; Madrid, Spain Maintenance: Titrate qWeek by 500 mg; no more than 2000 mg/day in divided doses Initial: 500 mg PO q12hr or 850 mg PO qDay with meals; increase q2Weeks Maintenance: 1500-2550 mg/day PO divided q8-12hr with meal Glucophage XR: 500 mg PO qDay with dinner; titrate by 500 mg/day qWeek; not to exceed 2000 mg/day Fortamet: 500-1000 mg PO qDay; titrate by 500 mg/day qWeek; not to exceed 2500 mg/day eGFR 30-45 mL/min/1.73 m: Initiating not recommended Obtain GFR at least annually in all patients taking metformin; assess eGFR more frequently in patients at increased risk for renal impairment (eg, elderly) If eGFR falls to <4 Continue reading >>

Metformin Contraindications

Metformin Contraindications

The biguanide metformin (dimethylbiguanide) was initially introduced for use in the treatment of type 2 diabetes mellitus in the late 1950s. Today this drug is considered to be the first-choice agent and the “gold standard” for most people with type 2 diabetes. It has been estimated that the annual number of people receiving prescriptions for metformin worldwide is more than 120 million. The efficacy and benefits of metformin treatment in type 2 diabetes have been confirmed by large-scale studies and recognized by many consensus statements. Still, a large list of contraindications may increase the incidence of serious adverse effects, which precludes many patients from taking metformin. Intolerance and contraindications to metformin Three particular contraindications to the use of metformin have been suggested. They include renal impairment with elevated serum creatine levels (i.e. more than 136 mmol/l in men and 124 mmol/l in women) or abnormal creatinine clearance, congestive heart failure requiring pharmacologic treatment and advanced age (more than 80 years of age). Renal impairment represents a contraindication to metformin usage due to the increased risk of lactic acidosis (a form of metabolic acidosis due to the inadequate clearance of lactic acid from the blood). Although lactic acidosis linked to metformin is a rare condition, with an estimated prevalence of one to five cases per 100 000 population, it has a reported mortality of 30-50%. However, recent studies have suggested that metformin can be used safely, unless the estimated glomerulal filtration rate (the volume of fluid that is filtered from the capillaries of the glomeruli into the kidney tubules per unit time) falls below 30 ml/min, with a dose reduction advised at 45 ml/min. Congestive heart fail Continue reading >>

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

Fda Drug Safety Communication: Fda Revises Warnings Regarding Use Of The Diabetes Medicine Metformin In Certain Patients With Reduced Kidney Function

Fda Drug Safety Communication: Fda Revises Warnings Regarding Use Of The Diabetes Medicine Metformin In Certain Patients With Reduced Kidney Function

[ 4-8-2016 ] The U.S. Food and Drug Administration (FDA) is requiring labeling changes regarding the recommendations for metformin-containing medicines for diabetes to expand metformin’s use in certain patients with reduced kidney function. The current labeling strongly recommends against use of metformin in some patients whose kidneys do not work normally. We were asked1,2 to review numerous medical studies regarding the safety of metformin use in patients with mild to moderate impairment in kidney function,3-14 and to change the measure of kidney function in the metformin drug labeling that is used to determine whether a patient can receive metformin. We have concluded our review, and are requiring changes to the labeling of all metformin-containing medicines to reflect this new information. Health care professionals should follow the latest recommendations when prescribing metformin-containing medicines to patients with impaired kidney function. Patients should talk to their health care professionals if they have any questions or concerns about taking metformin. Metformin-containing medicines are available by prescription only and are used along with diet and exercise to lower blood sugar levels in patients with type 2 diabetes. When untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease. Metformin-containing medicines are available as single-ingredient products and also in combination with other drugs used to treat diabetes (see FDA Approved metformin-containing Medicines). The current drug labeling strongly recommends against metformin use in some patients whose kidneys do not work normally because use of metformin in these patients can increase the risk of developing a serious and potentially dead Continue reading >>

Metformin - Oral, Glucophage

Metformin - Oral, Glucophage

are allergic to dapagliflozin or any of the ingredients in FARXIGA. Symptoms of a serious allergic reaction may include skin rash, raised red patches on your skin (hives), swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing. If you have any of these symptoms, stop taking FARXIGA and contact your healthcare provider or go to the nearest hospital emergency room right away have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems Ketoacidosis occurred in people with type 1 and type 2 diabetes during treatment with FARXIGA. Ketoacidosis is a serious condition which may require hospitalization and may lead to death. Symptoms may include nausea, tiredness, vomiting, trouble breathing, and abdominal pain. If you get any of these symptoms, stop taking FARXIGA and call your healthcare provider right away. If possible, check for ketones in your urine or blood, even if your blood sugar is less than 250 mg/dL Kidney problems. Sudden kidney injury occurred in people taking FARXIGA. Talk to your doctor right away if you reduce the amount you eat or drink, or if you lose liquids; for example, from vomiting, diarrhea, or excessive heat exposure Serious urinary tract infections (UTI), some that lead to hospitalization, occu Continue reading >>

Metformin Indications

Metformin Indications

Metformin is primarily suited for the treatment of subjects with non-insulin-dependent diabetes mellitus (type II diabetes). Compared to other antidiabetic agents, it has the advantages of lowering rather than increasing body weight, of not causing hypoglycemia, and of entailing a reduction of triglycerides and LDL-cholesterol levels. Metformin is therefore recommended in single drug therapy especially for obese subjects. In the majority of the treated subjects, a lowering of blood glucose levels by at least 25% is achieved (i.e. almost identical results as with sulfonylureas at the beginning of treatment). Metformin can also be combined with other antidiabetic agents. It can thus e.g. be used when there is secondary failure with sulfonylureas. Occasionally a small dose of metformin combined with a sulfonylurea is sufficient to restore an adequate diabetic control. In carefully selected cases, a combination with insulin can also be sensible particularly for obese subjects with relative insulin resistance. Proof that the drug has an advantageous effect on the prognosis of diabetes (complications, mortality) does not exist. Continue reading >>

Is Alcohol Contraindicated With Metformin

Is Alcohol Contraindicated With Metformin

Is Alcohol Contraindicated With Metformin Is Alcohol Contraindicated With Metformin Is Alcohol Contraindicated With Metformin Metformin and Alcohol / Food Interactions - Drugs.com Metformin and Alcohol / Food Interactions. Overview; Side Effects; Dosage; Interactions; Patient Tips; ... Ask your doctor before using ethanol together with metFORMIN. Contraindications for metformin oral - WebMD WebMD provides common contraindications for metformin oral. ... metformin contraindications ... Habit of Drinking Too Much Alcohol ... Metformin and Alcohol - Diabetes Home Page An Overview of Metformin and Alcohol Metformin (Glucophage ... Glucophage, Glucophage XR (metformin) dosing, indications ... ... comprehensive interactions, contraindications, ... during metformin therapy because alcohol potentiates the effects of metformin on lactate metabolism ... Glucophage, Glucophage XR (Metformin Hcl) Drug ... - RxList Learn about overdosage and contraindications for the drug Glucophage, Glucophage XR (Metformin Hcl ... GLUCOPHAGE and GLUCOPHAGE XR are contraindicated in ... Metformin's contraindications should be contraindicated Metformin's contraindications should be contraindicated. James McCormack, ... hepatic disease, excessive alcohol intake, surgery) .5 In particular ... Metformin Contraindications - News Medical Metformin Contraindications. ... Intolerance and contraindications to metformin. Three particular contraindications to the use of metformin have been suggested. Metformin - Side Effects, Uses, Dosage, Overdose ... - rxwiki ... overdose, pregnancy, alcohol and more. Learn more about Metformin Home Medications Conditions News Discounts Pharmacy Solutions About Us ... Glyburide and Metformin: MedlinePlus Drug Information Glyburide and Metformin: learn about side effects .. Continue reading >>

Metformin In The Diabetic Elderly Patient: An Old, Safe And Effective Treatment

Metformin In The Diabetic Elderly Patient: An Old, Safe And Effective Treatment

Metformin in the diabetic elderly patient: an old, safe and effective treatment Over-65 diabetics represent about half of the patients visiting general practitioners. Although diabetes pathogenesis in geriatric and young age are similar, treatment gold standards and clinical conditions are extremely variable, requiring a more individualised approach.1 In this context, a recent review points out that there is no clear evidence for the optimal glycaemic target in the elderly patient and that patient’s preferences and pharmacologic burden must be taken into consideration, within the therapeutic choices, together with the possible risks and benefits associated to single treatments.2 This study also suggests a HbA1c value between 7.5% and 9.0% as optimal glycaemic target in the elderly patient. Steps for the individualised treatment of diabetes in the elderly patient:2 Estimate desired benefits upon the life expectancy Estimate the risks potentially associated with intensive glycaemic control (age, polypharmacy, disease duration, social support) Particularly in the elderly patient, the onset of hypoglycaemia is often associated with severe consequences and is facilitated by several factors, such as polypharmacy and the risk of subsequent interactions, the mistakes caused by the reduced ability of handling medicines, the inability of evaluating the relation between ingested carbohydrates and the therapy, the scarce symptomatology of neuropathies and the reduced adrenergic reaction.3 Hypoglycaemia absolute risk increases with age, therefore in elderly diabetics it is often preferable to avoid intensive hypoglycaemic treatments that increase the risk of hypoglycaemia4 whilst low hypoglycaemia risk treatments should be privileged, even at the expense of a less than optimal gl Continue reading >>

Metformin (hcl) - Drug Monograph - Druginfosys.com

Metformin (hcl) - Drug Monograph - Druginfosys.com

18 Hormones and other endocrine drugs and contraceptives Metformin (HCl)'s dosage details are as follows: Frequency may be increased upto 3times/day, if needed. Gradually increase upto 2-3 g/day. No data regarding the neonatal dosage details of Metformin (HCl) is available. Manufacturers of Metformin (HCl) in Pakistan Site designed by Pharma Professional Services and developed by Hasan Computing Systems Information provided on this Web site is neither intended nor implied to be a substitute for professional medical advice. You should not use this information on this web site or the information on links from this site to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Pharma Professional Services advises you to always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. You should check with your physician/health care provider before using any of the means or methods presented on this site. If you undertake any treatment methods displayed on this site without such supervision, you are solely and entirely responsible for it's outcome. Pharma Professional Services nor anyone connected with this site cannot be held responsible for your actions nor any conditions resulting thereof. Continue reading >>

Metformin

Metformin

Postmarketing cases of Metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of Metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia), an increased lactate/pyruvate ratio; and Metformin plasma levels generally >5 mcg/mL (see PRECAUTIONS). Risk factors for Metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g. carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage Metformin-associated lactic acidosis in these high risk groups are provided (see DOSAGE AND ADMINISTRATION, CONTRAINDICATIONS, and PRECAUTIONS). If Metformin-associated lactic acidosis is suspected, immediately discontinue Metformin and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended (see PRECAUTIONS). Table 1: Select Mean (±S.D.) Metformin Pharmacokinetic Parameters Following Single or Multiple Oral Doses of Metformin Hydrochloride Tablets Subject Groups: Metformin hydrochloride tablets dose* (number of subjects) Cmax† (mcg/mL) Tmax‡ (hrs) Renal Clearance (mL/min) * All doses given fasting except the first 18 doses of the multiple dose studies † Peak plasma concentration ‡ Time to peak plasma concentration § Co Continue reading >>

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