Metformin (HCl)

Metformin (HCl) is oral biguanide antidiabetic agent, introduced in 1950s. It reduces elevated blood glucose concentration in diabetic patients, but it does not increase insulin secretion. Metformin (HCl) is used alone or in combination with insulin or chlorpropamide. Most useful in overweight subjects, where it suppresses appetite. May cause nausea, vomiting and diarrhea.

Metformin (HCl) is primarily indicated in conditions like Diabetes mellitus, Hyperlipoproteinemia, Insulin dependent diabetes mellitus, Insulin resistance, Non-insulin dependent diabetes mellitus, Obesity.

Metformin (HCl) is contraindicated in conditions like Alcohol dependence, Anemia, Myocardial infarction, Septicemia, Infections, Respiratory disease, Ketosis, Cardiovascular disease, Diabetic coma, Trauma, Liver damage, Iron deficiency, Vitamin B12 deficiency, Renal impairment, Diabetic retinopathy.

The severe or irreversible adverse effects of Metformin (HCl), which give rise to further complications include Vasculitis, Pneumonitis, Malabsorption of vit B12, Malabsorption of folic acid, Megaloblastic anemia, Hypoglycemia. Metformin (HCl) produces potentially life-threatening effects which include Lactic Acidosis. which are responsible for the discontinuation of Metformin (HCl) therapy. The symptomatic adverse reactions produced by Metformin (HCl) are more or less tolerable and if they become severe, they can be treated symptomatically, these include Abdominal distension, Flatulence, Nausea, Vomiting, Anorexia, Diarrhea, Skin reactions, Weight Loss, Hypersensitivity, Metallic taste.

Metformin should be used with caution in patients with pre-existing liver disease, kidney disease, heart trouble or if have any allergy, infections. Avoid excessive use of alcohol while taking this. It is not recommended for use during pregnancy and should be used only if clearly needed during lactation.

Drug should not be given to Paediatrics, Pregnant Mothers, Cardiac / Hypertensive Patients, patients suffering from Kidney dysfunction, patients suffering from Liver Malfunction, Geriatrics, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

500 to 3000 mg (1800 (1750)) 12 hourly PO — Frequency may be increased upto 3times/day, if needed. Gradually increase upto 2-3 g/day.

( ) — Not recommended in this age group

No neonatal dosage information is recorded for this medicine yet.

Metformin (HCl) is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAcarboseAcarbose and guar gum both decrease the absorption of metformin.AlcoholEthanol initiate effects of metformin on lactate metabolism.ModerateAvoid intake of alcohol and notify the signs of lactic acidosis like malaise,respiratory distress,somnolence and irregular heart beat.Amiloride (HCl)Amiloride compete with metformin for renal tubular transport thus decreases excretion of metformin leads risk of lactic acidosis.ModerateMonitor patient glucose level and adjust metformin dose.AtenololAtenolol enhance the hypoglycemic effect of metformin.ModerateMonitoring of patient blood glucose level should be done when these drugs are coadministered.Chlorpromazine (HCl)Chlorpromazine decreases the hypoglycemic effect of metformin by interfering with blood glucose control. ModerateClosely monitor the blood glucose level. Adjust the dose of metformin accordingly.Cimetidine (HCl)Cimetidine decreases the renal tubular secretion of metformin result in increased AUC upto 50% and decreases the plasma clearence upto 27% reult in increased plasma level may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Monitor thr blood glucose level regularly. Patient should notify to physician if experience any sign of lactic acidosis.DigoxinDigoxin decreases the excretion of metformin by competing the renal tubular transport.ModerateDose of metformin should be reduced.Dolutegravirdolutegravir may increased the level of metforminclose monitoring and dose adjustment recommendedFrusemide or FurosemideFurosemide increases the plasma concentration while mwtformin decreases the peak concentration and elimination half life upto 31%and 32%respectively. Increase plasma level of metformin increases the risk of lactic acidosis.ModerateClosely monitor blood glucose level Patient should notify to physician if experience signs of lactic acidosisGlibenclamideHydrochlorothiazideThiazide (hydrochlorothiazide) antagonize the effect of metformin.Insulin AspartMetformin potentiate the hypoglycemic effect of insulin by increasing cellular mechanism controlled by insulin.ModerateClosely monitor the development of hypoglycaemia in patient.IoxaglateAdministration of intravascular iodinated radiocontrast media in patients treated with biguanides such as metformin may precipitate lactic acidosis, a rare but potentially serious and fatal complication of biguanide therapy. Iodinated contrast material can cause acute alterations in renal function, including acute renal failure, which is a known risk factor for biguanide-induced lactic acidosis.MajorBiguanide therapy should be temporarily discontinued at the time of, or prior to, radiographic studies involving intravascular administration of iodinated contrast media, and not resumed until at least 48 hours after the procedure and renal function has been re-evaluated and determined to be normal.IsoniazidIsoniazid decreases the hypoglycemic effect of metformin by interfering with blood glucose control.ModerateClosely monitor the blood glucose level. Adjust the dose of metformin accordingly.Metoprolol (Tartrate)Metoprolol increases the hypoglycemic effect by inhibiting hepatic glycogenolysis and insulin secretion.ModerateClosely monitor the blood glucose level on regular basis.NifedipineNifedipine increases the bioavailability of metformin by increasing its absorption thus increases the risk of lactic acidosis.ModerateClosely monitor the blood glucose level of patient. Patient should notify the sign of lactic acidosis to physician.PhenprocoumonMetformin increases elimination of phenprocoumon.Porcine InsulinProcainamide (HCl)Procainamide reduces the excretion of metformin by competing for renal tubular transport results in increased level of metforminmay lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.Propranolol (HCl)propranolol increases the hypoglycemic effect by inhibiting hepatic glycogenolysis and insulin secretion.ModerateClosely monitor the blood glucose level on regular basis.QuinidineQuinidine reduces the excretion of metformin by competing for renal tubular transport results in increased level of metformin may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.RanitidineRanitidine reduces the excretion of metformin by competing for renal tubular transport results in increased level of metformin may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.Thiamine HCl (Vitamin B1)Metformin (HCl) may reduce thiamine activity.TolbutamideTriamtereneTriamterene reduces the excretion of metformin by competing for renal tubular transport results in increased level of metformin may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.TrimethoprimTrimethoprim reduces the excretion of metformin by competing for renal tubular transport results in increased level of metformin may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.Vancomycin (HCl)Vancomycin reduces the excretion of metformin by competing renal tubular transport results in increased level of metformin may lead to lactic acidosis.ModerateSlowly reduce the dose of metformin. Closely monitor the blood glucose level. Patient should notify to physician if experience signs of lactic acidosis.VandetanibVandetanib is an inhibitor of organic cation transporter 2 and metformin is a substrate of OCT2. Therefore Vandetanib decrease the elimination of metformin.Requires dose adjustment of metformin. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Tab Store in a well closed container, Between 15°C-30°C. Protect from Moisture.