Metformin

When ATH:
A10BA02

Characteristic.

Metformin hydrochloride is a white or colorless crystalline powder. It is soluble in water and almost nerastvorim in acetone, ether and chloroform. Molecular weight 165,63.

Pharmacological action.
Hypoglycemic.

Application.

Diabetes mellitus type 2 (especially in cases, accompanied by obesity) the ineffectiveness of correction of hyperglycemia dietary therapy, incl. in combination with sulfonylureas drugs.

Contraindications.

Hypersensitivity, kidney disease or renal failure (creatinine levels more 0,132 mmol/l in men and 0,123 mmol/l in women), expressed human liver; states, accompanied by hypoxia (incl. cardiac and respiratory failure, acute phase of myocardial infarction, acute cerebral circulation insufficiency, anemia); degidratatsiya, infectious diseases, extensive surgery and trauma, Saint Martin's evil, acute or chronic metabolic acidosis, including Diabetic Ketoacidosis with coma or without it, acidosis in history, compliance with a low calorie diet (less 1000 kcal / day), studies using radioactive isotopes, pregnancy, lactation.

Restrictions apply.

Childhood (efficacy and safety of children are not identified), elderly (senior 65 years) age (as a result of slow metabolism it is necessary to assess the risk/benefit ratio). Nor should appoint people, performing heavy physical work (increased risk of laktatnogo azidoza).

Pregnancy and breast-feeding.

When pregnancy is possible, if the effect of therapy outweighs the potential risk to the fetus (adequate and well-controlled studies on the use during pregnancy has not been).

Category actions result in FDA - B. (The study of reproduction in animals revealed no risk of adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not done.)

At the time of treatment should stop breastfeeding.

Side effects.

From the digestive tract: at the beginning of the course of treatment-anorexia, diarrhea, nausea, vomiting, flatulence, abdominal pain (reduced when administered during a meal); metallic taste in mouth (3%).

Cardio-vascular system and blood (hematopoiesis, hemostasis): in a few cases, megaloblastic anemia (the result of malabsorption of vitamin B₁₂ and folic acid).

Metabolism: gipoglikemiâ; in rare cases, lactate acidosis (weakness, drowsiness, gipotenziya, resistant bradiaritmia, respiratory disorders, abdominal pain, myalgia, gipotermiя).

For the skin: rash, dermatitis.

Cooperation.

Effect of metformin weaken tiazidnye dioretiki and others, corticosteroids, fenotiazinы, glucagon, thyroid hormones, Estrogens, incl. consisting of oral contraceptives, phenytoin, a nicotinic acid, sympathomimetic, calcium antagonists, Isoniazid. In a single dose in healthy volunteers nifedipine increased removals, C_max and AUC of metformin, T_max and T_1/2 If this is not changed. Gipoglikemicescoe effect increase insulin, sulfonylureas, acarbose, NSAIDs, MAO inhibitors, oxytetracycline, ACE inhibitors, derivatives klofibrata, cyclophosphamide, beta-blockers. Furosemide increases (C)_max on 22%. Preparations (amilorid, Digoxin, morphine, prokaynamyd, quinidine, quinones, ranitidine, triamteren and Vancomycin), secreted into the tubules, compete for tubular transport systems and in the long-term therapy may increase C_max on 60%. Reduces C_max and T_1/2 furosemide on 31 and 42,3% respectively. Zimetidin slows elimination of metformin, as a result of which increases the risk of developing lactic acid acidosis. Incompatible with alcohol (increased risk of acidosis milk).

Overdose.

Symptoms: Lactic acidosis.

Treatment: hemodialysis, simptomaticheskaya therapy.

Dosing and Administration.

Inside, during or after a meal. Dose selected individually, but not more 3 g/day in a few receptions.

Precautions.

It continuously monitor kidney function, glomeruljarnuju filter, blood glucose. Particularly careful monitoring of blood glucose is required in the application of metformin in combination with drugs sulfonylureas or insulin (risk of hypoglycemia). Combined treatment with metformin and insulin in hospital should be held prior to the establishment of an adequate dose of each drug. In patients on continuous therapy with metformin should be 1 Once a year to determine the content of vitamin B₁₂ due to a possible reduction of its suction. You must determine the level of lactate in plasma at least 2 once a year, as well as on myalgia. With increasing content of lactate medication overturned. Do not use before surgery and during 2 days after their spending, as well as for 2 days before and after the execution of the diagnostic studies (in/in urografia, angiography etc.).

Cooperation