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Metformin

instruction for use



Drugs with active ingredient metformin (metformin) : Vero-Metformin; Glikomet; Glikomet-500; Gliminfor; Gliformin; Glukofagum; Glyukofazh; Dianormet; Metfogamma; Metfogamma 500; Metfogamma 850; Metformin; Metformin-BMS; Metformin-vero; Metformin hydrochloride; Orabetum; Siofor; Siofor 500; Siofor 850; Pliva Forminum.

Metformin - treatment of non-insulin-dependent diabetes mellitus of the II type, especially against the background of obesity at unsatisfactory compensation of a metabolism a diet and physical activity. Metformin - a key to a solution of the problem of insulin resistance.

  • improves digestion of glucose fabrics due to increase in sensitivity to insulin;
  • reduces products of glucose a liver;
  • reduces vsasyvayeny glucose in intestines.

Active - active ingredient: Hydrochloride / Metformin Metformin / Metformin.

Dosage forms: Tablets for intake.

Property / Effect of metformin :
Metformin - oral gipoglikemiziruyushchy means from group of biguanides.

  • increases sensitivity of peripheral receptors to insulin;
  • strengthens glucose utilization by muscles;
  • delays absorption of glucose and other carbohydrates from a GIT;
  • brakes a gluconeogenesis in a liver;
  • increases sensitivity of fabrics to insulin;
  • reduces insulin inactivation;
  • reduces glucose content in blood;
  • causes considerable lowering of body weight in the patients with diabetes having obesity;
  • reduces appetite;
  • renders favorable effect on lipidic exchange: reduces the content of the general cholesterol, level of triglycerides and LDL;
  • has anti-fibrinolytic properties;
  • does not stimulate secretion of insulin and has no hypoglycemic effect at healthy faces.

Pharmacokinetics:
It is well soaked up from a GIT. The bioavailability is 50-60%. At a concomitant use of food the absorption of metformin decreases and delayed. Metformin is quickly distributed in body tissue. Practically does not contact proteins of plasma. In very insignificant degree it biotransformirutsya in an organism. It is removed by kidneys. The clearance of metformin at healthy faces is 440 ml/min. that demonstrates active kanaltsiyevy secretion. T1/2 - 9-12 h.
At patients with a renal failure of T1/2 increases, the risk of cumulation of metformin in an organism appears.

Indications:
Non-insulin-dependent diabetes mellitus (II type), especially against the background of obesity (at unsatisfactory compensation of a metabolism a diet and physical activity).
Insulin-dependent diabetes mellitus (type I) as addition to insulin therapy (especially in the gross obesity with secondary insulin resistance).

Route of administration of metformin and dose:
Inside in time or after a meal.
The mode of dosing is set individually.
Pill should be taken entirely, in time or directly after meal.
The initial dose makes 0.5-1 g/days. In 10-15 days perhaps further gradual increase in a dose depending on hypoglycemia level. The maintenance dose of drug averages 1.5-2 g/days. It is necessary to consider that usually further increase in a dose does not lead to further increase in efficiency. The maximum dose - 3 g/days.
For reduction of by-effects from a GIT the daily dose should be divided into 2-3 receptions.

Metformin overdose :
Symptoms: development of a hypoglycemia, laktatsidoz (lactic acidosis) is possible. It is possible to refer nausea, vomiting, diarrhea, fervescence, an abdominal pain, muscle pains to precursory symptoms of a laktatsidoz; then breath increase, dizziness, disturbance of consciousness, a lump is possible.
Treatment: immediate cancellation of metformin, urgent hospitalization, definition of concentration of a lactate in blood; if necessary carry out symptomatic therapy. The hemodialysis is most effective (brings a lactate out of an organism).

Contraindications:

  • hypersensitivity to drug or its components;
  • diabetes with tendency to a laktatsidoz (pulmonary insufficiency, shock, heart failure, a myocardial infarction);
  • diabetes with existence in the anamnesis of episodes of a laktatsidoz;
  • diabetic ketoacidosis;
  • diabetic coma or prekoma;
  • serious violations of function of a liver (hepatitis, cirrhosis, steatosis);
  • renal failures (more than 12 mg of % or 0.132 mmol/l men have a creatinine level and women have 0.123 mmol/l), acute diseases in which there is a risk of developing a renal failure;
  • dehydration (in diarrhea, vomiting);
  • observance of a hypohigh-calorie diet (less than 1000 kcal/days);
  • serious injuries and surgical interventions (when performing insulin therapy is shown);
  • serious respiratory diseases, fever, serious infectious diseases;
  • serious cardiovascular illness (decompensation of heart failure, cardiogenic or toxic infectious shock, sharp phase of a myocardial infarction, disturbance blood circulation of peripheral arteries);
  • gangrene;
  • adrenal insufficiency;
  • alcoholism and acute alcoholic poisoning;
  • pregnancy, lactation.
  • Prescribing of metformin is not recommended to small children.
  • Prescribing of metformin is not recommended at therapy by diuretics or other hypotensive drugs which intake can lead to a renal failure.
  • Treatment by metformin has to be suspended in 48 hours prior to carrying out radiological (radio isotope or radiological) researches with contrasting use, for example excretory urography or an intravenous angiography with introduction of iodinated contrast means. It can be renewed in 48 hours after the end of a research.

Restrictions to metformin use :
Children's age (the efficiency and safety of use for children are not defined), elderly (65 years) age are more senior (owing to the slowed-down metabolism it is necessary to estimate a ratio advantage/risk).

Use of metformin during pregnancy and a lactation:
Contraindicated. During the planning or emergence of pregnancy metformin it is necessary to cancel and appoint insulin therapy. For the period of treatment it is necessary to stop breastfeeding.

Side effect of metformin :
From bodies of a GIT: anorexia (lack of appetite), nausea, vomiting, diarrhea, a meteorism , abdominal pain (arise at the beginning of therapy more often and pass independently), metal smack in a mouth.
From a metabolism: in exclusively exceptional cases - lactic acidosis, the hypoglycemia demands drug withdrawal (weakness, drowsiness, hypotension, reflex bradyarrhythmia, respiratory disturbances, an abdominal pain, myalgia, a hypothermia).
From a cardiovascular system and blood (hemopoiesis, a hemostasis): in some cases at prolonged use - megaloblastny anemia, B12 vitamin hypovitaminosis (result of disturbance of absorption of B12 vitamin and folic acid).
Allergic reactions: skin rash, dermatitis.

Special instructions and precautionary measures:
It is not recommended to use in acute infections and exacerbation of chronic infectious and inflammatory diseases, injuries, acute surgical defeats in dehydration conditions.
Persons should not appoint more senior than 60 years or performing hard physical activity (owing to the increased risk of developing lactic acidosis - a laktatsidoz).
During treatment the control of function of kidneys (glomerular filtration) and a liver, glucose level in blood is necessary. It is necessary to determine B12 vitamin content once a year.
It is not necessary to appoint metformin if creatinine level in blood plasma is higher than 135 µmol/l at men and 110 µmol/l is at women.
The patient has to be warned about need of the address to the doctor when developing infectious diseases of a respiratory system and urinogenital bodies and also during the developing of vomiting, an abdominal pain, myalgias, the general weakness (possible symptoms of a laktatsidoz).
Do not apply before surgeries or within 2 days after their carrying out and also during 2 days before performance of diagnostic tests (in/in urography, an angiography, etc.).
The undesirable phenomena from a GIT can be reduced by use of antacids, derivatives of atropine or spasmolysants. At the constant phenomena of dyspepsia metformin should be cancelled.
At conversion of the patient to metformin, it is appointed right after cancellation of the previous drug, except for chlorpropamide replacement (the 2 weeks break in treatment caused by long T1/2 of drug is necessary).

Medicinal interaction:
Effect of metformin is strengthened by NPVS, MAO inhibitors, Oxytetracyclinum, APF inhibitors derivative of Clofibratum, cyclophosphamide, beta blockers.
At combined use of metformin with sulphonylurea derivatives, insulin, acarbose and salicylates the potentiation of hypoglycemic action is possible. Let's combine with sulphonylurea derivatives, insulin.
Nifedipine increases absorption, Cmax, prolongs metformin removal.
The effect of metformin is weakened by fenotiazina, hormones of a thyroid gland, are oestrogenic, oral contraceptives, Phenytoinum, niacin, antagonists of calcium, an isoniazid.
At simultaneous use of drug metformin with danazoly development of hyper glycemic effect is possible (such combination is not recommended).
At combined use of drug, metformin and Chlorpromazinum should be considered that the neuroleptic at use in high doses reduces release of insulin and increases glucose level in blood (at the same time dose adjustment of metformin under control of level of glucose in blood can be required).
At simultaneous carrying out injections of beta2-sympathomimetics the weakening of hypoglycemic effect of metformin is possible (it is necessary to control glucose content in blood and if necessary to appoint insulin).
At joint purpose of GKS (for system and topical administration) affect efficiency of metformin, reducing tolerance to glucose and increasing glucose level in blood plasma, in certain cases causing a ketosis (in need of use of such combination the dose adjustment of metformin under control of level of glucose in blood is required).
Effect of metformin weaken thiazide, etc. diuretics. Furosemide increases metformin Cmax by 22%. Metformin reduces Cmax and T1/2 of furosemide by 31% and 42.3% respectively. Simultaneous use of loopback diuretics and metformin can lead to emergence of a laktatsidoz because of possible development of a functional renal failure.
The drugs (amiloride, digoxin, morphine, procaineamide, quinidine, quinine, ranitidine, Triamterenum and Vancomycinum) cosecreting in tubules compete for the tubular transport systems and at long therapy can increase Cmax by 60%.
Use of iodinated X-ray contrast means for carrying out a radiological research against the background of use of metformin can lead to development of a laktatsidoz against the background of a functional renal failure.
Against the background of drug use metformin it is not necessary to take alcohol and etanolsoderzhashchy medicines. At simultaneous use of drug, metformin with ethanol and etanolsoderzhashchy drugs raises risk of development of a laktatsidoz, especially at starvation or observance of a low-calorie diet.
Metformin weakens effect of indirect anticoagulants, changes - Cimetidinum. With care combine with indirect anticoagulants and Cimetidinum.

Metformin storage conditions :
List B. It is necessary to store drug out of children's reach at a temperature from 15 ° to 25 °C.
The expiration date is specified on packing.
Prescription status - according to the prescription.


It is applied at treatment:
Infertility , diabetes , Xanthomatosis diabetic
Comments:
Irina
25.10.2011 19:36
at first Metforal 850 accepted, and segalnya Metforal appointed 1000. In what difference?
Vladimir 84 years
03.11.2011 20:44
accepted Maninil5 sugar did not exceed 7 pieces Metoformin began to prnimat the 850th sugar of 10-11 pieces at us in pharmacies of maninil no, for a long time advise as me to arrive
Hope
24.07.2015 05:03
whether it is possible to accept at the same time metformin and flemoksin solyutab?
Joe Bueno: Not a huge fan of the audio, maybe an agenda, more food examples and specifics - less testimonies overly subjective, idk maybe in the studio just seems a bit not well planned. Still a fan obviously but just some constructive criticism.

Alwin Reid: Time stamps could help achieve your aim. You might get a certain amount to watch an entire hour, but you're more likely to get ppl to watch the piece they clicked on this for, and then maybe watch then whole thing. Another suggestion, is to do a clips YouTube similar to Joe rogan JRE YouTube. It will help give you more views more money more freedom to do more and reach more people. I've started this carnivore diet 4 says ago after watching Jacked Grampa insta live stream. I have tried every diet ever, quite literally and have suffered. I am experience no hunger and down 9lbs in 4 days. This is truly changing my life.

Lijah Lee: Love it, Mark you’re the homie. Love the realness mixed with a light sense of humor always. 8 days into carnivore and feeling great, always look forward to the videos everyday

Hey There: cheese is high in histamine which can be causing issues, anything fermented, or frozen for too long or ground beefs are higher in histamine.

SaintGummie: Really enjoyed the episode. I would like to see this in podcast form due to commuting. Unfortunately I don’t have time to commit to an hour to YouTube often. Love the power project and my introduction to the Bell brothers was “Bigger Stronger Faster”. Keep up the great work guys.

Hey There: even antibiotics cause weight gain bc of the change in the biome, antibiotics and toxins are also stored in fat, so when people hit a wall it may be a wall due to toxins, not so much carbs and sugars.althought of course the carbs and sugars are a whole other topic

Channel for the boys: I'm loving the carnivore diet. I hated eating salad and shit anyway so it's the perfect diet for me. I'm back training again now and I'm down 4kgs in 2 weeks. Thanks for the information boys and the motivation 🤘.

James Paolini: Great job talking about diet soda and sugar free energy drinks ,when I first started carnivore i drank diet soda at first, but now I drink 90 percent water ,when your ready to give up the diet drinks you will just do it


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