Monograph Details
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Endocrine System
> Diabetes
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GLUCOPHAGE |
| Manufacturer |
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Bristol-Myers Squibb |
| Legal Classification |
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Rx
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| Pharmacological Class |
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Biguanide. |
| Generic Name |
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Metformin HCl 500mg, 850mg, 1g; tabs. |
| Also |
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• GLUCOPHAGE XR
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| Indications |
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Adjunct to diet and exercise in type 2 diabetes as monotherapy, or (in adults) with a sulfonylurea or insulin. |
| Children |
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Take with meals. <10yrs: not recommended. ≥10yrs: Monotherapy only: Initially 500mg twice daily; may increase by 500mg/day at 1-week intervals. Max 2g/day in divided doses. |
| Adults |
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Take with meals. ≥17yrs: Monotherapy: Initially 500mg twice daily or 850mg once daily; may increase by 500mg/day at 1-week intervals or by 850mg/day in divided doses at 2-week intervals. Or, may increase from 500mg twice daily to 850mg twice daily after 2 weeks. Max 2.55g/day in 2–3 divided doses. Adding to insulin: initially 500mg once daily; may increase by 500mg/day at 1-week intervals; max 2.5g/day. Reduce insulin dose by 10–25% as needed. Concomitant sulfonylureas: see literature. |
| Contraindications |
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Renal disease or dysfunction. Metabolic acidosis, ketoacidosis. Concomitant intravascular iodinated contrast agents (suspend during and for 48 hours after use). |
| Precautions |
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Confirm normal renal function before starting and monitor (esp. in patients ≥80yrs). Avoid in hepatic disease. Discontinue if lactic acidosis, shock, acute MI, sepsis, or hypoxemia occurs. Suspend therapy if dehydration occurs or before surgery. Monitor hepatic function, hematology (esp. serum Vit. B12 in susceptible patients). Stress. Secondary failure. Elderly, debilitated, uncompensated strenuous exercise, malnourished or deficient caloric intake, adrenal or pituitary insufficiency, or alcohol intoxication: increased risk of hypoglycemia. Pregnancy (Cat.B), nursing mothers: not recommended; consider using insulin instead. |
| Interactions |
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Cationic drugs eliminated by renal tubular secretion (eg, amiloride, cimetidine, digoxin, procainamide, quinidine, trimethoprim, ranitidine), furosemide, nifedipine: may increase metformin levels. Avoid excessive alcohol intake (potentiates effects of metformin on lactate). Diuretics, steroids, phenothiazines, phenytoin, sympathomimetics, calcium channel blockers, isoniazid, niacin, others may cause hyperglycemia. Increased risk of hypoglycemia with alcohol, sulfonylureas, insulin, repaglinide. β-blockers may mask hypoglycemia. |
| Adverse Reactions |
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GI disturbances, transient taste disturbance, lactic acidosis (rare, half the cases are fatal). |
| How Supplied |
XR 500mg, 750mg—100
Tabs 500mg—100, 500
850mg, 1g—100 |
| Additional Resources |
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• Related Prescribing Note |
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