Metfogamma pills 850mg №30

Mechanism of action

Oral hypoglycemic drug from the group of biguanides. It inhibits gluconeogenesis in the liver, reduces the absorption of glucose from the intestine, increases peripheral glucose utilization, and also increases the sensitivity of tissues to insulin. It has no effect on insulin secretion by the pancreatic β-cells.

Reduces triglycerides, LDL.

Stabilizes or reduces body weight.

It has a fibrinolytic effect due to the suppression of a tissue-type plasminogen activator inhibitor.

Pharmacokinetics

Suction

After oral administration, Metformin is absorbed from the gastrointestinal tract. Bioavailability after taking the standard dose is 50-60%. C_max after ingestion is achieved after 2 hours.

Distribution

Practically does not bind to plasma proteins. Accumulates in the salivary glands, muscles, liver, kidneys.

Removal

Excreted unchanged with urine. T_1/2 is 1.5-4.5 hours

Pharmacokinetics in special clinical situations

With impaired renal function, the drug may accumulate.

Indications

- Type 2 diabetes mellitus (non-insulin-dependent) without ketoacidosis (especially in patients with obesity) with poor diet therapy.

Dosage and administration

Set individually, taking into account the level of glucose in the blood.

The initial dose is, as a rule, 850 mg (1 tab.) / Day. A further gradual increase in dose is possible depending on the effect of therapy. Maintenance dose is 850-1700 mg (1-2 tab) / day. The maximum daily dose is 2550 mg (3 tab).

The daily dose exceeding 850 mg is recommended to be taken in 2 doses (in the morning and in the evening).

Have elderly patients The recommended dose should not exceed 850 mg / day.

Tablets should be taken with a meal whole, washed down with a small amount of liquid (a glass of water).

The drug is intended for long-term use.

Due to the increased risk of lactic acidosis, with severe metabolic disorders, the dose should be reduced.

Side effect

Gastrointestinal: nausea, vomiting, abdominal pain, diarrhea, lack of appetite, metallic taste in the mouth (as a rule, do not require stopping treatment, and the symptoms go away on their own without changing the drug dose; the frequency and severity of side effects can be reduced with a gradual increase in the dose of metformin); rarely - pathological abnormalities of liver tests, hepatitis (disappear after drug withdrawal).

Allergic reactions: skin rash.

On the part of the endocrine system: hypoglycemia (when used in inadequate doses).

Metabolism: rarely - lactic acidosis (requires discontinuation of treatment), with long-term use - hypovitaminosis B₁₂ (impaired absorption).

Hemic and lymphatic: in some cases - megaloblastic anemia.

Contraindications

- diabetic ketoacidosis, diabetic precoma, coma;

- pronounced renal dysfunction;

- cardiac and respiratory failure, acute phase of myocardial infarction, acute cerebrovascular accident, dehydration, chronic alcoholism and other conditions that may contribute to the development of lactic acidosis;

- lactic acidosis and indications of it in the anamnesis;

- serious surgeries and injuries (in these cases, insulin therapy is indicated);

- abnormal liver function;

- acute alcohol poisoning;

- use for at least 2 days before and 2 days after conducting radioisotope or x-ray studies with the introduction of iodine-containing contrast agent;

- compliance with a low-calorie diet (less than 1000 calories / day);

- pregnancy;

- lactation period (breastfeeding);

- hypersensitivity to the drug.

It is not recommended to use the drug in patients older than 60 years who perform heavy physical work, due to the increased risk of lactic acidosis.

Use during pregnancy and lactation

The drug is contraindicated for use during pregnancy and lactation (breastfeeding).

Special notes

During the period of use of the drug should be monitored indicators of renal function. At least 2 times a year, as well as the appearance of myalgia should determine the content of lactate in the plasma.

Use of the drug Metfohamma is possible.^® 850 in combination with sulfonylurea derivatives or insulin, especially careful monitoring of blood glucose levels is necessary.

Influence on ability to drive motor transport and control mechanisms

When used as a monotherapy, the drug does not affect the ability to drive vehicles and work with mechanisms.

The combination of metformin with other hypoglycemic drugs (sulfonylurea derivatives, insulin) may develop hypoglycemic states in which the ability to drive vehicles and other potentially dangerous activities that require increased attention and psychomotor reactions is deteriorating.

Overdosage

Symptoms: may develop lactic acidosis with a fatal outcome. The cause of the development of lactic acidosis may also be the cumulation of the drug due to impaired renal function. The early symptoms of lactic acidosis are nausea, vomiting, diarrhea, a decrease in body temperature, pain in the abdomen, pain in the muscles, and, in the future, increased breathing, dizziness, impaired consciousness and the development of coma.

Treatment: if there are signs of lactic acidosis, treatment with Metphogamma 850 should be immediately stopped, the patient should be urgently hospitalized and, having determined the concentration of lactate, the diagnosis should be confirmed. Hemodialysis is most effective for removing lactate and metformin from the body.If necessary, conduct symptomatic therapy.

With combination therapy with sulfonylurea drugs, hypoglycemia may develop.

Drug interaction

With simultaneous use with sulfonylurea derivatives, acarbose, insulin, NSAIDs, MAO inhibitors, oxytetracycline, ACE inhibitors, clofibrate derivatives, cyclophosphamide and beta-adrenergic blockers, the hypoglycemic effect of metformin may be enhanced.

When used simultaneously with GCS, oral contraceptives, epinephrine (adrenaline), sympathomimetics, glucagon, thyroid hormones, thiazide and "loop" diuretics, phenothiazine derivatives and nicotinic acid, the hypoglycemic action of metformin may be reduced.

Cimetidine slows down the excretion of metformin, and as a result, the risk of lactic acidosis increases.

Metformin can weaken the effect of anticoagulants (coumarin derivatives).

When taken simultaneously with ethanol may develop lactic acidosis.

With simultaneous use of Nifedipine increases the absorption of metformin, C_maxslows excretion.

Cationic drugs (amlodipine, Digoxin, morphine, procainamide, quinidine, quinine, Ranitidine, triamterene, vancomycin) secreted in the tubule, compete for canalicular transport systems and with prolonged therapy can increase C_max metformin by 60%.

Terms and conditions of storage

The drug should be stored out of the reach of children at a temperature not higher than 25 ° C. Shelf life - 4 years.