Risk or onset delay reduction of type 2 DM in adult, overwt patients w/ impaired glucose tolerance &/or fasting glucose &/or increased HbA1c. Monotherapy or in combination w/ other oral antidiabetics or insulin for type 2 DM in adults when dietary management & exercise alone does not result in adequate glycaemic control.
Risk or onset delay reduction of type 2 DM Initially metformin 500 mg XR tab once daily, adjust doses based on blood glucose measurements after 10-15 days. Max: 1,500 mg once daily. Monotherapy & combination w/ other oral antidiabetics Initially 1 tab once daily, adjust doses based on blood glucose measurements after 10-15 days. Max: 2 tab once daily. Patient already treated w/ metformin Start w/ same daily dose of metformin IR tab. Transfer from another oral antidiabetic agents Discontinue the other agent & initiate at dose indicated. Combination w/ insulin Initially 1 tab once daily, adjust insulin dose based on blood glucose measurements. Max: 1,500 mg once daily. Renal impairment GFR 30-44 mL/min Max: 1,000 mg daily, GFR 45-89 mL/min Max: 2,000 mg daily.
Increased risk of lactic acidosis. Discontinue use 48 hr prior to & at the time of surgery w/ general, spinal or epidural anaesth; intravascular administration of iodinated contrast agents. Regularly monitor use in patients w/ stable heart failure. Continue energy-restricted diet in overwt patients. Assess GFR prior to & regularly thereafter. Periodically monitor vit B12 levels & regularly monitor glycaemic status during therapy. Increased risk of hypoglycaemia w/ concomitant use of insulin or other oral antidiabetics. Concomitant use w/ drugs acutely impairing renal function eg, antihypertensives, diuretics, NSAIDs. Hepatic & renal insufficiency. Pregnancy. Not recommended during lactation. Not to be used in childn. Not recommended in elderly ≥75 yr.
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