Metformin
Metformin
MetforminPharmacological action
Peroral hypoglycemic preparation. Metformin accelerates process of transformation of a glucose in a glycogen at the expense of circulation improvement in a liver, strengthens an anaerobic glycolysis. Improves glucose consumption in peripheric tissues, including in muscles, at the expense of influence on insulinic receptors that is essential to patients with superfluous mass of a body with resistance of tissues to insulin. Metformin does not influence quantity of insulin in blood, but changes its pharmacodynamics at the expense of depression of a parity of the bound insulin to free and risings of a parity of insulin to proinsulin. Has favorable influence on a condition of a lipide exchange, reducing level of the general cholesterol (on 10-20 %), triglycerides (on 10-20 %, and at high initial level on 50 %).
Promotes depression of mass of a body and reduces risk of development of cardiovascular diseases.
Indications
- a diabetes (type II), especially in a combination to adiposity at a dietetics inefficiency;
- a diabetes (type I) at patients with adiposity as addition to an insulin therapy for the purpose of depression of requirement for insulin.
Dosage regimen
Establish individually.
The initial dose makes 0 g (1-2 tablets. On 500mg or 1 tablet. On 850 mg) in days the Dose should be raised gradually before reception of optimum effect, the maintenance dose, as a rule, makes from 1-1/days tablet. On 500mg) till 1.75 g/24h (2 tablet. On 850. The maximum daily dose makes from 2.5 g (3 tablets. On 850 mg) to 3 g (6 tablets 500mg).
The expressed effect can appear after 14 days of treatment, therefore it is not necessary to enlarge a preparation dose too quickly.
For reduction of by-effects from the party GASTROINTESTINAL TRACT the daily dose should be parted on 2-3 receptions.
The preparation should be accepted inside during meal or it is immediate after it.
Side effect
From the alimentary system: often - abdominal pains, a nausea, vomiting, absence of appetite, metal taste in a mouth, a diarrhoeia.
Allergic reactions: a dermal eruption.
From endocrine system: a hypoglycaemia (at application in a combination to derivatives); a lactic acidosis (especially at a fabric hypoxia, renal insufficiency, a circulatory unefficiency, hepatic and respiratory insufficiency).
The other: in single instances at long application - depression of concentration of vitamin B12 and Acidum folicum in blood serum.
Contraindications
- a coma;
- A lactic acidosis (including in the anamnesis);
- A metabolic acidosis;
- The expressed disturbances of function of kidneys (creatinine level in blood serum> 1.5 mg/l);
- The expressed disturbances of function of a liver;
- An alcoholism;
- A circulatory unefficiency with a fabric hypoxia;
- An acute phase of a myocardial infarction;
- Respiratory insufficiency;
- A dehydration;
- A syndrome of diabetic foot;
- Pregnancy;
- A lactemia (thoracal feeding);
- A hypersensibility to Metforminum.
Preparation do not prescribe to patients aged is more senior 65 years.
Pregnancy and lactemia
Adequate and strictly controllable clinical researches of safety of application of Metformin preparation at pregnancy and in a lactemia (thoracal feeding) it was not spent.
During pregnancy the woman recommend to translate for insulin.
In need of application of a preparation in a lactemia it is necessary to stop thoracal feeding.
Special indicatings
Prior to the beginning of treatment it is necessary to estimate functional ability of kidneys as renal insufficiency is contraindication to Metformin application.
At Metformin application there is a risk of development of the lactic acidosis which symptoms are the general bad state of health, the expressed delicacy and muscular pains, a nausea, vomiting, a diarrhoeia, abdominal pains, deep or a hurried breathing; body temperature dropping, falling of a BP and a bradycardia is thus possible. The lactic acidosis is a condition menacing to a life, and demands intensive treatment in the conditions of a hospital. The patient should be warned about possibility of occurrence of these symptoms and about necessity of the immediate notice of the doctor at their development. At occurrence described above symptoms it is necessary to stop reception of a preparation and to define level of electrolytes, Sodium lactatum in bloods, value pH, an alkaline reserve. Further it is necessary to restore normal value pH bloods (introduction of 8.4 % of a solution of sodium of bicarbonate), if necessary - prescribe insulin, symptomatic therapy; spend a hemodialysis.
The use of alcohol against Metformin application raises risk of occurrence of a lactic acidosis.
The probability of development of hypoglycemic conditions raises at Metforminum application in a combination to insulin, at an insufficient food, after appreciable exercise stresses or at the alcohol use.
In treatment it is necessary to supervise function of kidneys.
In plasma it is necessary to spend definition of the maintenance of Sodium lactatum not less often than 2 times a year.
It is not necessary to prescribe a preparation to persons aged is more senior 60 years, performing serious physical work as thus at the given category of patients the risk of development of a lactic acidosis is enlarged.
Do not recommend Metformin application at acute infectious diseases, an exacerbation of chronic infectious-inflammatory diseases, traumas, acute surgical diseases when insulin therapy carrying out is shown; before surgical operations and within 2 days after their carrying out.
It is not necessary to accept a preparation within not less than 2 days to and 2 days after radiological or radiological research with use of contrast agents.
Metformin efficiency can decrease in process of diabetes advance. In such cases expediently joint appointment of a preparation with insulin, thus is required especially careful control of level of a glucose in blood.
Influence on ability to driving of motor transport and to management of mechanisms
The question on possibility of driving of vehicles and management of mechanisms should be solved only after an estimation of individual reaction of the patient on a preparation. The preparation does not reduce ability to concentration of attention, however against its application development of hypoglycemic conditions at which ability to management of motor transport and employment by other potentially dangerous kinds of the activity demanding special attention and fast psychomotor reactions worsens is possible.
Metformin Overdosage
Symptoms: a lactic acidosis.
Treatment: preparation cancellation, urgent hospitalisation, a hemodialysis. If necessary spend symptomatic therapy.
Conditions and periods of storage
The preparation should be stored in a place inaccessible to children at temperature from 15 to 25 C. The Period of validity - 3 years.
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