Indications
Treatment of sort 2 diabetes mellitus, especially in overweight patients when dietary administration and work out alone does not result in satisfactory glycaemic control. In grown-ups: Metformin may be utilized as monotherapy or in combination with other verbal antidiabetic specialists or with insulin. In children from 10 a long time of age and teenagers: Metformin may be utilized as monotherapy or in combination with insulin. A decrease of diabetic complications has been appeared in overweight sort 2 diabetic grown-up patients treated with metformin as first-line treatment after eat less disappointment.

Pharmacology
Metformin is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is different from those of sulfonylureas and it does not produce hypoglycemia. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization.

Dosage & Administration

Metformin immediate release tablet: Dosage of Metformin Hydrochloride must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily doses.

• Adult: The usual starting dose of Metformin is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in divided doses. For those patients requiring additional glycemic control, Glucomin may be given to a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given three times a day with meals.
• Children: The usual starting dose of Metformin is 500 mg twice a day, given with meals. Dosage increases should be made in increments of 500 mg weekly up to a maximum of 2000 mg per day, given in divided doses.

Metformin extended release tablet: Swallow Metformin XR tablet whole and never crush, cut or chew.

• Adult: The usual starting dose of Metformin XR is 500 mg once daily with the evening meal. Dose should be increased in increments of 500 mg weekly, up to a maximum of 2000 mg once daily with the evening meal, alternatively increased to 1000 mg twice daily taken with meal. Patient receiving Metformin immediate release tablet may be switched to Metformin extended release tablet up to a maximum recommended daily dose.
• Children: Metformin extended release tablet has not been studied in children.
• Renal impaired patient: Do not use Metformin in patients with eGFR below 30 mL/min/1.73 m2. Asses risk/benefit of counting if eGFR falls below 45 mL/min/1.73 m2.

Interaction
Co-administration with Carbonic anhydrase (Topiramate, Zonisamide) may increment chance of lactic acidosis. Drugs (Ranolazine, Dolutegravir, Cimetidine) that decrease Metformin clearance may increment the aggregation of Metformin. Liquor can potentiate the impact of Metformin on lactate digestion system.

Contraindications
Extreme touchiness to the dynamic substance or to any of the excipients. Any sort of intense metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis). Severe renal disappointment (GFR <30 mL/min). Acute conditions with the potential to modify renal work such as: drying out, extreme disease, shock. Acute or inveterate infection, which may cause tissue hypoxia such as: cardiac or respiratory disappointment, later myocardial dead tissue, stun, Hepatic insufciency, intense liquor inebriation, liquor abuse.

Side Effects
Blood and lymphatic framework clutters: Not known: Hemolytic anemia Metabolism and nourishment clutters: Exceptionally uncommon: Lactic acidosis. Diminish of vitamin B12 assimilation with a diminish of serum levels amid long-term utilize of metformin. Thought of such etiology is suggested on the off chance that a understanding presents with megaloblastic frailty. Cases of fringe neuropathy in patients with vitamin B12 insufficiency have been detailed in post-marketing involvement (recurrence not known) Nervous framework disarranges: Common: Taste unsettling influence. Not known: Encephalopathy

Pregnancy & Lactation
Gastrointestinal disarranges: Exceptionally common: Gastrointestinal clutters, such as queasiness, heaving, loose bowels, stomach torment, and misfortune of craving. These undesirable impacts happen most regularly amid the start of treatment and resolve suddenly in most cases. To avoid them, it is suggested that metformin be taken in 2 or 3 day by day dosages amid or after dinners. A moderate increment of the measurements may moreover progress gastrointestinal tolerability. Hepatobiliary disarranges: Exceptionally uncommon: Disconnected reports of liver work test anomalies or hepatitis settling upon metformin discontinuation. Skin and subcutaneous tissue clutters: Exceptionally uncommon: Skin responses, such as erythema, pruritus, urticaria.Metformin Hydrochloride is known to be significantly excreted by the kidney and the hazard of Metformin aggregation and lactic acidosis increments with the degree of impedance of renal work. Metformin may lower vitamin B12 level. It too increments hazard of hypoglycemia when utilize in combination with affront or affront secretagogue.

Precautions & Warnings
Metformin Hydrochloride is known to be significantly excreted by the kidney and the hazard of Metformin aggregation and lactic acidosis increments with the degree of impedance of renal work. Metformin may lower vitamin B12 level. It too increments hazard of hypoglycemia when utilize in combination with affront or affront secretagogue.

Therapeutic Class
Biguanides

Storage Conditions
Protect from light and moisture by storing below 30°C. Keep the medicine out of children's reach.