Glucophage 250mg by Merck

GLUCOPHAGE 250mg

Description
GLUCOPHAGE (metformin hydrochloride tablets) and GLUCOPHAGE XR (metformin hydrochlo-ride extended-release tablets) are oral antihyperglycemic drugs used in the management of type 2 diabetes. Metformin hydrochloride (N, N-dimethylimidodicarbonimidic diamide hydrochloride) is not chemically or pharmacologically related to any other classes of oral antihyperglycemic agents.

Metformin hydrochloride is a white to off-white crystalline compound with a molecular formula of C 4 H 11 N 5 HCl and a molecular weight of 165.63. Metformin hydrochloride is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pKa of metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68. 

GLUCOPHAGE tablets contain 500 mg, 850 mg, or 1000 mg of metformin hydrochloride. Each tablet contains the inactive ingredients povidone and magnesium stearate. In addition, the coating for the 500-mg and 850-mg tablets contains hydroxypropyl methylcellulose (hypromellose) and the coating for the 1000-mg contains hydroxypropyl methylcellulose and polyethylene glycol. 

GLUCOPHAGE XR contains 500 mg of metformin hydrochloride as the active ingredient. Each tablet contains the inactive ingredients sodium carboxymethyl cellulose, hydroxypropyl methylcel-lulose, microcrystalline cellulose, and magnesium stearate. 

System Components and Performance GLUCOPHAGE XR tablets comprise a dual hydrophilic polymer matrix system. Metformin hydrochloride is combined with a drug release controlling polymer to form an "inner" phase, which is then incorporated as discrete particles into an "external" phase of a second polymer. After administration, fluid from the gastrointestinal (GI) tract enters the tablet, causing the polymers to hydrate and swell. Drug is released slowly from the dosage form by a process of diffusion through the gel matrix that is essen-tially independent of pH. The hydrated polymer system is not rigid and is expected to be broken up by normal peristalsis in the GI tract. The biologically inert components of the tablet may occasionally remain intact during GI transit and will be eliminated in the feces as a soft, hydrated mass

INDICATIONS:

Non-insulin dependent diabetes when diet has failed and especially if the patient is overweight. Glucophage can be given alone as initial therapy, or can be administered in combination with a sulphonylurea. In insulin-dependent diabetes, Glucophage may be given as an adjuvant to patients whose symptoms are poorly controlled.

CONTRA-INDICATIONS:

Sensitivity to metformin hydrochloride. Diabetic coma and ketoacidosis, impairment of renal function, chronic liver disease, cardiac failure and recent myocardial infarction. History of, or states associated with, lactic acidosis such as shock or pulmonary insufficiency, alcoholism (acute or chronic), and conditions associated with hypoxemia. Pancreatitis. The use of Glucophage during pregnancy is not advised. There is no information available concerning the safety of Glucophage during lactation.

WARNINGS:

Sensitivity to metformin hydrochloride. Diabetic coma and ketoacidosis, impairment of renal function, chronic liver disease, cardiac failure and recent myocardial infarction. History of, or states associated with, lactic acidosis such as shock or pulmonary insufficiency, alcoholism (acute or chronic), and conditions associated with hypoxemia. Pancreatitis. The use of Glucophage during pregnancy is not advised. There is no information available concerning the safety of Glucophage during lactation.

DOSAGE AND DIRECTIONS FOR USE:

It is important that Glucophage tablets be taken in divided doses with meals.

Adults:

Initially, one 850 mg tablet twice a day or one 500 mg tablet three times a day, with or after food. Good diabetic control may be achieved within a few days, but it is not usual for the full effect to be delayed for up to two weeks. If control is incomplete a cautious increase in dosage to a maximum of 3 g daily is justified. Once control has been obtained it may be possible to reduce the dosage of Glucophage.

Children:

Glucophage is not recommended for use.

Elderly:

Glucophage is indicated in the elderly, but not when renal function is impaired.
Combination therapy - see "Special Precautions"

SIDE-EFFECTS AND SPECIAL PRECAUTIONS:

Gastro-intestinal adverse effects with anorexia, nausea and vomiting. Metallic taste. Lactic acidosis has been associated with Glucophage but, has occurred to a greater extent in patients with contra-indications to therapy. In patients with a metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonaemia) lactic acidosis should be suspected and Glucophage therapy stopped. Lactic acidosis is a medical emergency which must be treated in hospital.
Glucophage is excreted by the kidney and regular monitoring of renal function is advised in all diabetics. Glucophage therapy should be stopped 2-3 days before surgery and clinical investigations such as intravenous urography and intravenous angiography and reinstated only after control of renal function has been regained. The use of Glucophage is not advised in conditions which may cause dehydration or in patients suffering from serious infections, trauma or on low calorie intake.
Patients receiving continuous Glucophage therapy should have an annual estimation of Vitamin B12 levels because of reports of decreased Vitamin B12 absorption.
During concomitant therapy with a sulphonylurea, blood glucose should be monitored because combined therapy may cause hypoglycaemia. Stabilisation of diabetic patients with Glucophage and insulin should be carried out in hospital because of the possibility of hypoglycaemia until the correct ratio of the two drugs has been obtained.
Reduced renal clearance of Glucophage has been reported during cimetidine therapy, so a dose reduction should be considered. An interaction between Glucophage and anticoagulants is a possibility and dosage of the latter may need adjustment.
Contra-indications should be carefully observed.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT:

Hypoglycaemia can occur when Glucophage is given concomitantly with a sulphonylurea, insulin or alcohol. In excessive dosage, and particularly if there is a possibility of accumulation, lactic acidosis may develop. Intense symptomatic and supportive therapy is recommended which should be particularly directed at correcting fluid loss and metabolic disturbance.

IDENTIFICATION:

Glucophage 500 mg Tablets - White, round, biconvex, film-coated tablets.
Glucophage 850 mg Tablets - White, round shallow, biconvex film-coated tablets.

PRESENTATION:

Glucophage 500 mg Tablets 500 mg - 100's and 500's
Glucophage 850 mg Tablets 850 mg - 60's and 300's

STORAGE INSTRUCTIONS:

Store below 25°C. Protect from light and moisture.
Keep out of reach of children.