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Glumetza
metformin
Black Box Warnings .
Lactic Acidosis
post-marketing cases of hypothermia, hypotension, resistant bradyarrhythmias, and death; onset may be subtle w/ nonspecific sx incl. malaise, myalgias, resp. distress, somnolence, abdominal pain; lab findings incl. lactate >5 mmol/L, anion gap acidosis (w/o evidence of ketonuria or ketonemia), incr. lactate/pyruvate ratio, metformin level >5 mcg/mL; risk factors may incl. renal impairment, concomitant meds, pts 65 yo and older, radiocontrast study, any surgery, hypoxemia, excessive acute or chronic alcohol intake, or hepatic insufficiency; D/C metformin immed. if lactic acidosis suspected, hospitalize pt and institute general supportive care, prompt HD recommended
Adult Dosing .
Dosage forms: ER TAB: 500 mg, 1000 mg
diabetes mellitus, type 2
- [1000-2000 mg PO qpm]
- Start: 1000 mg PO qpm, incr. by 500 mg/day qwk as tolerated; Max: 2000 mg/day; Alt: 1000 mg PO bid if qd inadequate; Info: give w/ meals; do not cut/crush/chew tab; hold tx for surgery if restricting food/fluid; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
polycystic ovary syndrome (off-label)
- [1500-2000 mg PO qpm]
- Info: give w/ meals; do not cut/crush/chew tab; hold tx for surgery if restricting food/fluid; D/C for iodinated contrast study if eGFR 30-60, hepatic dz hx, alcoholism hx, heart failure hx, or receiving contrast intra-arterially; restart after 48h if stable renal fxn
renal dosing
- [diabetes mellitus, type 2]
- eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Alt: decr. usual dose by 50% if eGFR 30-44
- HD/PD: avoid use
- [polycystic ovary syndrome]
- eGFR 30-44: avoid tx initiation; eGFR <30: contraindicated; Info: weigh risk/benefit if eGFR 30-44 during tx
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.