DIMET (METFORMIN HCI)

FORMULATION:
Each film-coated tablet contains:
Metformin Hydrochloride 500 mg
Metformin Hydrochloride 850 mg

INDICATIONS:
Non-insulin dependebnt diabetes: when diet has failed and specially if the patient is overweight Metformin can be given alone as initial theraphy or can be administered in combination with a sulfonylurea. In insulin dependent diabetes mellitus may be gevin as an adjuvant to patients whose symptoms are poorly controlled.

CONTRAINDICATIONS:
Sensitivity to metformin hydrochloride; diabetic comaand 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 insuffiency;alcoholism( acute or chronic) and conditions associated with hypoxemia;pancreatitis. The use of metformin during pregnancy is not advised. There is no information available concerning the safety of metformin during lactation.

DOSAGE AND DIRECTIONS FOR USE :
It is is important that metformin 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 is not usual for the full effect to be delayed for up to two weeks. If control is complete a cautious increase in dosage to maximum of 3 g daily is justified. Once control has been obtained it may be possible to reduce the dosage.
Children: Metformin is not recommended for use.
Elderly: Metformin is indicated in the elderly,but not when renal function is impaired.

ADVERSE EFFECTS AND SPECIAL PRECAUTIONS:
Gastro-intestinal adverse effects with anoxeria, nausea and vomoting, metallic taste. Lactic acidosis has been associated with Metformin but, has occured to a greater extent in patients with contra- indications to therapy. In patients with a metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketoneamia,) lactic acidosis should be suspected and metformin therapy stopped. Lactic acidosis is a medical emergency which must be treated in hospital.

Metformin is excreted by the kidney and regular monitoring of renal function is advised in all diabetics. Metformin therapy should be stopped 2-3 days before surgery and clinical invistigations

Such as intravenous urography and intravenous angiography and reinstated only after control of renal function has been regained. The use of Metromin is nit advised in conditions which may cause dehydration or in patients suffering from serious infections, trauma or on low calorie intake.

Patients receiving continuous metformin therapy should have an annual estimation of vitamin B12 levels because reports of decreased vitamin B12 absorption. During concomitant therapy with a sulfonylurea,blood glucose should be monitored because combined thearapy may cause hypoglycemia.stabilization of diabetic patients with Metformin and insulin should be carried out in hospital because of the possibility of hypoglycemia until the correct ratio of two drugs has been Metformin and anticoagulants possible and dosage of the latter may need adjusment. Contra-indications should be carefully observed.