Type 2 DM in adults, particularly overwt patients when dietary management & exercise alone does not result in adequate glycemic control as monotherapy or in combination w/ other oral antidiabetic agents or insulin.
Monotherapy & combination w/ other oral antidiabetic agents Initially 500 mg ER tab once daily. May be increased in increments of 500 mg every 10-15 days on the basis of blood glucose measurements. Max: 2 g once daily. Patient treated w/ metformin tab Starting dose of ER tab should be equiv to the daily dose of metformin IR tab. Combination w/ insulin Initially 500 mg ER tab once daily. Patient already treated w/ metformin & insulin combination therapy Dose should be equiv to the daily dose of metformin tab up to max of 1.5 g or 2 g respectively while insulin dosage is adjusted on the basis of blood glucose measurements.
Hypersensitivity. Diabetic ketoacidosis/pre-coma; acute conditions w/ potential to alter renal function eg, dehydration, severe infection, shock; acute or chronic disease which may cause tissue hypoxia eg, cardiac or resp failure, recent MI, shock. Renal failure or dysfunction (CrCl <60 mL/min). Hepatic insufficiency, acute alcohol intoxication, alcoholism.
Lactic acidosis. Poorly controlled diabetes, ketosis, prolonged fasting, excessive alcohol intake, hepatic insufficiency & any condition associated w/ hypoxia. Determine CrCl before initiating treatment & regularly thereafter at least annually in patients w/ normal renal function & at least 2-4 times a yr in patients w/ CrCl levels at the limit of normal & in the elderly. Discontinue metformin prior to, or at the time of administration of iodinated contrast media in radiological studies & not reinstituted until 48 hr afterwards. Discontinue metformin 48 hr before elective surgery w/ general spinal or peridural anaesth & may be restarted no earlier than 48 hr following surgery or resumption of oral nutrition provided normal renal function has been established. Continue diet w/ regular distribution of carbohydrate intake daily. Concomitant use w/ insulin or other oral antidiabetics (eg, sulfonylurea or meglitinides). Pregnancy & lactation.
Sign Out
