Metfo 500mg Tablet 1 Strip

✔️ Dosage & Administration: Immediate-Release Tablets

Adults:

• Initial dose: 500 mg twice daily or 850 mg once daily, taken with meals.
• Dose can be increased by 500 mg weekly or 850 mg every two weeks, up to a maximum of 2000 mg daily in divided doses.
• If further glycemic control is needed, the maximum daily dose can be increased to 2550 mg, preferably in three divided doses with meals.

Children (10 years and older):

• Initial dose: 500 mg twice daily with meals.
• Dose can be increased by 500 mg per week, up to a maximum of 2000 mg daily in divided doses.

✔️ Dosage & Administration: Extended-Release Tablets

• Adults: Start with 500 mg once daily with the evening meal. Dose may be increased by 500 mg weekly, up to a maximum of 2000 mg once daily or 1000 mg twice daily with meals.
• Children: Extended-release formulation is not studied for pediatric use.
• Patients with kidney impairment: Not recommended for those with an eGFR below 30 mL/min/1.73 m². For those with eGFR below 45 mL/min/1.73 m², assess the risk versus benefit before use.

Note: Do not crush, cut, or chew extended-release tablets.

✔️ Elderly:

• Since kidney function declines with age, dose adjustments based on renal function are necessary. Regular kidney assessments are advised.

✔️ Children (10-12 years):

Use with caution due to limited long-term data on growth and puberty.

✔️ Renal Function Monitoring

• Normal renal function: Test at least once a year.
• Patients with borderline kidney function & elderly: Test 2-4 times per year.
• Situations requiring extra caution: When starting diuretics, antihypertensives, or NSAIDs, as these may impair kidney function.
• Severely impaired kidneys (GFR <30 mL/min): Metfo is contraindicated.

✔️ Overdose Management

• Overdose up to 85 g has not caused hypoglycemia, but lactic acidosis has occurred in such cases.
• Lactic acidosis is a medical emergency requiring hospitalization.
• The most effective treatment for removing excess Metfo and lactic acid is hemodialysis.

✔️ Side Effects

Common:

• Gastrointestinal discomfort (nausea, vomiting, diarrhea, abdominal pain, loss of appetite), usually at the start of treatment but improving over time.

Rare but Serious:

• Lactic acidosis (very rare).
• Decreased vitamin B12 absorption (long-term use may lead to deficiency).
• Liver function abnormalities or hepatitis (resolves after stopping the drug).
• Skin reactions (rash, itching, hives).
• Taste disturbances.
• Rare cases of encephalopathy and hemolytic anemia.

✔️ Drug Interactions

• There is no known chronic interaction between Metfo and Furosemide.
• Nifedipine may increase Metfo absorption, though Metfo does not significantly affect Nifedipine.
• Cationic drugs like Digoxin, Quinidine, and Vancomycin may compete with Metfo for kidney excretion.
• Some medications, including diuretics, corticosteroids, thyroid hormones, estrogen-based contraceptives, and calcium channel blockers, may reduce Metfo’s effectiveness by raising blood glucose levels.

✔️ Metfo should not be used in individuals with:

• Allergies to Metfo or its ingredients.
• Acute metabolic acidosis (e.g., lactic acidosis, diabetic ketoacidosis).
• Severe kidney impairment (GFR <30 mL/min).
• Conditions affecting kidney function (e.g., severe dehydration, infection, or shock).
• Acute or chronic conditions causing oxygen deficiency in tissues (e.g., heart or lung failure, recent heart attack, shock).
• Liver disease, alcohol intoxication, or chronic alcoholism.

✔️ Use During Pregnancy & Lactation

• Pregnancy: Uncontrolled diabetes during pregnancy increases the risk of congenital defects and perinatal mortality. Insulin is preferred over Metfo to maintain normal blood sugar levels and reduce fetal complications.
• Breastfeeding: Metfo passes into breast milk, but adverse effects in infants are not well studied. Due to limited safety data, breastfeeding while on Metfo is not recommended. The benefits of breastfeeding should be weighed against potential risks.

✔️ Precautions & Warnings

• Metfo is primarily excreted through the kidneys, so impaired kidney function increases the risk of drug accumulation and lactic acidosis. Regular kidney function tests are recommended.
• It may lower vitamin B12 levels, so long-term users should monitor B12 status.
• There is an increased risk of hypoglycemia when taken with insulin or sulfonylureas.
• Should be discontinued 2–3 days before surgery or procedures involving contrast dyes and restarted only after kidney function stabilizes.
• Those using both Metfo and insulin should be closely monitored for hypoglycemia.
• Cimetidine may reduce Metfo clearance, so dose adjustment may be necessary.
• Potential interaction with anticoagulants may require dose modifications.

✔️ Storage Instructions

• Store below 30°C, protected from light and moisture.
• Keep out of reach of children.