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Inhibits hepatic gluconeogenesis, reduce the absorption of glucose from the intestine, increases peripheral glucose disposal, and also increases the sensitivity of tissues to insulin. When this has no effect on insulin secretion of pancreatic beta-cells causes hypoglycemic reactions. It reduces the level of triglycerides and low-density lipoprotein in blood. Stabilizes or reduces body weight. Has fibrinolytic action by inhibiting plasminogen activator inhibitor, tissue-type. After ingestion mёtformin absorbed from the gastrointestinal tract. The bioavailability after ingestion of standard dianabol pills doses of 50-60%. The maximum plasma concentration is reached 2.5 hours after oral administration. Almost does not bind to plasma proteins. It accumulates in the salivary glands, muscles, liver and kidneys. Provided unchanged by the kidneys. The half-life is 9-12 hours. When renal function is possible accumulation of the drug.

Indications
Diabetes mellitus type 2 without a tendency to ketoacidosis (especially in patients who are obese) when poor diet.

  • in combination with insulin – for diabetes mellitus type 2, especially when expressed by the degree of obesity accompanied by secondary insulin resistance.

 

Contraindications

  • diabetic ketoacidosis, diabetic precoma, coma;
  • impairment of renal function;
  • acute conditions with the risk of renal dysfunction: dehydration (diarrhea, vomiting), fever, severe infections, a condition of hypoxia (shock, sepsis, kidney infections, bronchopulmonary disease);
  • symptomatic manifestations of acute and chronic diseases which may lead to the development of tissue hypoxia (cardiac or respiratory failure, acute myocardial infarction, etc.);
  • major surgery and trauma (when shown holding insulin);
  • abnormal liver function:
  • chronic alcoholism, acute alcohol poisoning;
  • pregnancy, breast-feeding;
  • Hypersensitivity to the drug;
  • lactic acidosis (including history);
  • use for at least 2 days before and within 2 days after the radyoizotopnyh or radiological examinations with administration of iodine-containing contrast agent;
  • compliance with a hypocaloric diet (less than 1000 calories / day);

Do not use the drug in patients older than 60 years, performing heavy physical work, which is associated with an increased risk of developing lactic acidosis.

 

Application of pregnancy and breastfeeding period
when planning pregnancy, as well as in the event of pregnancy while taking metformin, it should be withdrawn and insulin. Since the data on the penetration into breast milk is not present, the drug is contraindicated in breastfeeding. If necessary, dianabol pills use of metformin during breast-feeding, breast-feeding should be discontinued.

Dosage and administration
The dose is established by the doctor individually, depending on the level of glucose in the blood.
The initial dose of 500-1000 mg / day. (1-2 tablets). . After 10-15 days may further gradual increase in the dose depending on the blood glucose level
maintenance dose of the drug is typically 1500-2000 mg / day (3-4 tablets) Maximum dose -. 3000 mg / day. (6 tablets).
In elderly patients the recommended daily dose should not exceed 1 g (2 tablets)
Tablets Metformin should be taken as a whole during or immediately after a meal, washed down with a little liquid (a glass of water). To reduce the side effects from the gastrointestinal tract daily dose should be divided into 2-3 doses.
Due to the increased risk of lactic acidosis, the dose should be reduced in severe metabolic disorders.

Side effect On the part of the digestive system organs: . Nausea, vomiting, “metallic” taste in the mouth, loss of appetite, diarrhea, flatulence, abdominal pain These symptoms are particularly common at the beginning of treatment and usually disappear on their own. These symptoms can be reduced by appointment antotsidov derivatives of atropine or antispasmodics. On the part of metabolism: rarely – lactic acidosis (requires discontinuation of treatment); long-term treatment – B12 vitamin deficiencies (malabsorption). From the side of hematopoiesis: in some cases – megaloblastic anemia. From the Endocrine:hypoglycemia. Allergic reactions: skin rash.

Overdose
If overdose of Metformin may develop lactic acidosis fatal. The reason for the development of lactic acidosis may also be the accumulation of the drug due to renal dysfunction. Early symptoms of lactic acidosis include nausea, vomiting, diarrhea, drop in body temperature, abdominal pain, pain in the muscles, in the future may be marked shortness of breath, dizziness, impaired consciousness and coma develop. Treatment: In the case. occurrence of lactic acidosis symptoms, treatment with metformin must be stopped immediately, the patient hospitalized immediately and determine the concentration of lactate, to confirm the diagnosis. The most effective measure for the excretion of lactate and metformin is hemodialysis. Spend as symptomatic treatment. If the drug metformin combination therapy with sulfonylurea may develop hypoglycaemia.

Interaction with other medicinal products is not recommended combinations: not recommended for concomitant use of danazol to avoid hyperglycemic action of the latter. If necessary, treatment with danazol and after discontinuation of the latter require dose adjustment of metformin under the control of blood glucose levels. Combinations requiring special care: chlorpromazine – when taken in high doses (100 mg daily) improves glycemia, reducing the release of insulin. When neuroleptic treatment and after discontinuation of the last required correction dose of metformin under the control of blood glucose levels. While the use of sulfonylureas, acarbose, insulin, non-steroidal anti-inflammatory drugs, monoamine oxidase inhibitors, oxytetracycline, angiotensin converting enzyme inhibitors, derivatives of clofibrate, cyclophosphamide, β-blockers may strengthening of hypoglycemic action of metformin. While the use of corticosteroids, oral contraceptives, epinephrine, sympathomimetics, glucagon, thyroid hormones, thiazide and “loop” diuretics, phenothiazine derivatives, derivatives of nicotinic acid may reduce the hypoglycemic dianabol pills action of metformin. Cimetidine slows the elimination of metformin, thus increasing the risk of lactic acidosis. Mёtformin may weaken the effect of anticoagulants (coumarin derivatives). Drinking alcohol increases the risk of lactic acidosis in acute alcohol intoxication, particularly in cases of starvation or low calorie diet compliance, as well as liver failure.

Cautions
During treatment necessary to monitor renal function. At least 2 times a year, as well as the appearance of myalgia should determine the content of lactate in plasma.
In addition, 1 every 6 months is necessary to monitor the level of creatinine in serum (especially in patients of advanced age) should be appointed Mёtformin if creatinine level in the blood above 135 umol / l for men and 110 umol / l for women.
It is possible to use the drug Mёtformin in combination with sulfonylureas. In this case it is necessary osrbenno careful control of blood glucose levels in the blood.
For 48 hours before and 48 hours after the rentgenokontrastpogo (urography, intravenous angiography) should stop taking Metformin.
When the patient bronchopulmonary infection or infectious disease urinary organs should be reported immediately the attending physician.
During the treatment should refrain from drinking alcohol, and drugs containing ethanol.

Effects on ability to drive vehicles and operate machinery
Use of the drug as a single agent does not affect the ability to drive vehicles and operate machinery.
With the combination of Metformin with other hypoglycemic agents (sulfonylureas, insulin, etc.) may develop hypoglycemic conditions under which worsens ability to road management and occupation of other potentially hazardous activities that require increased attention and rapid psychomotor reactions. steroiden kaufen

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