Metformine HCl Bluefish Uses

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What is Metformine HCl Bluefish?

Metformine HCl Bluefish is used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. With this type of diabetes, insulin produced by the pancreas is not able to get sugar into the cells of the body where it can work properly. Using Metformine HCl Bluefish alone, with a type of oral antidiabetic medicine called a sulfonylurea, or with insulin, will help to lower blood sugar when it is too high and help restore the way you use food to make energy.

Many people can control type 2 diabetes with diet and exercise. Following a specially planned diet and exercise will always be important when you have diabetes, even when you are taking medicines. To work properly, the amount of Metformine HCl Bluefish you take must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet or exercise, you will want to test your blood sugar to find out if it is too low. Your doctor will teach you what to do if this happens.

Metformine HCl Bluefish does not help patients does not help patients who have insulin-dependent or type 1 diabetes because they cannot produce insulin from their pancreas gland. Their blood glucose is best controlled by insulin injections.

Metformine HCl Bluefish is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, Metformine HCl Bluefish is used in certain patients with the following medical conditions:

Metformine HCl Bluefish indications

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In maturity onset (non-insulin-dependent) obese diabetics and juvenile diabetics in whom diet alone has failed as monotherapy or in combination with insulin, glitazones or sulfonylureas. Also as an adjunct to diet and exercise to improve glycemic control in patients with type-2 diabetes.

Glitazones are used in combination with Metformine HCl Bluefish HCl when glycemic control is poor on Metformine HCl Bluefish HCl monotherapy and maximum tolerated dose (preferable) of Metformine HCl Bluefish HCl has been tried. The combination of glitazone plus Metformine HCl Bluefish HCl is preferred to glitazone plus sufonylurea, particularly for obese patients.

How should I use Metformine HCl Bluefish?

Use Metformine HCl Bluefish extended-release tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Metformine HCl Bluefish extended-release tablets.

Uses of Metformine HCl Bluefish in details

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Use: Labeled Indications

Diabetes mellitus, type 2: Management of type 2 diabetes mellitus when hyperglycemia cannot be managed with diet and exercise alone.

Note: If not contraindicated and if tolerated, Metformine HCl Bluefish is the preferred initial pharmacologic agent for type 2 diabetes management (ADA 2020).

Off Label Uses

Antipsychotic-induced weight gain

Data from multiple meta-analyses of randomized controlled trials with varying degrees of heterogeneity (primarily in patients with schizophrenia and schizoaffective disorder) support the use of Metformine HCl Bluefish in promoting modest weight loss and preventing weight gain associated with second-generation antipsychotics in adult patients

Metformine HCl Bluefish description

Metformine HCl Bluefish is a biguanide antihyperglycemic agent used for treating non-insulin-dependent diabetes mellitus (NIDDM). It improves glycemic control by decreasing hepatic glucose production, decreasing glucose absorption and increasing insulin-mediated glucose uptake. Metformine HCl Bluefish may induce weight loss and is the drug of choice for obese NIDDM patients. Use of Metformine HCl Bluefish is associated with modest weight loss. When used alone, Metformine HCl Bluefish does not cause hypoglycemia; however, it may potentiate the hypoglycemic effects of sulfonylureas and insulin. Its main side effects are dyspepsia, nausea and diarrhea. Dose titration and/or use of smaller divided doses may decrease side effects. Metformine HCl Bluefish should be avoided in those with severely compromised renal function (creatinine clearance < 30 ml/min), acute/decompensated heart failure, severe liver disease and for 48 hours after the use of iodinated contrast dyes due to the risk of lactic acidosis. Lower doses should be used in the elderly and those with decreased renal function. Metformine HCl Bluefish decreases fasting plasma glucose, postprandial blood glucose and glycosolated hemoglobin (HbA1c) levels, which are reflective of the last 8-10 weeks of glucose control. Metformine HCl Bluefish may also have a positive effect on lipid levels. In 2012, a combination tablet of linagliptin plus Metformine HCl Bluefish hydrochloride was marketed under the name Jentadueto for use in patients when treatment with both linagliptin and Metformine HCl Bluefish is appropriate.

Metformine HCl Bluefish dosage

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Metformine HCl Bluefish Dosage

Generic name: Metformine HCl Bluefish HYDROCHLORIDE 500mg

Dosage form: tablet, film coated, extended

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

There is no fixed dosage regimen for the management of hyperglycemia in patients with type 2 diabetes with Metformine HCl Bluefish® or any other pharmacologic agent. Dosage of Metformine HCl Bluefish® must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily dose. The maximum recommended daily dose of Metformine HCl Bluefish® Extended-Release Tablets in adults is 2500 mg.

Metformine HCl Bluefish® should be taken with a full glass of water once daily with the evening meal. Metformine HCl Bluefish® should be started at a low dose, with gradual dose escalation, both to reduce gastrointestinal side effects and to permit identification of the minimum dose required for adequate glycemic control of the patient.

During treatment initiation and dose titration, fasting plasma glucose should be used to determine the therapeutic response to Metformine HCl Bluefish® and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately three months. The therapeutic goal should be to decrease both fasting plasma glucose and glycosylated hemoglobin levels to normal or near normal by using the lowest effective dose of Metformine HCl Bluefish®, either when used as monotherapy or in combination with sulfonylurea or insulin.

Monitoring of blood glucose and glycosylated hemoglobin will also permit detection of primary failure, i.e., inadequate lowering of blood glucose at the maximum recommended dose of medication, and secondary failure, i.e., loss of an adequate blood glucose lowering response after an initial period of effectiveness.

Short-term administration of Metformine HCl Bluefish® may be sufficient during periods of transient loss of control in patients usually well-controlled on diet alone.

Recommended Dosing Schedule

The usual starting dose of Metformine HCl Bluefish® (Metformine HCl Bluefish hydrochloride) Extended-Release Tablets is 1000 mg taken with a full glass of water once daily with the evening meal, although 500 mg may be utilized when clinically appropriate. Dosage increases should be made in increments of 500 mg weekly, up to a maximum of 2500 mg once daily with the evening meal.

In randomized trials, patients currently treated with immediate-release Metformine HCl Bluefish were switched to Metformine HCl Bluefish®. Results of this trial suggest that patients receiving immediate-release Metformine HCl Bluefish treatment may be safely switched to Metformine HCl Bluefish® once daily at the same total daily dose, up to 2500 mg once daily. Following a switch from immediate-release Metformine HCl Bluefish to Metformine HCl Bluefish®, glycemic control should be closely monitored and dosage adjustments made accordingly.

Pediatrics– There is no pediatric information available for Metformine HCl Bluefish®.

Transfer From Other Antidiabetic Therapy

When transferring patients from standard oral hypoglycemic agents other than chlorpropamide to Metformine HCl Bluefish®, no transition period generally is necessary. When transferring patients from chlorpropamide, care should be exercised during the first two weeks because of the prolonged retention of chlorpropamide in the body, leading to overlapping drug effects and possible hypoglycemia.

Concomitant Metformine HCl Bluefish® and

Oral Sulfonylurea Therapy in Adult Patients

If patients have not responded to four weeks of the maximum dose of Metformine HCl Bluefish® monotherapy, consideration should be given to gradual addition of an oral sulfonylurea while continuing Metformine HCl Bluefish® at the maximum dose, even if prior primary or secondary failure to a sulfonylurea has occurred. Clinical and pharmacokinetic drug-drug interaction data are currently available only for Metformine HCl Bluefish plus glyburide (also known as glibenclamide). With concomitant Metformine HCl Bluefish® and sulfonylurea therapy, the desired control of blood glucose may be obtained by adjusting the dose of each drug. However, attempts should be made to identify the minimum effective dose of each drug to achieve this goal. With concomitant Metformine HCl Bluefish® and sulfonylurea therapy, the risk of hypoglycemia associated with sulfonylurea therapy continues and may be increased. Appropriate precautions should be taken.

If patients have not satisfactorily responded to one to three months of concomitant therapy with the maximum dose of Metformine HCl Bluefish® and the maximum dose of an oral sulfonylurea, consider therapeutic alternatives including switching to insulin with or without Metformine HCl Bluefish®.

Concomitant Metformine HCl Bluefish® and Insulin Therapy in Adult Patients

The current insulin dose should be continued upon initiation of Metformine HCl Bluefish® therapy. Metformine HCl Bluefish® therapy should be initiated at 500 mg once daily in patients on insulin therapy. For patients not responding adequately, the dose of Metformine HCl Bluefish® should be increased by 500 mg after approximately 1 week and by 500 mg every week thereafter until adequate glycemic control is achieved. The maximum recommended daily dose for Metformine HCl Bluefish® Extended-Release Tablets is 2500 mg. It is recommended that the insulin dose be decreased by 10% to 25% when fasting plasma glucose concentrations decrease to less than 120 mg/dL in patients receiving concomitant insulin and Metformine HCl Bluefish®. Further adjustment should be individualized based on glucose-lowering response.

Specific Patient Populations

Metformine HCl Bluefish® is not recommended for use in pregnancy, and is not recommended in patients below the age of 17 years.

The initial and maintenance dosing of Metformine HCl Bluefish® should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment should be based on a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of Metformine HCl Bluefish®.

Monitoring of renal function is necessary to aid in prevention of lactic acidosis, particularly in the elderly.

More about Metformine HCl Bluefish (Metformine HCl Bluefish)

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Metformine HCl Bluefish interactions

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What other drugs will affect Metformine HCl Bluefish?

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Drug Interactions (Clinical Evaluation Of Drug Interactions Conducted With Immediate-Release Metformine HCl Bluefish)

Glyburide

In a single-dose interaction study in type 2 diabetes patients, co-administration of Metformine HCl Bluefish and glyburide did not result in any changes in either Metformine HCl Bluefish pharmacokinetics or pharmacodynamics. Decreases in glyburide AUC and Cmax were observed, but were highly variable. The single-dose nature of this study and the lack of correlation between glyburide blood levels and pharmacodynamic effects, makes the clinical significance of this interaction uncertain.

Furosemide

A single-dose, Metformine HCl Bluefish-furosemide drug interaction study in healthy subjects demonstrated that pharmacokinetic parameters of both compounds were affected by co-administration. Furosemide increased the Metformine HCl Bluefish plasma and blood Cmax by 22% and blood AUC by 15%, without any significant change in Metformine HCl Bluefish renal clearance. When administered with Metformine HCl Bluefish, the Cmax and AUC of furosemide were 31% and 12% smaller, respectively, than when administered alone, and the terminal half-life was decreased by 32%, without any significant change in furosemide renal clearance. No information is available about the interaction of Metformine HCl Bluefish and furosemide when co-administered chronically.

Nifedipine

A single-dose, Metformine HCl Bluefish-nifedipine drug interaction study in normal healthy volunteers demonstrated that co-administration of nifedipine increased plasma Metformine HCl Bluefish Cmax and AUC by 20% and 9%, respectively, and increased the amount excreted in the urine. Tmax and half-life were unaffected. Nifedipine appears to enhance the absorption of Metformine HCl Bluefish. Metformine HCl Bluefish had minimal effects on nifedipine.

Cationic Drugs

Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, or vancomycin) that are eliminated by renal tubular secretion theoretically have the potential for interaction with Metformine HCl Bluefish by competing for common renal tubular transport systems. Such interaction between Metformine HCl Bluefish and oral cimetidine has been observed in normal healthy volunteers in both single- and multiple-dose, Metformine HCl Bluefish-cimetidine drug interaction studies, with a 60% increase in peak Metformine HCl Bluefish plasma and whole blood concentrations and a 40% increase in plasma and whole blood Metformine HCl Bluefish AUC. There was no change in elimination half-life in the single-dose study. Metformine HCl Bluefish had no effect on cimetidine pharmacokinetics. Although such interactions remain theoretical (except for cimetidine), careful patient monitoring and dose adjustment of Metformine HCl Bluefish® and/or the interfering drug is recommended in patients who are taking cationic medications that are excreted via the proximal renal tubular secretory system.

Other

Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. When such drugs are administered to a patient receiving Metformine HCl Bluefish®, the patient should be closely observed for loss of blood glucose control. When such drugs are withdrawn from a patient receiving Metformine HCl Bluefish®, the patient should be observed closely for hypoglycemia.

In healthy volunteers, the pharmacokinetics of Metformine HCl Bluefish and propranolol, and Metformine HCl Bluefish and ibuprofen were not affected when coadministered in single-dose interaction studies.

Metformine HCl Bluefish is negligibly bound to plasma proteins and is, therefore, less likely to interact with highly protein-bound drugs such as salicylates, sulfonamides, chloramphenicol, and probenecid, as compared to the sulfonylureas, which are extensively bound to serum proteins.

Metformine HCl Bluefish side effects

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What are the possible side effects of Metformine HCl Bluefish?

During treatment initiation, the most common adverse reactions are nausea, vomiting, diarrhoea, abdominal pain and loss of appetite which resolve spontaneously in most cases.

In a US double-blind clinical study of Metformine HCl Bluefish in patients with type 2 diabetes, a total of 141 patients received Metformine HCl Bluefish therapy (up to 2550 mg/day) and 145 patients received placebo. Adverse reactions reported in >5% of the Metformine HCl Bluefish patients, and that was more common in Metformine HCl Bluefish than placebo-treated patients, are listed in Table 2.

Diarrhea led to discontinuation of study medication in 6% of patients treated with Metformine HCl Bluefish. Additionally, the following adverse reactions were reported in >1% to <5% of Metformine HCl Bluefish patients and were more commonly reported with Metformine HCl Bluefish than placebo: Abnormal stools, hypoglycemia, myalgia, lightheaded, dyspnea, nail disorder, rash, increased sweating, taste disorder, chest discomfort, chills, flu syndrome, flushing, palpitation.

In worldwide clinical trials, over 900 patients with type 2 diabetes have been treated with Metformine HCl Bluefish extended-release tablet in placebo- and active-controlled studies. In placebo-controlled trials, 781 patients were administered Metformine HCl Bluefish extended-release tablet and 195 patients received placebo. Adverse reactions reported in >5% of the Metformine HCl Bluefish extended-release tablet patients and that were more common in Metformine HCl Bluefish extended-release tablet than placebo treated patients, are listed in Table 3.

Diarrhea led to discontinuation of study medication in 0.6% of patients treated with Metformine HCl Bluefish extended-release tablet. Additionally, the following adverse reactions were reported in >1% to <5% of Metformine HCl Bluefish extended-release tablet patients and were more commonly reported with Metformine HCl Bluefish extended-release tablet than placebo: Abdominal pain, constipation, abdomen distention, dyspepsia/heartburn, flatulence, dizziness, headache, upper respiratory infection, taste disturbance.

In clinical trials with Metformine HCl Bluefish in pediatric patients with type 2 diabetes, the profile of adverse reactions was similar to that observed in adults.

Other reported adverse events with use of Metformine HCl Bluefish are: Skin reactions eg, erythema, pruritus and urticaria; isolated reports of liver function tests abnormalities or hepatitis resolving upon Metformine HCl Bluefish discontinuation; lactic acidosis; decrease of vitamin B12 absorption with decrease of serum levels during long-term use of Metformine HCl Bluefish, consideration of such etiology is recommended if a patient presents with megaloplastic anaemia.

Metformine HCl Bluefish contraindications

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What is the most important information I should know about Metformine HCl Bluefish?

Metformine HCl Bluefish® is contraindicated in patients with:

  1. Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels ≥1.5 mg/dL [males], ≥1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia.
  2. Known hypersensitivity to Metformine HCl Bluefish.
  3. Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin.

Metformine HCl Bluefish® should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function.

WARNINGS

Lactic Acidosis:

Lactic acidosis is a rare, but serious, metabolic complication that can occur due to Metformine HCl Bluefish accumulation during treatment with Metformine HCl Bluefish® (Metformine HCl Bluefish hydrochloride) Extended-Release Tablets; when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis may also occur in association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever there is significant tissue hypoperfusion and hypoxemia. Lactic acidosis is characterized by elevated blood lactate levels (>5 mmol/ L), decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. When Metformine HCl Bluefish is implicated as the cause of lactic acidosis, Metformine HCl Bluefish plasma levels >5 μg/mL are generally found.

The reported incidence of lactic acidosis in patients receiving Metformine HCl Bluefish hydrochloride is very low (approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient-years). Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/ surgical problems and multiple concomitant medications. Patients with congestive heart failure requiring pharmacologic management, in particular those with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia, are at increased risk of lactic acidosis. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient's age. The risk of lactic acidosis may, therefore, be significantly decreased by regular monitoring of renal function in patients taking Metformine HCl Bluefish® (Metformine HCl Bluefish hydrochloride) Extended-Release Tablets and by use of the minimum effective dose of Metformine HCl Bluefish®. In particular, treatment of the elderly should be accompanied by careful monitoring of renal function. Metformine HCl Bluefish® treatment should not be initiated in patients ≥80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced, as these patients are more susceptible to developing lactic acidosis. In addition, Metformine HCl Bluefish® should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis. Because impaired hepatic function may significantly limit the ability to clear lactate, Metformine HCl Bluefish® should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or chronic, when taking Metformine HCl Bluefish®, since alcohol potentiates the effects of Metformine HCl Bluefish hydrochloride on lactate metabolism. In addition, Metformine HCl Bluefish® should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure.

The onset of lactic acidosis often is subtle, and accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress. There may be associated hypothermia, hypotension, and resistant bradyarrhythmias with more marked acidosis. The patient and the patient's physician must be aware of the possible importance of such symptoms and the patient should be instructed to notify the physician immediately if they occur. Metformine HCl Bluefish® should be withdrawn until the situation is clarified. Serum electrolytes, ketones, blood glucose and, if indicated, blood pH, lactate levels, and even blood Metformine HCl Bluefish levels may be useful. Once a patient is stabilized on any dose level of Metformine HCl Bluefish®, gastrointestinal symptoms, which are common during initiation of therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

Levels of fasting venous plasma lactate above the upper limit of normal but less than 5 mmol/L in patients taking Metformine HCl Bluefish® do not necessarily indicate impending lactic acidosis and may be explainable by other mechanisms, such as poorly controlled diabetes or obesity, vigorous physical activity, or technical problems in sample handling.

Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia).

Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking Metformine HCl Bluefish®, the drug should be discontinued immediately and general supportive measures promptly instituted. Because Metformine HCl Bluefish hydrochloride is dialyzable (with a clearance of up to 170 mL/min under good hemodynamic conditions), prompt hemodialysis is recommended to correct the acidosis and remove the accumulated Metformine HCl Bluefish. Such management often results in prompt reversal of symptoms and recovery.



Active ingredient matches for Metformine HCl Bluefish:

Metformin in Netherlands.


List of Metformine HCl Bluefish substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
Metfortal 1000mg Tablet SR (Talent India )$ 0.04
Metfortal 500mg Tablet SR (Talent India )$ 0.02
METFOTIME 1000MG TABLET SR 1 strip / 10 tablet srs each (TTK Healthcare Ltd)$ 0.48
Metfron 500 mg x 500's (Asian Pharm)
Metfron 500 mg x 1, 000's (Asian Pharm)
Metfron tab 500 mg 1000's (Asian Pharm)
Metfron tab 500 mg 500's (Asian Pharm)
Metgem 1000mg Tablet (Sun Pharmaceutical Industries Ltd)$ 0.04
Methormyl 500 mg x 3 x 10's (Mugi)$ 2.14
Methpica 500 mg x 100's (Tropica mas)$ 12.09
Metica 500 mg x 10's (SPPL)
Metica 850 mg x 10's (SPPL)
500 mg x 10's (SPPL)$ 0.18
850 mg x 10's (SPPL)$ 0.22
Metica 500mg TAB / 10 (SPPL)$ 0.18
Metica 850mg TAB / 10 (SPPL)$ 0.22
METICA 500MG TABLET 1 strip / 10 tablets each (SPPL)$ 0.10
METICA tab 500 mg x 10's (SPPL)$ 0.18
METICA tab 850 mg x 10's (SPPL)$ 0.22
Metica 500mg Tablet (SPPL)$ 0.01
Metkap 500mg TAB / 100 (KAPL)$ 0.82

References

  1. PubChem. "metformin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. DrugBank. "metformin". http://www.drugbank.ca/drugs/DB00331 (accessed September 17, 2018).
  3. MeSH. "Hypoglycemic Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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