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Generic Name: metformin hydrochloride, dosage Form: tablet, film coated, extended release, medically reviewed on March 1, 2018. Show On This Page, view All, warning: lactic acidosis. Postmarketing cases of what is the difference between metformin hcl and metformin er metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied what is the difference between metformin hcl and metformin er only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels ( 5 mmol/Liter anion gap acidosis (without evidence of ketonuria or ketonemia an increased lactate/pyruvate ratio, and metformin plasma levels generally 5 mcg/mL see Warnings and Precautions (.1 ). Risk factors for metformin-associated lactic acidosis include renal what is the difference between metformin hcl and metformin er impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure excessive. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the full prescribing information see Dosage and Administration (.2 Contraindications ( 4 Warnings and Precautions (.1 Drug Interactions ( 7 and Use in Specific. If metformin-associated lactic acidosis is suspected, immediately discontinue Glumetza and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended see Warnings and Precautions (.1 ). Indications and Usage for Glumetza, glumetza is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Important Limitations of Use, glumetza should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. Glumetza Dosage and Administration. Recommended Dosage, the starting dose of Glumetza in patients who are not currently taking metformin is 500 mg orally, once daily with the evening meal. Increase the dose in 500 mg increments every 1-2 weeks if a higher dose of Glumetza is needed and there are no gastrointestinal (GI) what is the difference between metformin hcl and metformin er adverse reactions. The dosage of Glumetza must be individualized on the basis of both effectiveness and tolerability, while not exceeding the maximum recommended daily dose of 2000. Recommendations for Use in Renal Impairment. Assess renal function prior to initiation of Glumetza and periodically thereafter. Glumetza is contraindicated in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/minute/1.73. Initiation of Glumetza in patients with an eGFR between 3045 mL/minute/1.73 m2 is not recommended. In patients taking Glumetza whose eGFR later falls below 45 mL/min/1.73 m2, assess the benefit risk of continuing therapy. Discontinue Glumetza if the patients eGFR later falls below 30 mL/minute/1.73 m2 see Contraindications ( 4 ) and Warnings and Precautions (.1 ). Switching from Immediate-Release Metformin to Glumetza. If switching from immediate-release metformin to Glumetza, initiate Glumetza once daily at the same total dose, up to 2000 mg once daily. Discontinuation for Iodinated Contrast Imaging Procedures. Discontinue Glumetza at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m2; in patients with a history of liver disease, alcoholism or heart failure; or in patients who will be administered intra-arterial. Re-evaluate eGFR 48 hours after the imaging procedure; restart Glumetza if renal function is stable see Warnings and Precautions (.1 ). Important Administration Instructions Administer Glumetza orally, once daily with the evening meal. Glumetza tablets must be swallowed whole and never split, crushed or chewed. If a dose of Glumetza is missed, instruct patients not to take two doses the same day and to resume their usual dose of Glumetza with the next schedule dose see Patient Counseling Information ( 17 ). Dosage Forms and Strengths Glumetza (metformin hydrochloride extended-release tablets) 500 mg are available as white, film-coated, oval-shaped tablets with M500 on one side. Glumetza (metformin hydrochloride extended-release tablets) 1000 mg are available as white, film-coated, oval-shaped tablets with M1000 on one side. Contraindications Glumetza is contraindicated in patients with: Severe renal impairment (eGFR below 30 mL/min/1.73 m2) see Warnings and Precautions (.1 ). Known hypersensitivity to metformin hydrochloride. Acute or chronic metabolic acidosis, including diabetic ketoacidosis. Diabetic ketoacidosis should be treated with insulin. Warnings and Precautions Lactic Acidosis There have been postmarketing cases of metformin-associated lactic acidosis, including fatal cases. These cases had a subtle onset and were accompanied by nonspecific symptoms such as malaise, myalgias, abdominal pain, respiratory distress, or increased somnolence; however, hypothermia, hypotension and resistant bradyarrhythmias have occurred with severe acidosis. Metformin-associated lactic acidosis was characterized by elevated blood lactate concentrations ( 5 mmol/Liter anion gap acidosis (without evidence of ketonuria or ketonemia and an increased lactate/pyruvate ratio; metformin plasma levels generally 5 mcg/mL.
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