Glymax
Generic Name
Metformin Hydrochloride
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Description
Overview of the medicine
Glymax (Metformin) is an oral anti-diabetic medication used to manage type 2 diabetes mellitus, particularly in overweight patients, when diet and exercise alone have not been sufficient. It helps lower blood glucose levels by decreasing glucose production in the liver, decreasing intestinal absorption of glucose, and improving insulin sensitivity.
Uses & Indications
Dosage
Adults
Initial dose 500 mg once or twice daily with meals, gradually increasing to a maximum of 2000-2500 mg/day in divided doses. Extended-release formulations typically taken once daily.
Elderly
Dose titration with careful monitoring of renal function is recommended due to potential age-related decrease in renal function.
Renal_impairment
Contraindicated in severe renal impairment (eGFR < 30 mL/min). Dose adjustment required for eGFR 30-60 mL/min, not to exceed 1000 mg/day.
How to Take
Take orally with meals (usually dinner for once-daily doses, or with breakfast and dinner for twice-daily doses) to reduce gastrointestinal side effects.
Mechanism of Action
Metformin primarily reduces hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis. It also enhances insulin sensitivity in peripheral tissues (skeletal muscle and adipose tissue), leading to increased glucose uptake and utilization. Additionally, it delays intestinal glucose absorption.
Pharmacokinetics
Onset
Onset of action is usually within days, with maximal effects seen within 2 weeks.
Excretion
Primarily excreted unchanged by the kidneys (renal excretion).
Half life
Plasma elimination half-life is approximately 4 to 9 hours.
Absorption
Oral bioavailability is 50-60%. Absorption is incomplete and saturable.
Metabolism
Metformin is not metabolized in the liver and is excreted unchanged in the urine.
Side Effects
Contraindications
- Severe renal impairment (eGFR < 30 mL/min)
- Metabolic acidosis, including diabetic ketoacidosis
- Hypersensitivity to metformin or any component of the formulation
- Acute or chronic metabolic acidosis (including lactic acidosis)
- Dehydration, acute heart failure, severe infection, acute myocardial infarction
Drug Interactions
Alcohol
Increases the risk of lactic acidosis. Avoid excessive alcohol intake.
Cimetidine
Can increase metformin plasma concentrations, increasing risk of lactic acidosis.
Iodinated Contrast Agents
Temporarily discontinue metformin before or at the time of an iodinated contrast imaging procedure in patients with an eGFR between 30-60 mL/min/1.73m², a history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the procedure; restart metformin if renal function is stable.
Diuretics (Thiazides, Loop Diuretics)
May increase blood glucose levels, potentially requiring metformin dose adjustment. Can also increase risk of lactic acidosis by impairing renal function.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Overdose of metformin can lead to lactic acidosis, a medical emergency that requires immediate hospitalization. Symptoms include malaise, myalgias, respiratory distress, somnolence, and abdominal distress. Hemodialysis is the most effective method to remove metformin and lactate from the blood.
Pregnancy & Lactation
Pregnancy Category B. Limited human data suggest no increased risk of major congenital malformations. Use during pregnancy only if clearly needed. Metformin is excreted into breast milk; however, amounts are generally considered too low to pose significant risk to breastfed infants. Consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 to 36 months
Availability
Pharmacies, hospitals
Approval Status
Approved by major regulatory bodies (e.g., FDA, EMA, DGDA)
Patent Status
Generic (Patent expired)
WHO Essential Medicine
YesClinical Trials
Metformin has been extensively studied in numerous clinical trials demonstrating its efficacy and safety in managing type 2 diabetes. Notable trials include the UK Prospective Diabetes Study (UKPDS) which showed its cardiovascular benefits.
Lab Monitoring
- Renal function (eGFR) before initiation and at least annually (more frequently in elderly or those with risk factors)
- HbA1c levels regularly to monitor glycemic control
- Vitamin B12 levels periodically, especially in patients with risk factors for deficiency (e.g., long-term use, vegetarian diet)
Doctor Notes
- Assess renal function (eGFR) before initiating and periodically during treatment.
- Educate patients on symptoms of lactic acidosis and emphasize avoiding excessive alcohol.
- Consider Vitamin B12 monitoring in long-term users, especially with symptoms of neuropathy or anemia.
- Discontinue prior to iodinated contrast procedures and major surgeries as per guidelines.
Patient Guidelines
- Take Metformin with food to help reduce stomach upset.
- Monitor your blood glucose levels regularly as advised by your doctor.
- Be aware of the symptoms of lactic acidosis (e.g., unusual muscle pain, difficulty breathing, unusual sleepiness, stomach pain) and seek immediate medical attention if they occur.
- Do not stop taking Metformin without consulting your doctor.
- Inform your doctor if you are scheduled for any surgery or imaging tests involving contrast dyes.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. Do not double the dose to catch up.
Driving Precautions
Metformin generally does not affect the ability to drive or operate machinery as it does not cause hypoglycemia when used alone. However, if used in combination with other anti-diabetic medications (e.g., sulfonylureas, insulin), hypoglycemia may occur, which could impair driving ability. Exercise caution.
Lifestyle Advice
- Maintain a healthy diet and regular exercise regimen.
- Avoid excessive alcohol consumption to reduce the risk of lactic acidosis.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.