It is taken orally, during or after meals.

The dose and frequency of administration depends on the dosage form used.

With monotherapy, the initial single dose for adults is 500 mg, depending on the dosage form used, the frequency of administration is 1-3 times / day. It is possible to use 850 mg 1-2 times / day. If necessary, the dose is gradually increased with an interval of 1 week. up to 2-3 g / day.

When monotherapy for children aged 10 years and older, the initial dose is 500 mg or 850 1 time / day or 500 mg 2 times / day. If necessary, at intervals of at least 1 week, the dose can be increased to a maximum of 2 g / day in 2-3 doses.

After 10-15 days, the dose must be adjusted based on the results of the determination of glucose in the blood.

In combination therapy with insulin, the initial dose of metformin is 500-850 mg 2-3 times / day. The dose of insulin is selected based on the results of the determination of glucose in the blood.

  Application during pregnancy and lactation:

There have been no adequate and well-controlled studies on the safety of metformin during pregnancy. Use during pregnancy is possible in cases of extreme necessity, when the expected benefit of therapy to the mother outweighs the possible risk to the fetus. Metformin crosses the placental barrier.

Metformin in small amounts is excreted in breast milk, while the concentration of metformin in breast milk can be 1/3 of the concentration in the mother's plasma. Side effects were not observed in newborns with breastfeeding while taking metformin. However, due to the limited amount of data, use during breastfeeding is not recommended. The decision to stop breastfeeding should be made taking into account the benefits of breastfeeding and the potential risk of side effects in the baby.

Preclinical studies have shown that metformin does not have a teratogenic effect at doses that are 2-3 times higher than the therapeutic doses used in humans. Metformin has no mutagenic potential and does not affect fertility.

Acute or chronic metabolic acidosis, diabetic ketoacidosis, diabetic precoma, and coma; renal failure, impaired renal function (CC <60 ml / min); dehydration, severe infection, hypoglycemic shock, which can lead to impaired renal function; clinically pronounced symptoms of acute and chronic diseases that can lead to the development of tissue hypoxia (including heart failure, acute myocardial infarction, respiratory failure); the use of contrasting iodine-containing substances for intravascular administration (including during intravascular urography, intravenous cholangiography, angiography, CT); acute alcohol intoxication, chronic alcoholism; hypersensitivity to metformin.

From the digestive system: possible (usually at the beginning of treatment) nausea, vomiting, diarrhea, flatulence, abdominal discomfort; in isolated cases - impaired liver function indicators, hepatitis (disappear after stopping treatment).

From the side of metabolism: very rarely - lactic acidosis (discontinuation of treatment is required).

From the side of the hematopoietic system: very rarely - a violation of the absorption of vitamin B12.

The profile of adverse reactions in children aged 10 years and older is the same as in adults.

With simultaneous use with sulfonylurea derivatives, acarbose, insulin, salicylates, MAO inhibitors, oxytetracycline, ACE inhibitors, with clofibrate, cyclophosphamide, the hypoglycemic effect of metformin may increase.

With simultaneous use with GCS, hormonal contraceptives for oral administration, danazol, epinephrine, glucagon, thyroid hormones, phenothiazine derivatives, thiazide diuretics, nicotinic acid derivatives, the hypoglycemic effect of metformin may decrease.

In patients receiving metformin, the use of iodine-containing contrast agents for the purpose of diagnostic studies (including intravenous urography, intravenous cholangiography, angiography, CT) increases the risk of developing acute renal dysfunction and lactic acidosis. These combinations are contraindicated.

Beta2-adrenomimetics in the form of injections increase the concentration of glucose in the blood due to stimulation of β2-adrenergic receptors. In this case, it is necessary to control the concentration of glucose in the blood. It is recommended to prescribe insulin if necessary.

Concomitant use of cimetidine may increase the risk of lactic acidosis.

Simultaneous reception of "loop" diuretics can lead to the development of lactic acidosis due to possible functional renal failure.

Concomitant use with ethanol increases the risk of developing lactic acidosis.

Nifedipine increases the absorption and C max of metformin.

Cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim and vancomycin) secreted in the renal tubules compete with metformin for tubular transport systems and can lead to an increase in its C max.

There are extremely limited data on sibutramine overdose. In case of overdose, the patient should consult a doctor. Symptoms: most often - tachycardia, increased blood pressure, headache, dizziness. Treatment: there is no specific treatment or specific antidote