Metaglip i Sverige

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Metformin had no effect on cimetidine pharmacokinetics.

• Alcohol intake Alcohol is known to potentiate the effect of metformin on lactate metabolism.
• Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning.

Lactic acidosis may Metaglip i Sverige occur Metaglip i Sverige association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever there is significant tissue Metaglip i Sverige and hypoxemia, Metaglip i Sverige. The incidence of lactic acidosis in patients receiving metformin hydrochloride is very low approximately 0. In more than 20,000 patient-years exposure to metformin in clinical trials, there were no reports of lactic acidosis. 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 Metaglip i Sverige acidosis may, therefore, be significantly decreased by regular monitoring of renal Metaglip i Sverige in patients taking metformin Lactic acidosis is a medical emergency that must be treated in a hospital setting. Such management often results in prompt reversal of symptoms and recovery.

The study involved 823 patients who were randomly assigned to 1 of 4 treatment groups Diabetes 19 Suppl. UGDP reported that patients treated for 5 to 8 years with diet plus a fixed dose of tolbutamide 1. A significant increase in total mortality was not observed, but the use of tolbutamide was discontinued based on the increase in cardiovascular mortality, Metaglip i Sverige, thus limiting the opportunity for the study to show an increase in overall mortality. Despite controversy regarding the interpretation of these results, the findings of the UGDP study provide an adequate basis for this warning. The patient should be informed of the potential risks and benefits of glipizide and of alternative modes of therapy.

Metaglip Tablet

The risk hypoglycemia is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant Metaglip i Sverige with other Metaglip i Sverige agents or ethanol. Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects. If hypoglycemia should occur in such patients, it may be prolonged and appropriate management should be instituted.

Hemolytic anemia Treatment of patients with glucose-6-phosphate dehydrogenase G6PD deficiency with sulfonylurea agents can lead to hemolytic anemia.

Hur Mycket Är En Metaglip

In postmarketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency. Metformin Hydrochloride Monitoring Metaglip i Sverige renal function Metformin is known to Metaglip i Sverige substantially excreted by the kidney, and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. In patients with advanced age, METAGLIP glipizide and metformin should be carefully titrated to Metaglip i Sverige the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function. Before initiation of METAGLIP glipizide and metformin therapy and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal dysfunction is anticipated, renal function should be assessed more frequently and METAGLIP glipizide and metformin discontinued if evidence of renal impairment is present.

Therefore, in patients in whom any such study is planned, METAGLIP glipizide and metformin should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been reevaluated and found to be normal. Hypoxic states Cardiovascular collapse shock from whatever cause, acute congestive heart failure, acute myocardial infarction, and other conditions characterized by hypoxemia have been associated with lactic acidosis and may also cause prerenal azotemia.

Surgical procedures METAGLIP glipizide and metformin therapy should be temporarily suspended for any surgical procedure except minor procedures not associated with restricted intake of food and fluids and should not be restarted until the patient’s oral intake has resumed and renal function been evaluated as normal, Metaglip i Sverige. Metaglip i Sverige intake Alcohol is known to potentiate Metaglip i Sverige effect of metformin on lactate metabolism. Due to its effect on the gluconeogenic capacity of the liver, alcohol may also increase the risk of hypoglycemia. Impaired hepatic function Since impaired hepatic function has been associated with some cases of lactic acidosis, METAGLIP glipizide and metformin should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Such decrease, possibly due to interference with B12 absorption from the B12- intrinsic factor complex is, however, very rarely associated with anemia and appears to be rapidly reversible with discontinuation of metformin or vitamin B12 supplementation.

Certain individuals those with inadequate vitamin B12 or calcium intake or absorption appear to be predisposed to developing subnormal vitamin B12 levels.

Change in clinical status of patients with previously controlled Metaglip i Sverige 2 diabetes A patient with type 2 diabetes previously well controlled on metformin who develops laboratory abnormalities or clinical illness especially vague and Metaglip i Sverige defined illness should be evaluated promptly for evidence of ketoacidosis or lactic acidosis. Patients should be Metaglip i Sverige to discontinue METAGLIP glipizide and metformin immediately and promptly notify their health practitioner if unexplained hyperventilation, myalgia, malaise, unusual somnolence, or other nonspecific symptoms occur. The risks of hypoglycemia, Metaglip i Sverige, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members.

While megaloblastic anemia has rarely been seen with metformin therapy, if this is suspected, vitamin B12 deficiency should be excluded, Metaglip i Sverige. The following data are based on findings in studies performed with the individual products. Bacterial and in vivo mutagenicity tests were uniformly negative. Studies in rats of both sexes at doses up to 75 times the human dose showed no effects on fertility.

Generisk Metaglip Köper Bäst

No evidence of carcinogenicity with metformin alone was found in either male or female mice. Similarly, there was no tumorigenic potential observed with metformin alone in male rats. There was no evidence of a mutagenic potential of metformin alone in the Metaglip i Sverige in vitro tests: Results in the in vivo mouse micronucleus test were also negative. Teratogenic Effects – Pregnancy Category C Recent information strongly suggests that abnormal blood glucose levels Metaglip i Sverige pregnancy are associated with a higher incidence of congenital abnormalities, Metaglip i Sverige.

Metaglip i Sverige experts recommend that insulin be used during pregnancy to maintain blood glucose as close to normal as possible. If hypoglycemia should occur in such patients, it may be prolonged and appropriate management should be instituted. Hemolytic anemia Treatment of patients with glucose-6-phosphate dehydrogenase G6PD deficiency with sulfonylurea agents can lead to hemolytic anemia.

Because Metaglip belongs to the class of sulfonylurea agents, caution should be used in patients with G6PD deficiency and a non-sulfonylurea alternative should be considered. In postmarketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency. Metformin Hydrochloride Monitoring of renal function Metformin is known to be substantially excreted by the kidney, and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function.

In patients with advanced age, Metaglip should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function. Before initiation of Metaglip therapy and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal dysfunction is anticipated, renal function should be assessed more frequently and Metaglip discontinued if evidence of renal impairment is present.

Metaglip Description

Therefore, in patients in whom any such study is Metaglip i Sverige, Metaglip Metaglip i Sverige be temporarily Metaglip i Sverige prerenal azotemia.

Surgical procedures Metaglip therapy should be temporarily suspended for any surgical procedure Metaglip i Sverige minor procedures not associated with restricted intake of food and fluids and should not be restarted until the on lactate metabolism.

Patients, therefore, should be warned against excessive alcohol intake, Metaglip i Sverige, acute or chronic, while receiving Metaglip. Metaglip i Sverige to its Metaglip i Sverige on the gluconeogenic capacity of the liver, alcohol may also increase the risk of hypoglycemia. Impaired hepatic function Since impaired hepatic function has been associated with some cases of lactic acidosis, Metaglip should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Such decrease, possibly due to interference with B12 absorption from the B12-intrinsic factor complex is, however, very rarely associated with anemia and appears to be rapidly reversible with discontinuation of metformin or vitamin B12 supplementation.

Certain individuals those with inadequate vitamin B12 or calcium intake or absorption appear to be predisposed to developing subnormal vitamin B12 levels. Change in clinical status of patients with previously controlled type 2 diabetes A patient with type 2 diabetes previously well controlled on metformin who develops laboratory abnormalities or clinical illness especially vague and poorly defined illness should be evaluated promptly for evidence of ketoacidosis or lactic acidosis.

Information for Patients Metaglip Patients should be informed of the potential risks and benefits of Metaglip and alternative modes of therapy. Patients should be advised to discontinue Metaglip immediately and promptly notify their health practitioner if unexplained hyperventilation, myalgia, malaise, unusual somnolence, or other nonspecific symptoms occur. The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members.

Patients should be counseled against excessive alcohol intake, either acute or chronic, while receiving Metaglip. See Patient Information printed below. While megaloblastic anemia has rarely been seen with metformin therapy, if this is suspected, vitamin B12 deficiency should be excluded. A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known. Tmax and half-life were unaffected.

Nifedipine appears to enhance the absorption of metformin. Metformin had minimal effects on nifedipine. There was no change in elimination half-life in the single-dose study. Metformin had no effect on cimetidine pharmacokinetics.

Carcinogenesis, Mutagenesis, in studies performed with the individual products.

Bacterial and in vivo mutagenicity tests were uniformly negative. Studies in rats of both sexes at doses up to 75 times the Metaglip i Sverige dose showed effects on fertility, Metaglip i Sverige. These doses are both approximately 4 times the maximum recommended human daily Metaglip i Sverige dose of 2000 mg of the metformin component of Metaglip based on body surface area comparisons. No evidence of carcinogenicity with metformin alone was found Metaglip i Sverige either Metaglip i Sverige or female mice. Similarly, there was no tumorigenic potential observed with metformin alone in male rats.

There was no evidence of a mutagenic potential of metformin alone in the following in vitro tests: Results in the in vivo mouse micronucleus test were also negative. Pregnancy Category C Recent information strongly suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities. Most experts recommend that insulin be used during pregnancy to maintain blood glucose as close to normal as possible.

Because animal reproduction studies are not always predictive of human response, Metaglip should not be used during pregnancy unless clearly needed. There are no adequate and well-controlled studies in pregnant women with Metaglip or its individual components. No animal studies have been conducted with the combined products in Metaglip. This fetotoxicity has been similarly noted with other sulfonylureas, such as tolbutamide and tolazamide. The effect is perinatal and believed to be directly related to the pharmacologic hypoglycemic action of glipizide.

In studies in rats and rabbits, no teratogenic effects were found. This represents an exposure of about 2 and 6 times the MRHD dose of 2000 mg of the metformin component of Metaglip based on body surface area comparisons for rats and rabbits, respectively.

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