Glucophage Long: reviews, instructions for use, price

Pharmacodynamics and pharmacokinetics

Metformin is a biguanide with a hypoglycemic effect that can reduce the concentration of glucose in the blood plasma. However, it does not stimulate the production of insulin , and therefore does not cause hypoglycemia . During treatment, peripheral receptors become more sensitive to insulin, and glucose utilization by cells increases. The synthesis of glucose by the liver is reduced due to inhibition of glycogenolysis and gluconeogenesis. There was a delay in glucose absorption in the gastrointestinal tract.

The active component of the drug stimulates the production of glycogen by acting on glycogen synthase. The transport capacity of any membrane glucose transporters increases.

When treated with metformin, patients maintain body weight or notice a moderate decrease. The substance has a beneficial effect on lipid metabolism: reducing the level of total cholesterol, triglycerides and LDL.

Extended-release tablets are characterized by slow absorption. Therefore, the therapeutic effect lasts for at least 7 hours. The absorption of the drug does not depend on food and does not cause accumulation. Slight binding to plasma proteins is noted. Metabolism occurs without the formation of metabolites. The components are excreted unchanged through the kidneys.

Glucophage long

Use during pregnancy and breastfeeding

Decompensated diabetes mellitus during pregnancy is associated with an increased risk of birth defects and perinatal mortality.
Limited evidence suggests that the use of metformin in pregnant women does not increase the risk of birth defects in children.

When planning pregnancy, as well as in case of pregnancy while using metformin, the drug should be discontinued and insulin therapy should be prescribed. It is necessary to maintain blood glucose concentrations at a level as close to normal as possible to reduce the risk of fetal malformations.

Metformin is excreted in breast milk. No side effects were observed in breastfeeding newborns while taking metformin. However, due to limited data, the use of the drug 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.

Use for liver dysfunction

Contraindication: liver failure, impaired liver function.

Use for renal impairment

Contraindicated in case of renal failure or impaired renal function (creatinine clearance less than 60 ml/min), in acute conditions with a risk of developing renal dysfunction, incl. dehydration (with chronic or severe diarrhea, repeated bouts of vomiting), severe infectious diseases (for example, respiratory and urinary tract infections), shock.

Use in children

Contraindicated in children and adolescents under 18 years of age due to the lack of data on use.

Use in elderly patients

The drug should be used with caution in patients over 60 years of age who perform heavy physical work, which is associated with an increased risk of developing lactic acidosis.

special instructions

Lactic acidosis

Lactic acidosis is an extremely rare but serious (high mortality rate unless promptly treated) complication that can occur due to accumulation of metformin. Cases of lactic acidosis in patients receiving metformin occurred mainly in diabetic patients with severe renal failure.

Other associated risk factors should be considered, such as poorly controlled diabetes, ketosis, prolonged fasting, excessive alcohol consumption, liver failure and any condition associated with severe hypoxia. This may help reduce the incidence of lactic acidosis.

The risk of developing lactic acidosis should be taken into account when nonspecific signs appear, such as muscle cramps accompanied by dyspepsia, abdominal pain, general weakness and severe malaise.

Lactic acidosis is characterized by acidotic shortness of breath, vomiting, abdominal pain, muscle cramps and hypothermia followed by coma. Diagnostic laboratory parameters are a decrease in blood pH (<7.25), plasma lactate content >5 mmol/l, increased anion gap and lactate/pyruvate ratio. If lactic acidosis is suspected, stop taking the drug and consult a doctor immediately.

Surgical operations

The use of metformin should be discontinued 48 hours before elective surgery and can be continued no earlier than 48 hours after, provided that renal function has been found to be normal during the examination.

Kidney function

Since metformin is excreted by the kidneys, before starting treatment, and regularly thereafter, it is necessary to determine CC: at least once a year in patients with normal renal function, and 2-4 times a year in elderly patients, as well as in patients with CC on lower limit of normal. In the case of CC less than 45 ml/min, the use of the drug is contraindicated.

Particular caution should be exercised in case of possible impairment of renal function in elderly patients, with simultaneous use of antihypertensive drugs, diuretics or NSAIDs.

Heart failure

Taking metformin in acute heart failure and chronic heart failure with unstable hemodynamic parameters is contraindicated.

Other Precautions

Patients are advised to continue to follow a diet with even carbohydrate intake throughout the day.

Overweight patients are recommended to continue to follow a hypocaloric diet (but not less than 1000 kcal/day). Patients should also exercise regularly.

Patients should tell their doctor about any treatment they are undergoing and any infectious diseases such as respiratory or urinary tract infections.

Standard laboratory tests should be performed regularly to monitor diabetes mellitus.

Metformin does not cause hypoglycemia when used alone, but caution is recommended when used in combination with insulin or other oral hypoglycemic agents (for example, sulfonylureas or repaglinide). Symptoms of hypoglycemia include weakness, headache, dizziness, increased sweating, rapid heartbeat, blurred vision, or difficulty concentrating.

It is necessary to warn the patient that the inactive components of the drug Glucophage® Long can be excreted unchanged through the intestines, which does not affect the therapeutic activity of the drug.

Impact on the ability to drive vehicles and operate machinery

Monotherapy with Glucophage Long does not cause hypoglycemia and therefore does not affect the ability to drive a car or operate machinery.

However, patients should be warned about the risk of hypoglycemia when using metformin in combination with other hypoglycemic drugs (sulfonylureas, insulin, repaglinide).

Contraindications for use

The drug is not prescribed for:

sensitivity to metformin and other components;
diabetic ketoacidosis , precoma , coma ;
impairment or insufficiency of kidney or liver function;
acute forms of various diseases;
extensive injuries and operations;
chronic alcoholism , alcohol intoxication;
pregnancy;
lactic acidosis;
use 48 hours before or after radioisotope or x-ray studies involving the administration of iodinated contrast agent;
hypocaloric diets;
under 18 years of age.

Caution when prescribing this drug should be exercised in relation to elderly patients and people performing heavy physical work, as this can cause the development of lactic acidosis when treating nursing women.

GLUCOPHAGE LONG tablet. prolong 750 mg No. 30

special instructions

Lactic acidosis
Lactic acidosis is a rare but serious complication (high mortality if not promptly treated) that may occur due to accumulation of metformin. Cases of lactic acidosis when taking metformin occurred mainly in patients with diabetes mellitus with severe renal failure.

Other associated risk factors should be taken into account, such as decompensated diabetes mellitus, ketosis, prolonged fasting, alcoholism, liver failure and any condition associated with severe hypoxia. This may help reduce the incidence of lactic acidosis.

The risk of developing lactic acidosis should be taken into account when nonspecific signs appear, such as muscle cramps accompanied by dyspeptic disorders, abdominal pain and severe asthenia.

Lactic acidosis is characterized by severe malaise with general weakness, acidotic shortness of breath, vomiting, abdominal pain, muscle cramps and hypothermia followed by coma.

Diagnostic laboratory parameters are a decrease in blood pH (less than 7.25), plasma lactate concentration over 5 mmol/l, increased anion gap and lactate/pyruvate ratio. If lactic acidosis is suspected, stop taking the drug and consult a doctor immediately.

Surgical operations

Kidney function

Since metformin is excreted by the kidneys, before starting treatment and regularly thereafter, it is necessary to determine creatinine clearance: at least once a year in patients with normal renal function, and 2-4 times a year in elderly patients, as well as in patients with creatinine clearance of lower limit of normal.

Particular caution should be exercised in case of possible impairment of renal function in elderly patients, with simultaneous use of antihypertensive drugs, diuretics or non-steroidal anti-inflammatory drugs.

Heart failure

Patients with heart failure have a higher risk of developing hypoxia and renal failure. Patients with chronic heart failure should have cardiac and renal function monitored regularly while taking metformin. Taking metformin in acute heart failure and chronic heart failure with unstable hemodynamic parameters is contraindicated.

Other Precautions

- Patients are advised to continue to follow a diet with even carbohydrate intake throughout the day. Overweight patients are recommended to continue to follow a hypocaloric diet (but not less than 1000 kcal/day). Patients should also exercise regularly.

— Patients should inform their doctor about any treatment they are undergoing and any infectious diseases such as colds, respiratory tract infections or urinary tract infections.

— It is recommended that routine laboratory tests be performed regularly to monitor diabetes mellitus.

Symptoms of hypoglycemia include weakness, headache, dizziness, increased sweating, rapid heartbeat, blurred vision, or difficulty concentrating.

— It is necessary to warn the patient that the inactive components of the drug Glucophage Long can be excreted unchanged through the intestines, which does not affect the therapeutic activity of the drug.

Side effects

During drug therapy, the development of lactic acidosis , megaloblastic anemia , and decreased absorption of vitamin B12 is possible.

Disturbances in the functioning of the nervous system and gastrointestinal tract are also possible: changes in taste, nausea, vomiting, pain, diarrhea, loss of appetite. Typically, such symptoms bother you at the beginning of treatment and gradually disappear. To prevent their development, patients are recommended to take metformin together or immediately after meals.

In rare cases, deviations in the activity of the liver and bile and the manifestation of allergic skin reactions .

Instructions for use Glucophage Long (Method and dosage)

The tablets are intended to be taken orally whole with a small volume of liquid. It is recommended to do this daily during dinner.

According to the instructions for use, the choice of dosage of extended-release tablets is carried out individually for a particular patient, taking into account blood glucose concentrations.

Glucophage Long 750 mg and 500 mg can be prescribed as mono- or combination therapy. It is important to strictly adhere to the prescribed dosages and regularly monitor blood sugar levels.

Glucophage Long tablets prolong 1000 mg No. 60

Compound

Active substance: metformin hydrochloride 1000 mg.
Excipients: carmellose sodium - 50 mg, hypromellose 2208 - 392.3 mg, magnesium stearate - 7 mg.

Pharmacokinetics

Suction

The average time to reach Cmax of metformin (1214 ng/ml) in blood plasma (TCmax) is 5 hours (range 4-10 hours) after a single oral dose of 1 tablet of Glucophage Long in the dosage form of a 1000 mg extended-release tablet.

At steady state, identical to that of regular-release metformin, Cmax and AUC increase disproportionately to dose. Following a single oral dose of metformin extended-release tablets at a dose of 2000 mg, the AUC is similar to that observed after administration of metformin regular-release tablets at a dose of 1000 mg twice daily.

Intra-individual variability in Cmax and AUC following administration of metformin extended-release tablets is similar to that observed after administration of regular-release tablets.

When metformin extended-release tablets are administered at a dose of 1000 mg after meals, AUC increases by 77% (Cmax and TCmax increase by approximately 1 hour).

The absorption of metformin from extended-release tablets does not change depending on the composition of the food taken.

No accumulation is observed with repeated administration of metformin in the form of extended-release tablets at a dose of up to 2000 mg.

Distribution

Communication with plasma proteins is negligible. Cmax in the blood is lower than Cmax in plasma and is achieved after approximately the same time. Average Vd ranges from 63-276 hp.

Metabolism

No metabolites have been detected in humans.

Removal

Metformin is excreted unchanged by the kidneys. The renal clearance of metformin is >400 ml/min, indicating that metformin is eliminated by glomerular filtration and tubular secretion. After oral administration, T1/2 is about 6.5 hours.

With impaired renal function, the clearance of metformin decreases in proportion to CC, T1/2 increases, which can lead to an increase in the concentration of metformin in plasma.

Indications for use

Type 2 diabetes mellitus in adults, especially in obese patients, with ineffective diet therapy and exercise:

as monotherapy;
in combination with other oral hypoglycemic agents or insulin.

Contraindications

Hypersensitivity to metformin or to any excipient;
diabetic ketoacidosis; diabetic precoma, coma;
renal failure or impaired renal function (creatinine clearance <45 ml/min);
acute conditions that occur with a risk of developing renal dysfunction, incl. dehydration (with chronic or severe diarrhea, repeated bouts of vomiting), severe infectious diseases (for example, respiratory and urinary tract infections), shock;
clinically pronounced manifestations of acute and chronic diseases that can lead to the development of tissue hypoxia (including acute heart failure, chronic heart failure with unstable hemodynamic parameters, respiratory failure, acute myocardial infarction);
extensive surgical operations and injuries when insulin therapy is indicated;
liver failure, liver dysfunction;
chronic alcoholism, acute alcohol poisoning;
lactic acidosis (including history);
use for a period of less than 48 hours before and within 48 hours after radioisotope or x-ray studies with the introduction of an iodinated contrast agent (for example, intravenous urography);
following a hypocaloric diet (less than 1000 kcal/day);
pregnancy;
children under 18 years of age due to the lack of data on use.

Use the drug with caution in patients over 60 years of age who perform heavy physical work, which is associated with an increased risk of developing lactic acidosis; in patients with renal failure (creatinine clearance 45-59 ml/min); during breastfeeding.

Directions for use and doses

The drug Glucophage® Long 1000 mg is taken orally. The tablets are swallowed whole, without chewing, with a sufficient amount of liquid, 1 time per day during or after dinner.

The dose of Glucophage® Long 1000 mg is selected by the doctor individually for each patient based on the results of measuring the concentration of glucose in the blood.

Monotherapy and combination therapy in combination with other hypoglycemic agents

Glucophage® Long 1000 mg should be taken once a day during or after dinner.
Glucophage Long 1000 mg is prescribed as maintenance therapy for patients taking metformin in the form of regular-release tablets at a dose of 1000 mg or 2000 mg. To switch to Glucophage Long 1000 mg, the daily dose must be equivalent to the daily dose of metformin regular release.
Patients taking metformin in the form of regular-release tablets at a dose exceeding 2000 mg are not recommended to switch to Glucophage Long 1000 mg.
For patients not taking metformin, the recommended starting dose of Glucophage Long is 500 mg or 750 mg once a day with dinner (the following formulations of Glucophage Long are available: extended-release tablets 500 mg and 750 mg). Every 10-15 days, it is recommended to adjust the dose based on the results of measuring blood glucose concentrations. Slowly increasing the dose promotes better gastrointestinal tolerability.
In case of switching from another hypoglycemic agent, dose selection is carried out as described above, starting with the administration of the drug Glucophage® Long 500 mg or 750 mg, with a possible subsequent transition to the drug Glucophage® Long 1000 mg.

Combination with insulin

To achieve better glycemic control, metformin and insulin can be used in combination therapy. The usual starting dose of Glucophage Long is one 500 mg or 750 mg tablet once a day with dinner, while the insulin dose is adjusted based on the results of measuring blood glucose concentrations. Then it is possible to switch to Glucophage® Long 1000 mg.

Daily dose

The maximum recommended dose of Glucophage® Long 1000 mg is 2 tablets per day (2000 mg). If adequate glycemic control cannot be achieved when taking the maximum recommended dose once a day, the maximum dose can be divided into two doses: 1 1000 mg tablet with breakfast and 1 1000 mg tablet with dinner. If adequate glycemic control is not achieved in this case, a switch to regular-release metformin (for example, Glucophage® film-coated tablets) with a maximum daily dose of 3000 mg is possible.

Patients with kidney failure

Metformin can be used in patients with moderate renal failure (creatinine clearance 45–59 ml/min) only in the absence of conditions that may increase the risk of developing lactic acidosis. The initial dose is 500 mg or 750 mg 1 time / day. The maximum dose is 1000 mg/day. Renal function should be carefully monitored every 3-6 months. If CC is below 45 ml/min, the drug should be stopped immediately.

Elderly patients

In elderly patients, the dose of metformin is adjusted based on assessment of renal function, which should be carried out regularly.

Duration of treatment

Glucophage® Long should be taken daily, without interruption. If treatment is stopped, the patient must inform the doctor.

Missing a dose

If a dose is missed, the patient should take the next dose at the usual time. You should not take a double dose of Glucophage® Long.

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 30 °C.

Best before date

3 years. Do not use after the expiration date.

special instructions

Lactic acidosis

Lactic acidosis is an extremely rare but serious complication (high mortality in the absence of immediate treatment) that can occur due to the accumulation of metformin. Cases of lactic acidosis in patients receiving metformin occurred mainly in diabetic patients with severe renal failure.

The risk of developing lactic acidosis should be taken into account when nonspecific signs appear, such as muscle cramps accompanied by dyspeptic disorders, abdominal pain and severe asthenia.

Lactic acidosis is characterized by severe malaise with general weakness, acidotic shortness of breath, vomiting, abdominal pain, muscle cramps and hypothermia followed by coma. Diagnostic laboratory parameters are decreased blood pH (<7.25), plasma lactate concentration >5 mmol/l, increased anion gap and lactate/pyruvate ratio. If lactic acidosis is suspected, stop taking the drug and consult a doctor immediately.

Surgical operations

Kidney function

Particular caution should be exercised in case of possible impairment of renal function in elderly patients with simultaneous use of antihypertensive drugs, diuretics or NSAIDs.

Heart failure

Taking metformin in acute heart failure and chronic heart failure with unstable hemodynamic parameters is contraindicated.

Other Precautions

Patients are advised to continue to follow a diet with even carbohydrate intake throughout the day. Overweight patients are recommended to continue to follow a hypocaloric diet (but not less than 1000 kcal/day). Patients should also exercise regularly.
Patients should inform their physician about any treatment they are undergoing and any infectious diseases such as colds, respiratory tract infections, or urinary tract infections.
It is recommended that routine laboratory tests be performed regularly to monitor diabetes mellitus.
Metformin does not cause hypoglycemia when used alone, but caution is recommended when used in combination with insulin or other oral hypoglycemic agents (for example, sulfonylureas or repaglinide, etc.). Symptoms of hypoglycemia include weakness, headache, dizziness, increased sweating, rapid heartbeat, blurred vision, or difficulty concentrating.

Description

Hypoglycemic agent for oral administration of the biguanide group.

Use in children

Contraindicated in children and adolescents under 18 years of age due to the lack of data on use.

Pharmacodynamics

Metformin is a biguanide with a hypoglycemic effect, reducing both basal and postprandial plasma glucose levels. It does not stimulate insulin secretion and therefore does not cause hypoglycemia. Increases the sensitivity of peripheral receptors to insulin and the utilization of glucose by cells. Reduces liver glucose production by inhibiting gluconeogenesis and glycogenolysis. Delays the absorption of glucose in the intestine.

Metformin stimulates glycogen synthesis by acting on glycogen synthase. Increases the transport capacity of all types of membrane glucose transporters.

While taking metformin, the patient's body weight either remains stable or decreases moderately.

Metformin has a beneficial effect on lipid metabolism: it reduces the content of total cholesterol, LDL and triglycerides.

Side effects

The frequency of side effects of the drug is assessed as follows: very common: ≥1/10 common: ≥1/100, <1/10 uncommon: ≥1/1000, <1/100 rare: ≥1/10,000, <1/1000 very rare: ≤1/10,000

Metabolic and nutritional disorders

Very rarely - lactic acidosis. With long-term use of metformin, a decrease in the absorption of vitamin B12 may be observed. When megaloblastic anemia is detected, the possibility of such an etiology must be taken into account.

Nervous system disorders

Often - taste disturbance (metallic taste in the mouth).

Gastrointestinal disorders

Very common: nausea, vomiting, diarrhea, abdominal pain and lack of appetite. Most often they occur during the initial period of treatment and in most cases resolve spontaneously. To prevent symptoms, it is recommended to take metformin during or after meals. Slowly increasing the dose may improve gastrointestinal tolerability.

Disorders of the liver and biliary tract

Very rarely - abnormal liver function tests and hepatitis; after discontinuation of metformin, these adverse effects completely disappear.

Skin and subcutaneous tissue disorders

Very rarely - skin reactions such as erythema (redness of the skin), itching, urticaria.

If any of the side effects indicated in the instructions are aggravated, or other side effects not listed in the instructions are noted, the patient should inform the doctor.

Use during pregnancy and breastfeeding

Decompensated diabetes mellitus during pregnancy is associated with an increased risk of birth defects and perinatal mortality.

Limited evidence suggests that the use of metformin in pregnant women does not increase the risk of birth defects in children.

When planning pregnancy, as well as in the event of pregnancy while using metformin, the drug should be discontinued and insulin therapy should be prescribed. It is necessary to maintain blood glucose concentrations at a level as close to normal as possible to reduce the risk of fetal malformations.

Interaction

Contraindicated combinations

Iodine-containing radiocontrast agents:

against the background of functional renal failure in patients with diabetes mellitus, radiological examination using iodine-containing radiocontrast agents can cause the development of lactic acidosis. Glucophage Long should be discontinued depending on renal function 48 hours before or during an X-ray examination using iodine-containing contrast agents and resumed no earlier than 48 hours after, provided that during the examination renal function was found to be normal.

Combinations not recommended

Alcohol.

With acute alcohol intoxication, the risk of developing lactic acidosis increases, especially in the case of:

malnutrition, low-calorie diet;
liver failure.

While taking the drug, you should avoid drinking alcohol and medications containing ethanol.

Combinations requiring caution

Medicines with indirect hyperglycemic effect

(for example, corticosteroids and tetracosactide (systemic and local), beta2-agonists, danazol, chlorpromazine when taken in large doses (100 mg per day) and diuretics): more frequent monitoring of blood glucose concentrations may be required, especially at the beginning of treatment. If necessary, the dose of Glucophage Long can be adjusted during treatment and after its cessation, based on the level of glycemia.

Diuretics:

simultaneous use of loop diuretics can lead to the development of lactic acidosis due to possible functional renal failure.

With simultaneous use of the drug Glucophage® Long with sulfonylurea derivatives, insulin, acarbose, salicylates

hypoglycemia may develop.

Nifedipine

increases absorption and Cmax 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 may lead to an increase in its Cmax.

Kolesevelam

when used simultaneously with metformin in the form of extended-release tablets, it increases the concentration of metformin in the blood plasma (increased AUC without a significant increase in Cmax).

Overdose

When using metformin at a dose of 85 g (42.5 times the maximum daily dose), the development of hypoglycemia was not observed, but in this case the development of lactic acidosis was observed. Significant overdose or associated risk factors can lead to the development of lactic acidosis.

Treatment: if signs of lactic acidosis appear, treatment with the drug must be stopped immediately, the patient must be urgently hospitalized and, after determining the lactate concentration, the diagnosis must be clarified. The most effective measure for removing lactate and metformin from the body is hemodialysis. Symptomatic treatment is also carried out.

Release form

Extended release tablets, 1000 mg.

Impact on the ability to drive vehicles and operate machinery

Monotherapy with Glucophage® Long does not cause hypoglycemia and therefore does not affect the ability to drive vehicles and machines.

However, it is possible to develop hypoglycemia when using metformin in combination with other hypoglycemic drugs (sulfonylurea derivatives, insulin, repaglinide, etc.). If symptoms of hypoglycemia appear, you should not drive vehicles or machinery.

Overdose

Taking metformin in a dosage of less than 85 g does not cause hypoglycemia . But the possibility of developing lactic acidosis remains.

If symptoms of lactic acidosis appear, you must immediately stop taking the medication and determine the lactate concentration in a hospital setting to clarify the diagnosis. The effectiveness of the procedure for removing lactate and metformin from the body using hemodialysis has been noted. Concomitant symptomatic therapy is also carried out.

Glucophage® Long

Lactic acidosis

Lactic acidosis is a very rare but serious complication (high mortality in the absence of immediate treatment) that can occur due to the accumulation of metformin. Cases of lactic acidosis when taking metformin occurred mainly in patients with diabetes mellitus with severe renal failure.

Other associated risk factors should be taken into account, such as decompensated diabetes mellitus, ketosis, prolonged fasting, alcoholism, severe infectious disease, liver failure, any condition associated with severe hypoxia and concomitant use of drugs that can cause the development of lactic acidosis (see section " Interaction with other drugs"). This may help reduce the incidence of lactic acidosis. The risk of developing lactic acidosis should be taken into account when nonspecific signs appear, such as muscle cramps accompanied by dyspeptic disorders, abdominal pain and severe asthenia.

Lactic acidosis is characterized by severe malaise with general weakness, acidotic shortness of breath, vomiting, abdominal pain, muscle cramps and hypothermia followed by coma.

Diagnostic laboratory parameters are a decrease in blood pH (less than 7.35), plasma lactate concentration over 5 mmol/l, increased anion gap and lactate/pyruvate ratio. If lactic acidosis is suspected, stop taking the drug and consult a doctor immediately.

Surgical operations

The use of metformin should be discontinued 48 hours before elective surgery and can be continued no earlier than 48 hours after, provided that renal function was found to be normal during the examination.

Kidney function

Since metformin is excreted by the kidneys, before starting treatment and regularly thereafter, it is necessary to determine creatinine clearance: at least once a year in patients with normal renal function, every 3-6 months in patients with creatinine clearance 45-59 ml/min and every 3 months in patients with creatinine clearance 30-44 ml/min.

In case of creatinine clearance less than 30 ml/min, the use of the drug is contraindicated.

Particular caution should be exercised in case of possible impairment of renal function in elderly patients, with dehydration (chronic or severe diarrhea, repeated bouts of vomiting), and with the simultaneous use of antihypertensive drugs, diuretics or non-steroidal anti-inflammatory drugs.

Heart failure

Patients with heart failure have a higher risk of developing hypoxia and renal failure.

Patients with chronic heart failure should have cardiac and renal function monitored regularly while taking metformin. Taking metformin in acute heart failure and chronic heart failure with unstable hemodynamic parameters is contraindicated.

Other Precautions

— Patients should inform their doctor about any treatment they are undergoing and any infectious diseases such as colds, respiratory tract infections or urinary tract infections.

— It is recommended that routine laboratory tests be performed regularly to monitor diabetes mellitus.

— Metformin, when used alone, does not cause hypoglycemia, but it is recommended to exercise caution when using it in combination with insulin or other oral hypoglycemic agents (for example, sulfonylurea derivatives or repaglinide, etc.). Symptoms of hypoglycemia include weakness, headache, dizziness, increased sweating, rapid heartbeat, blurred vision, or difficulty concentrating.

— It is necessary to warn the patient that the inactive components of the drug Glucophage® Long can be excreted unchanged through the intestines, which does not affect the therapeutic activity of the drug.

Interaction

The development of lactic acidosis can be caused by a combination of the drug with iodine-containing radiocontrast agents. Therefore, 48 hours before and after radiological examination using iodine-containing radiopaque agents, it is recommended to discontinue Glucophage Long.

Concomitant use with drugs with an indirect hyperglycemic effect - hormonal agents or tetracosactide , as well as β2-adrenergic agonists, danazol, Chlorpromazine and diuretics can affect the concentration of glucose in the blood. Therefore, it is necessary to monitor its indicators, and, if necessary, adjust dosages.

In addition, in the presence of renal failure, diuretics contribute to the development of lactic acidosis . Combination with sulfonylurea derivatives , acarbose , insulin , and salicylates often causes hypoglycemia.

Combinations with amiloride , digoxin , morphine , procainamide , quinidine , quinine , ranitidine , triamterene , trimethoprim and vancomycin , which are secreted in the renal tubules, compete with metformin for tubular transport, which increases its concentration.

Glucophage®

Lactic acidosis

Lactic acidosis is a very rare but serious (high mortality unless promptly treated) complication that can occur due to accumulation of metformin. Cases of lactic acidosis when taking metformin occurred mainly in patients with diabetes mellitus with severe renal failure.

The risk of developing lactic acidosis should be taken into account when nonspecific signs appear, such as muscle cramps accompanied by dyspeptic disorders, abdominal pain and severe asthenia. Lactic acidosis is characterized by acidotic shortness of breath, abdominal pain and hypothermia followed by coma.

Diagnostic laboratory parameters are a decrease in blood pH (less than 7.35), lactate content in the blood plasma over 5 mmol/l, increased anion gap and lactate/pyruvate ratio. If metabolic acidosis is suspected, stop taking the drug and consult a doctor immediately.

Surgical operations

Metformin should be discontinued during surgery under general, spinal or epidural anesthesia. Metformin therapy can be continued no earlier than 48 hours after surgery or resumption of food intake, provided that renal function has been examined and found to be normal.

Kidney function

Since metformin is excreted by the kidneys, before starting treatment and regularly thereafter, it is necessary to determine creatinine clearance:

at least once a year in patients with normal renal function,
every 3-6 months in patients with creatinine clearance 45-59 ml/min,
every 3 months in patients with creatinine clearance 30-44 ml/min.

In case of creatinine clearance less than 30 ml/min, the use of the drug is contraindicated.

Heart failure

Patients with heart failure have a higher risk of developing hypoxia and renal failure.

Patients with chronic heart failure should have cardiac and renal function monitored regularly while taking metformin.

Taking metformin in acute heart failure with unstable hemodynamic parameters is contraindicated.

Children and teenagers

The diagnosis of type 2 diabetes mellitus must be confirmed before starting treatment with metformin.

In clinical studies lasting 1 year, metformin was shown to have no effect on growth and puberty. However, due to the lack of long-term data, careful monitoring of the subsequent effects of metformin on these parameters in children, especially during puberty, is recommended.

The most careful monitoring is necessary for children aged 10-12 years.

The use of iodine-containing radiocontrast agents

Intravascular administration of iodinated radiocontrast agents can lead to the development of renal failure and accumulation of metformin, which increases the risk of developing lactic acidosis. Metformin should be discontinued, depending on renal function, 48 hours before or during an X-ray examination using iodinated contrast agents, and not resumed until 48 hours after it, provided that during the examination, renal function was found to be normal.

Other precautions:

— It is recommended that routine laboratory tests be performed regularly to monitor diabetes mellitus.

— Metformin in monotherapy does not cause hypoglycemia, however, it is recommended to exercise caution when using it in combination with insulin or other hypoglycemic agents (for example, sulfonylurea derivatives, repaglinide, etc.).

The use of Glucophage® is recommended for the prevention of type 2 diabetes mellitus in persons with prediabetes and additional risk factors for the development of overt type 2 diabetes mellitus, such as:

age less than 60 years;
body mass index (BMI)≥30 kg/m2;
history of gestational diabetes mellitus;
family history of diabetes in first-degree relatives;
increased concentration of triglycerides;
reduced concentration of HDL cholesterol;
arterial hypertension.

— Metformin did not affect fertility in male or female rats when administered at doses three times the maximum recommended daily dose for humans.

Analogs

Level 4 ATX code matches:
Bagomet

Diaformin

Metformin

Formetin

Gliformin

Glucophage

Siofor

The main analogues of this drug:

Siofor
Glucophage Long
Metformin
Gliformin
Merifatin
Formetin
Diasfor
Metadiene
Diaformin
Rinformin

Reviews about Glucophage

Quite often, patients leave reviews about Glucophage Long 750 mg, since this is the dosage prescribed for the treatment of type 2 diabetes in its middle stage. However, most patients note sufficient effectiveness of the drug. There are often reports that when diabetics with high body weight took this medicine, they subsequently noticed a moderate reduction in weight to more acceptable levels.

As for Glucophage XR 500, the medicine in this dosage can be prescribed at the initial stage of treatment. In the future, a gradual increase in the dose is allowed until the most effective dose is selected.

It should be noted that any hypoglycemic drugs can only be prescribed by a specialist. In addition to competent drug treatment, the doctor will recommend changes in diet and exercise, which should be an integral part of the life of people suffering from diabetes. Only this approach will ensure a normal quality of life and not so acutely feel all the unwanted symptoms of this disorder.

Price Glucophage Long, where to buy

The price of Glucophage Long 500 mg for 30 pieces per package is about 200 rubles.

Online pharmacies in RussiaRussia

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