METFORMIN TEVA SR

Posology Adults with normal renal function (GFR ≥ 90 mL/min) Monotherapy in Type 2 diabetes mellitus and combination with other oral antidiabetic agents: • The usual starting dose is one 500 mg metformin prolonged-release tablet once daily.

• After 10 to 15 days the dose should be adjusted on the basis of blood glucose measurements. A slow increase of dose may improve gastro- intestinal tolerability. The maximum recommended dose is 2000 mg daily. • Dosage increases should be made in increments of 500 mg every 10-15 days, up to a maximum of 2000 mg once daily with the evening meal.

If glycaemic control is not achieved on 2000 mg once daily, 1000 mg twice daily should be considered, with both doses being given with food. If glycaemic control is still not achieved, patients may be switched to standard metformin tablets to a maximum dose of 3000 mg daily.

• In patients already treated with metformin tablets, the starting dose of metformin prolonged-release tablets should be equivalent to the daily dose of metformin immediate release tablets. In patients treated with metformin at a dose above 2000 mg daily, switching to metformin prolonged-release tablets is not recommended.

• If transfer from another oral antidiabetic agent is intended: discontinue the other agent and initiate metformin prolonged-release tablets at the dose indicated above. • Metformin Teva SR 750 mg and Metformin Teva SR 1000 mg prolonged-release tablets are intended for patients who are already treated with metformin tablets (prolonged or immediate release).

• The dose of Metformin Teva SR 750 mg or Metformin Teva SR 1000 mg prolonged-release tablets should be equivalent to the daily dose of metformin tablets (prolonged or immediate release), up to a maximum dose of 1500 mg or 2000 mg respectively, given with the evening meal.

Combination with insulin Metformin and insulin may be used in combination therapy to achieve better blood glucose control. The usual starting dose is one 500 mg metformin prolonged-release tablet once daily, while insulin dosage is adjusted on the basis of blood glucose measurements.

For patients already treated with metformin and insulin in combination therapy, the dose of Metformin Teva SR 750 mg or Metformin Teva SR 1000 mg prolonged-release tablets should be equivalent to the daily dose of metformin tablets up to a maximum of 1500 mg or 2000 mg respectively, given with the evening meal, while insulin dosage is adjusted on the basis of blood glucose measurements.

In post marketing data and in controlled clinical studies, adverse event reporting in patients treated with metformin prolonged-release tablets was similar in nature and severity to that reported in patients treated with metformin immediate release tablets.

During treatment initiation, the most common adverse reactions are nausea, vomiting, diarrhoea, abdominal pain and loss of appetite, which resolve spontaneously in most cases. The following adverse reactions may occur with metformin prolonged-release tablets.

Frequencies are defined as follows: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.

4). 4). Nervous system disorders Common: • Taste disturbance. Gastrointestinal disorders Very common: • Gastrointestinal disorders such as nausea, vomiting, diarrhoea, abdominal pain and loss of appetite. These undesirable effects occur most frequently during initiation of therapy and resolve spontaneously in most cases.

A slow increase of the dose may also improve gastrointestinal tolerability. Hepatobiliary disorders Very rare • Isolated reports of liver function tests abnormalities or hepatitis resolving upon metformin discontinuation. Skin and subcutaneous tissue disorders Very rare: • Skin reactions such as erythema, pruritus, urticaria.

Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Lactic acidosis Lactic acidosis, a very rare, but serious, metabolic complication, most often occurs at acute worsening of renal function or cardiorespiratory illness or sepsis. Metformin accumulation occurs at acute worsening of renal function and increases the risk of lactic acidosis.

In case of dehydration (severe diarrhoea or vomiting, fever or reduced fluid intake), metformin should be temporarily discontinued and contact with a health care professional is recommended. Medicinal products that can acutely impair renal function (such as antihypertensives, diuretics and NSAIDs) should be initiated with caution in metformin-treated patients.

5). Patients and/or care-givers should be informed of the risk of lactic acidosis. Lactic acidosis is characterised by acidotic dyspnoea, abdominal pain, muscle cramps, asthenia and hypothermia followed by coma. In case of suspected symptoms, the patient should stop taking metformin and seek immediate medical attention.

35), increased plasma lactate levels (>5 mmol/L) and an increased anion gap and lactate/pyruvate ratio.

Patients with known or suspected mitochondrial diseases:

In patients with known mitochondrial diseases such as Mitochondrial Encephalopathy with Lactic Acidosis, and Stroke-like episodes (MELAS) syndrome and Maternal inherited diabetes and deafness (MIDD), metformin is not recommended due to the risk of lactic acidosis exacerbation and neurologic complications which may lead to worsening of the disease.

In case of signs and symptoms suggestive of MELAS syndrome or MIDD after the intake of metformin, treatment with metformin should be withdrawn immediately and prompt diagnostic evaluation should be performed. 2. 3. Cardiac function Patients with heart failure are more at risk of hypoxia and renal insufficiency.

In patients with stable chronic heart failure, metformin may be used with a regular monitoring of cardiac and renal function. 3). Administration of iodinated contrast agents Intravascular administration of iodinated contrast agents may lead to contrast induced nephropathy, resulting in metformin accumulation and an increased risk of lactic acidosis.

1. • Any type of acute metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis). • Diabetic pre-coma. • Severe renal failure (GFR < 30 mL/min). • Acute conditions with the potential to alter renal function such as: - dehydration, - severe infection, - shock.

• Disease which may cause tissue hypoxia (especially acute disease, or worsening of chronic disease) such as: - decompensated heart failure, - respiratory failure, - recent myocardial infarction, - shock. • Hepatic insufficiency, acute alcohol intoxication, alcoholism.