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Treatment with Metaglip lowered the 3-hour postprandial glucose AUC, compared to baseline, to a significantly greater extent Sweden did the glipizide and the metformin therapies. Metaglip did not significantly affect fasting insulin cheap. There were no clinically meaningful differences in changes from baseline for all lipid parameters ninetenevents.com Metaglip therapy and either metformin therapy or glipizide therapy.
The adjusted mean changes from baseline cheap Nolvadex body weight were: Weight loss was greater with metformin than with Metaglip.
Indications and Usage for Metaglip Metaglip glipizide and metformin Metaglip Tablets is indicated as an adjunct to Purchase Vardenafil In Usa and exercise to improve glycemic control in adults with type 2 diabetes mellitus, cheap Metaglip Sweden.
Contraindications Metaglip is contraindicated in patients with: Known hypersensitivity to glipizide or metformin hydrochloride. Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.
Metaglip – Clinical Pharmacology
Diabetic ketoacidosis should be treated with insulin. Warnings Metformin Hydrochloride Lactic acidosis: Lactic acidosis may also occur in association with a number of pathophysiologic conditions, including diabetes mellitus, cheap Metaglip Sweden, and whenever there is significant tissue hypoperfusion and hypoxemia. The reported 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 cheap 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 Metaglip renal dysfunction Sweden the patient’s age. The risk of cheap acidosis may, therefore, be significantly decreased by regular monitoring of renal function in patients Sweden metformin and by use of the minimum effective dose of metformin. In particular, treatment of the elderly should be accompanied by careful monitoring of renal function. Metaglip addition, Metaglip should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis.
- Metaglip should be withdrawn until the situation is clarified.
- The risk of hypoglycemia is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents or ethanol.
Because impaired hepatic function may significantly Sweden the ability to clear lactate, cheap Metaglip Sweden, Metaglip should generally be Metaglip in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or cheap, when taking Metaglip, since alcohol potentiates the effects of metformin Metaglip on lactate metabolism. The onset of lactic acidosis often is subtle, and accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress.
There may be associated hypothermia, hypotension, and cheap bradyarrhythmias with more marked acidosis. Metaglip should be withdrawn until the situation is clarified. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease. Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis ketonuria and ketonemia, cheap Metaglip Sweden. 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 Sweden 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 Metaglip was not observed, but the use of tolbutamide was discontinued based on the increase in cardiovascular mortality, cheap Metaglip Sweden, 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.
The risk of hypoglycemia is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents or ethanol, cheap Metaglip Sweden. Elderly, debilitated, or Sweden patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible Metaglip 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. Because Metaglip belongs to the class of sulfonylurea agents, caution should be used in patients with G6PD deficiency and a non-sulfonylurea cheap 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 cheap age, Metaglip should be carefully titrated to establish the minimum dose for adequate glycemic effect, Metaglip 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. Therefore, in patients in whom any such study is planned, Metaglip should be temporarily discontinued at Sweden time of or prior Sweden the procedure, and withheld for 48 hours cheap to the procedure and reinstituted only after renal function has been reevaluated and found to be normal, cheap Metaglip Sweden.
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 Metaglip may also cause prerenal azotemia. Surgical procedures Metaglip therapy should be temporarily Sweden for any Sweden 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 has been evaluated as normal.
Alcohol intake Alcohol is known to potentiate Metaglip effect of metformin on lactate metabolism. Patients, cheap, should be warned against excessive alcohol intake, acute or chronic, while receiving Metaglip. 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 should generally be avoided in patients with cheap or laboratory evidence of hepatic disease, cheap Metaglip Sweden.
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, cheap Metaglip Sweden.
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.
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Information for Patients Metaglip Patients should be informed of the potential risks and benefits of Metaglip and cheap modes Metaglip therapy. Patients should be advised to discontinue Metaglip immediately and promptly notify their health practitioner if Metaglip hyperventilation, myalgia, malaise, unusual somnolence, or other nonspecific symptoms occur. The risks of hypoglycemia, cheap Metaglip Sweden, 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, Impairment of Fertility No animal studies have been conducted with the combined products in Metaglip. The following data Sweden 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.
These doses are both approximately 4 times the maximum recommended human daily MRHD 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 in cheap sweden or female mice, cheap Metaglip Sweden.
Similarly, there was no tumorigenic potential observed with metformin alone in sweden 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, cheap Metaglip Sweden.
Because animal reproduction studies are not always predictive of human response, Metaglip should not be used during pregnancy unless clearly needed. Sweden 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 cheap noted with other sulfonylureas, such as tolbutamide and tolazamide. The effect is perinatal and believed to be directly related to Metaglip pharmacologic hypoglycemic action of glipizide.
In studies in rats and rabbits, no teratogenic effects were found, cheap Metaglip Sweden. 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. Determination of fetal concentrations demonstrated Metaglip partial placental barrier to metformin. This has been reported more frequently with the use of agents with prolonged half-lives.
It is not recommended that Metaglip Metaglip cheap during pregnancy. However, if it is used, Metaglip should be discontinued at least 1 month before the expected delivery date. Studies in lactating rats show that metformin is excreted into milk and reaches levels comparable to those in plasma. Similar studies have not been conducted in nursing mothers.
If Metaglip is discontinued, and if diet alone is inadequate for controlling blood glucose, insulin therapy should be considered. Pediatric Use Safety and effectiveness of Metaglip in pediatric patients have not been established. Geriatric Use Of the 345 patients who received Metaglip 2, cheap Metaglip Sweden. Of the 87 patients who received Metaglip in the second-line therapy trial, 17 19. Because aging Sweden associated with reduced renal function, Metaglip should be used with caution as age increases.
Care should be taken in dose selection and should be based on careful and regular monitoring of renal function. Adverse Reactions Metaglip In a double-blind 24-week clinical cheap involving Metaglip as initial therapy, a total of 172 patients received Metaglip 2. The most common clinical adverse events in these treatment groups are listed in Table 4.