Diabetmin Composition, Use, Dose, Side Effect
Diabetmin is a popular oral antidiabetic agent in Nigeria. It comes in different strengths and tablet formulation. There is 500mg, 850mg, 1000mg and retard. Not all products are available in Nigeria except diabetmin 500mg tablets. It is manufactured and marketed by Hovid Bhd, Malaysia.
Composition Of Diabetmin
Diabetmin 500 mg Tablet: Metformin hydrochloride 500 mg per tablet
Diabetmin Retard Tablet: Metformin hydrochloride 850 mg per tablet (modified release)
Diabetmin 850 mg Tablet: Metformin hydrochloride 850 mg per tablet
Diabetmin 1000 mg Tablet: Metformin hydrochloride 1000 mg per tabletDiabetmin
Action And Pharmacology Of Diabetmin
Diabetmin contains Metformin. Metformin is an oral biguanide antidiabetic agent. Its mode of action is thought to be multifactorial and includes delay uptake of glucose from the gastro-intestinal tract; increased peripheral glucose utilization mediated by increased insulin sensitivity; and inhibition of increased hepatic and renal gluconeogenesis.
Pharmacokinetics
Metformin hydrochloride is slowly and incompletely absorbed from the gastro-intestinal tract. The absolute bioavailability of a single 500 mg is reported to be about 50 to 60%, although this is reduced somewhat if taken with food. Plasma protein binding is negligible. It is excreted unchanged in urine. The plasma elimination Half-Life is reported to range from about 2 to 6 hours after oral administration.
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Indications Of Diabetmin
Diabetmin is used in the treatment of non-insulin dependent diabetes mellitus (type 2) in adults not responding to exercise and dietary modification. Diabetimin may be used as monotherapy or in combination with other oral antidiabetic agents, or with insulin.
Contraindications
This medication is contraindicated in patients with the following medical conditions;
Hypersensitivity to metformin.
Any condition needing close blood glucose control, such as: severe burns, dehydration, diabetic coma, diabetic ketoacidosis, hyperosmolar nonketotic coma, severe infection, major surgery, and severe trauma.
Conditions associated with hypothermia, such as: cardio respiratory insufficiency, cardiovascular collapse, congestive heart failure, acute myocardial infarction.
Severe, acute, or chronic hepatitis disease.
Active or history of lactic acidosis.
Renal function impairment or renal disease.
Diagnostic on medical examinations using intravascular iodinated contrast media such as: angiography, intravenous cholangiography geography, computed tomography (CT) scan, pyelography and urography.
Precautions
Lactic Acidosis
Lactic acidosis is a rare, but serious (high mortality in the absence of prompt treatment), metabolic complications that can occur due to metformin accumulation. Reported cases of lactic acidosis in patients on metformin have occurred primarily in diabetic patients with significant renal failure. The incidence of lactic acidosis can and should be reduced by accessing also other associated risk factors such as poorly controlled diabetes, ketosis, prolonged fasting, excessive alcohol intake, hepatic insufficiency and any condition associated with hypoxia.
Diagnosis: Lactic acidosis is characterized by acidosis dyspnea, abdominal pain and hypothermia followed by coma. Diagnostic laboratory findings and decreased blood pH, plasma lactate levels above 5 mmol/L, and an increased anion gap and lactate/pyruvate ratio. If metabolic acidosis is suspected, diabetmin should be discontinued and the patient should be hospitalized immediately.
Renal Function
As metformin is excreted by the kidney, serum creatinine levels should be determined before initiating treatment and regularly thereafter:
At least annually in patients with normal renal function.
At least two to four times a year in patients with serum creatinine levels at the upper limit of normal and in elderly subjects.
Decreased renal function in elderly subjects is frequent and asymptomatic. Special caution should be exercised in situations where renal function may become impaired, for example when initiating antihypertensive therapy or diuretic therapy and when starting therapy with an NSAID.
Administration of iodinated contrast agents: as the intravascular administration of iodinated contrast materials in radiologic studies can lead to renal failure, metformin should be discontinued prior to, or at the time of the test and not be reinstituted until 48 hours afterwards, and only after renal function has been re-evaluated and found to be normal.
Surgery
Diabetmin should be discontinued before elective surgery with general anesthesia and should not usually resume earlier than 48 hours afterwards.
Other Precautions
All patients should continue that diet with regular distribution of carbohydrate intake during the day. overweight patients should continue their energy restricted diet.
The usual laboratory tests for diabetes monitoring should be performed regularly.
Metformin alone never causes hypoglycemia, although caution is advised when it is used in combination with insulin or sulfonylureas.
Use In Pregnancy And Lactation
For fertility and pregnancy problems, adequate and well-controlled studies in humans have not been done and documented. For patient plans to become pregnant or during pregnancy, control blood glucose with diet alone or a combination of diet and insulin is recommended why use of diabetmin is discouraged. Diabetmin is distributed into breast milk, but safety for use in nursing mothers has not been established.
Main Sides/Adverse Effects Of Diabetmin
Diabetmin can cause;
Gastrointestinal adverse effects including anorexia, diarrhea, dyspnea, flatulence, nausea, vomiting.
Headache, metallic taste, weight loss.
Anemia, megaloblastic, hypoglycemia, lactic acidosis.
Long-term diabetmin therapy may cause a decrease of vitamin B12 absorption with decrease of serum levels.
Drug Interactions
Concurrent use of this medication with the following may interact with metformin:
Acute or chronic ingestion of alcohol.
Cimetidine or other cationic medications excreted by renal tubular transport.
Furosemide.
Hyperglycemia causing and hypoglycemia causing medications.
Overdose
Symptoms of overdose: hypoglycemia and lactic acidosis.
Treatment Of Overdose
For hypoglycemia: treating with immediate injection of a source of glucose and counseling patients to obtain emergency medical assistance immediately.
For lactic acidosis: hemodialysis with sodium bicarbonate.
Dosage And Administration
Oral
Monotherapy and combination with other oral antidiabetic agents:
Usual adult dose:
Diabetmin 500mg tablet: initial dose of one tablet two to three times daily with or after meals.
Diabetmin retard tablet: initial dose of one tablet two times daily with or after meals.
Diabetmin 850 mg tablet: initial dose of one tablet two times daily with or after meals.
Diabetmin 1000 mg tablet: initial dose of one tablet once daily with or after meals.
If necessary, medication can be increased gradually to a maximum of 3 g daily.
If transfer from another oral antidiabetic agent is intended, discontinue the other agent and initiate diabetmin at the dose indicated above.
Combination With Insulin
Diabetmin and insulin may be used in combination therapy to achieve better blood glucose control. Diabetmin is given at the usual starting dose of one tablet 2 to 3 times daily why insulin dosage is adjusted on the basis of blood glucose measurement.
Usual children dose: diabetmin is not recommended for use in children
Usual geriatric dose: please refer to adult dose (due to potential for decreased renal function, the dosage should be adjusted based on renal function and maximum doses are not advice for use in the elderly).
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