Recommended Dosing Schedule: Adults: In General, Clinically Significant Responses are not Seen at Doses Below 1500 mg Per Day. However, a Lower Recommended Starting Dose and Gradually Increased Dosage is Advised to Minimize Gastrointestinal Symptoms. The Usual Starting Dose of Metformin Tablets is 500 mg Twice a Day or 850 mg Once a Day, Given with Meals. Dosage Increases should be Made in Increments of 500 mg Weekly or 850 mg Every 2 Weeks, up to a Total of 2000 mg Per Day, Given in Divided Doses. Patients can Also be Titrated from 500 mg Twice a Day to 850 mg Twice a Day after 2 Weeks. For those Patients Requiring Additional Glycemic Control, Metformin may be Given to a Maximum Daily Dose of 2550 mg Per Day. Doses Above 2000 mg may be Better Tolerated Given 3 Times a Day with Meals.
Pediatrics: The Usual Starting Dose of Metformin is 500 mg Twice a Day, given with Meals. Dosage Increases should be Made in Increments of 500 mg Weekly up to a Maximum of 2000 mg Per Day, given in Divided Doses.
Polycystic Ovary Syndrome: Polycystic Ovary Syndrome, Initially 500 mg with Breakfast for 1 Week, then 500 mg with Breakfast and Evening Meal for 1 Week, then 1.5-1.7 g Daily in 2-3 Divided Doses.
Transfer from Other Antidiabetic Therapy: When Transferring Patients from Standard OralHhypoglycemic Agents other than Chlorpropamide to Metformin no Transition Period Generally is Necessary. When Transferring Patients from Chlorpropamide, Care should be Exercised During the First 2 Weeks Cecause of the Prolonged Retention of Chlorpropamide in the Body, Leading to Overlapping Drug Effects and Possible Hypoglycemia.
Concomitant Metformin Oral Sulfonylurea Therapy in Adult Patients: If Patients have not Responded to 4 Weeks of the Maximum Dose of Metformin Monotherapy, Consideration should be Given to Gradual Addition of an Oral Sulfonylurea while Continuing Metformin at the Maximum Dose,Even if Prior Primary or Secondary Failure to a Sulfonylurea has Occurred. With Concomitant Metformin and Sulfonylurea Therapy, the Desired Control of Blood Glucose may be Obtained by Adjusting the Dose of Each Drug. However, Attempts should be Made to Identify the Minimum Effective Dose of Each Drug to Achieve this Goal. With Concomitant Metformin and Sulfonylurea Therapy, the Risk of Hypoglycemia Associated with Sulfonylurea Therapy Continues and may be Increased. Appropriate Precautions should be Taken.
Concomitant Metformin and Insulin Therapy in Adult Patients:The Current Insulin Dose should be Continued Upon Initiation of Metformin Therapy. Metformin Therapy should be Initiated at 500 mg Once Daily in Patients on Insulin Therapy. For Patients not Responding Adequately, the Dose of Metformin should be Increased by 500 mg After Approximately 1 Week and by 500 mg Every Week there after Until Adequate Glycemic Control is Achieved. The Maximum Recommended Daily Dose is 2500 mg for Metformin. It is Recommended that the Insulin Dose to be Decreased by 10% to 25% when Fasting Plasma Glucose Concentrations Decrease to Less Than 120 mg/dL in Patients Receiving Concomitant Insulin and Metformin. Further Adjustment should be Individualized Based on Glucoselowering Response.
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