Do not use in patients with eGFR below 30 mL/minute/1.73 m 2 (2.3).Prior to initiation, assess renal function with estimated glomerular filtration rate (eGFR) (2.3).Patients receiving metformin hydrochloride tablet may be switched to metformin hydrochloride extended-release tablets once daily at the same total daily dose, up to 2,000 mg once daily (2.1).Increase the dose in increments of 500 mg weekly, up to a maximum of 2,000 mg once daily with the evening meal (2.1).Starting dose: 500 mg orally once daily with the evening meal (2.1).
Swallow metformin hydrochloride extended-release tablets whole and never crush, cut or chew (2.1).(5.1)Īdult Dosage for Metformin Hydrochloride Extended-Release Tablets: ( 2) If lactic acidosis is suspected, discontinue metformin hydrochloride extended-release tablets and institute general supportive measures in a hospital setting.
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Steps to reduce the risk of and manage metformin- associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information. Risk factors include renal impairment, concomitant use of certain drugs, age >65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment.Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio and metformin plasma levels generally >5 mcg/mL. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias.WARNING: LACTIC ACIDOSIS See full prescribing information for complete boxed warning.
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