![]() ![]() (2.3) o Do not use in patients with eGFR below 30 mL/minute/1.73 mĢ (2.3) o Initiation is not recommended in patients with eGFR between 30-45 mL/minute/1.73 mĢ (2.3) o Assess risk/benefit of continuing if eGFR falls below 45 mL/minute/1.73 mĢ (2.3) o Discontinue if eGFR falls below 30 mL/minute/1.73 mĢ (2.3) Discontinuation for Iodinated Contrast Imaging Procedures: Prior to initiation, assess renal function with estimated glomerular filtration rate (eGFR).Patients receiving Metformin hydrochloride tablets may be switched to Metformin hydrochloride extended-release tablets once daily at the same total daily dose, up to 2000 mg once daily.Increase the dose in increments of 500 mg weekly, up to a maximum of 2000 mg once daily with the evening meal.Starting dose:500 mg orally once daily with the evening meal.Swallow Metformin hydrochloride extended-release tablets whole and never crush, cut or chew.(5.1)Īdult Dosage for Metformin hydrochloride extended-release tablets: If lactic acidosis is suspected, discontinue Metformin hydrochloride extended-release tablets and institute general supportive measures in a hospital setting. ![]() ![]() 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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