Metfor PR 1000 Dosage/Direction for Use

Adults with normal renal function (GFR > 90 mL/min): Reduction in the risk or delay of the onset of type 2 diabetes: Metformin should only be considered where intensive lifestyle modifications for 3 to 6 months have not resulted in adequate glycaemic control.
The therapy should be initiated with one tablet Metformin HCl PR 500 mg with the evening meal.
After 10 to 15 days dose adjustment on the basis of blood glucose measurements is recommended (OGTT and/or FPG and/or HbA1c values to be within the normal range). A slow increase of dose may improve gastro-intestinal tolerability. The maximum recommended dose is 4 tablets (2000 mg) once daily with the evening meal.
It is recommended to regularly monitor (every 3-6 months) the glycaemic status (OGTT and/or FPG and/or HbA1c value) as well as the risk factors to evaluate whether treatment needs to be continued, modified or discontinued.
A decision to re-evaluate therapy is also required if the patient subsequently implements improvements to diet and/or exercise, or if changes to the medical condition will allow increased lifestyle interventions to be possible.
Monotherapy in Type 2 diabetes mellitus and combination with other oral antidiabetic agents: The usual starting dose is one tablet of Metformin HCl PR 500 mg once daily.
After 10 to 15 days the dose should be adjusted on the basis of blood glucose measurements. A slow increase of dose may improve gastro-intestinal tolerability. The maximum recommended dose is 4 tablets daily.
Dosage increases should be made in increments of 500 mg every 10-15 days, up to a maximum of 2000 mg once daily with the evening meal. If glycaemic control is not achieved on Metformin HCl PR 2000 mg tablet once daily, Metformin HCl PR 1000 mg tablets twice daily should be considered, with both doses being given with food. If glycaemic control is still not achieved, patients may be switched to standard metformin tablets to a maximum dose of 3000 mg daily.
In patients already treated with metformin tablets, the starting dose of Metformin HCl SR tablets should be equivalent to the daily dose of metformin immediate release tablets. In patients treated with metformin at a dose above 2000 mg daily, switching to Metformin HCl SR is not recommended.
If transfer from another oral antidiabetic agent is intended: discontinue the other agent and initiate Metformin HCl PR tablet at the dose indicated as previously mentioned.
Metformin HCl PR 750 mg tablets and Metformin HCl PR 1000 mg tablets are intended for patients who are already treated with metformin tablets (prolonged or immediate release).
The dose of Metformin HCl PR 750 mg tablets or Metformin HCl PR 1000 mg tablets should be equivalent to the daily dose of metformin tablets (prolonged or immediate release), up to a maximum dose of 1500 mg or 2000 mg respectively, given with the evening meal.
Combination with insulin: Metformin and insulin may be used in combination therapy to achieve better blood glucose control. The usual starting dose of Metformin HCl PR tablet is one 500 mg tablet once daily, while insulin dosage is adjusted on the basis of blood glucose measurements.
For patients already treated with metformin and insulin in combination therapy, the dose of Metformin HCl SR 750 mg tablets or Metformin HCl SR 1000 mg tablets should be equivalent to the daily dose of metformin tablets up to a maximum of 1500 mg or 2000 mg respectively, given with the evening meal, while insulin dosage is adjusted on the basis of blood glucose measurements.
Elderly: Due to the potential for decreased renal function in elderly subjects, the metformin dosage should be adjusted based on renal function. Regular assessment of renal function is necessary. Benefit in the reduction of risk or delay of the onset of type 2 diabetes mellitus has not been established in patients 75 years and older and metformin initiation is therefore not recommended in these patients.
Renal impairment: A GFR should be assessed before initiation of treatment with metformin containing products and at least annually thereafter. In patients at increased risk of further progression of renal impairment and in the elderly, renal function should be assessed more frequently, e.g., every 3-6 months.
Paediatric population: In the absence of available data, Metformin HCl PR tablet should not be used in children.