📋 Indications & Clinical Dosage
*Maturity-onset diabetes mellitus, monotherapy or in combination with insulin or with sulphonylureas:*
Adults: Initially 500 -850 mg two or three times daily during or after meals, adjust dose according to response by increasing 500 mg or 850 mg after 10-15 days; max dose 3g daily.
With Insulin: Adults: Initially 500 mg daily, increase 500 mg every wk. Max: 2500 mg/day. Decrease insulin dose 10-25% when Fasting Plasma Glucose is less than desired level.
Children above 10yrs: Initially 500 -850 mg once daily during or after meals as mono therapy or with insulin, adjust dose after 10-15 days according to blood glucose level; max dose 2g daily in 2-3 divided dose.
⛔ Contraindications
Acute metabolic acidosis or pre-coma, hepatic or severe renal (GFR<30ml/min) impairment. Acute conditions predisposing to renal impairment, cardiac or respiratory failure, recent MI, alcoholism, pregnancy, lactation, and elderly (above 75yrs).
⚠️ Precautions & Warnings
Iodinated contrast materials, discontinue for 48 hrs before and after elective surgery, cardiac disorders, assess risk factors and discontinue immediately if metabolic acidosis suspected. Monitor renal function at least annually.
🔄 Drug Interactions
Alcohol, iodinated contrast agents, diuretics, corticosteroids, ACE inhibitors, NSAIDs, inhibitors of OCT1 & OCT2.
⚠️ Adverse Reactions / Side Effects
Reports of altered LFTs, hepatitis, GI upset, taste disturbance, skin reactions, reduced B12 absorptions, abnormal liver function tests, rarely lactic acidosis.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated or not recommended.
Lactation / Breastfeeding:
Contraindicated or not recommended.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.