During the treatment with Metfogamma 500, it is necessary to regularly monitor the concentration of glucose in the blood on an empty stomach and after eating.
The patient should be warned about the need to stop taking the drug and see a doctor if there is vomiting, abdominal pain, muscle cramps, general weakness and severe malaise. Obtuse symptoms can be a sign of beginning lactic acidosis.
Lactoacidosis is characterized by severe weakness, acidotic dyspnea, abdominal pain and hypothermia, followed by the development of coma.
Diagnostic laboratory indicators for lactic acidosis: a decrease in blood pH, an increase in plasma lactate concentration above 5 mmol / l, an increase in the anion interval and an increase in the lactate / pyruvate ratio.If metabolic acidosis is suspected, metformin should be discontinued and the patient should be immediately hospitalized.
Lactic acidosis is a rare but serious metabolic complication that may occur in connection with the cumulation of metformin. The cases of lactic acidosis were noted mainly in patients with diabetes mellitus with severe renal insufficiency. Risk factors are uncompensated diabetes mellitus, ketosis, prolonged fasting, excessive alcohol consumption, liver failure and other conditions accompanied by hypoxia. If there is a suspicion of the development of metabolic lactic acidosis metformin must be canceled and the patient should be immediately hospitalized.
Kidney function
Because the metformin is excreted by the kidneys before the beginning of treatment, and regularly afterwards, creatinine clearance in serum should be determined at least 1 time per year in patients with normal renal function, and less than 2-4 times per year in patients with reduced creatinine clearance and elderly patients.
Particular caution should be exercised in cases of impaired renal function, for example, during the initial period of concomitant therapy with antihypertensive drugs, diuretics, and NSAIDs.
Carrying out X-ray study (urography, intravenous angiography) with the use of iodine-containing rasgenocontrast agents can lead to renal failure. Preparation Metfogamma® 500 should be discontinued 48 hours before the radiographic examination, and resume the drug no earlier than 48 hours after it.
When conducting surgical interventions under general anesthesia, spinal or epidural anesthesia, Metfogamma® 500 should be discontinued 48 hours before surgery. Resume the drug is recommended not earlier than 48 hours after the operation.
When treating Metfogamma® 500, you should follow a diet with a uniform distribution of carbohydrates throughout the day. Patients with excessive body weight should follow a diet with calorie restriction.
Standard laboratory tests should be routinely performed to monitor diabetes mellitus, especially at the beginning of treatment with Metfogamma® 500.
Metformin with monotherapy does not cause hypoglycemia, but caution should be exercised when using the drug together with insulin or other hypoglycemic drugs (for example, sulfonylurea derivatives or repaglinide).In this case, a particularly careful control of the concentration of glucose in the blood is necessary.
It is necessary to inform the patient about the need to consult a doctor if symptoms of bronchopulmonary infection or infectious disease of the genito-urinary organs appear.
Against the background of the use of Metfogamma® 500, you should refrain from taking alcohol because of the increased risk of hypoglycemia and disulfiram-like effect.
Hypovitaminosis B12 when taking the drug due to a violation of absorption and has a reversible nature - the content of vitamin B12 quickly restored when the drug is withdrawn. Decreased vitamin B content12 should be taken into account in patients with megaloblastic anemia.