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Glucophage

Clinical Pharmacology
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Clinical Pharmacology

After administration of a single oral GLUCOPHAGE 500 mg tablet with food, geometric mean metformin Cmax and AUC differed less than 5% between pediatric type 2 diabetic patients (12 to 16 years of age) and gender- and weight-matched healthy adults (20 to 45 years of age), all with normal renal function.

Gender

Metformin pharmacokinetic parameters did not differ significantly between normal subjects and patients with type 2 diabetes when analyzed according to gender (males = 19, females = 16). Similarly, in controlled clinical studies in patients with type 2 diabetes, the antihyperglycemic effect of GLUCOPHAGE was comparable in males and females.

Race

No studies of metformin pharmacokinetic parameters according to race have been performed. In controlled clinical studies of GLUCOPHAGE in patients with type 2 diabetes, the antihyperglycemic effect was comparable in whites (n=249), blacks (n=51), and Hispanics (n=24).

Clinical Studies

Glucophage

In a double-blind, placebo-controlled, multicenter U.S. clinical trial involving obese patients with type 2 diabetes whose hyperglycemia was not adequately controlled with dietary management alone (baseline fasting plasma glucose [FPG] of approximately 240 mg/dL), treatment with GLUCOPHAGE (up to 2550 mg/day) for 29 weeks resulted in significant mean net reductions in fasting and postprandial plasma glucose (PPG) and hemoglobin A1c (HbA1c) of 59 mg/dL, 83 mg/dL, and 1.8%, respectively, compared to the placebo group (see Table 2).

Table 2: GLUCOPHAGE vs Placebo Summary of Mean Changes from
Baseline* in Fasting Plasma Glucose, HbA1c, and Body Weight,
at Final Visit (29-week study)


  GLUCOPHAGE
(n=141)
Placebo
(n=145)
p–Value
FPG (mg/dL)
Baseline 241.5 237.7 NS**
Change at FINAL VISIT -53.0 6.3 0.001
Hemoglobin A1c (%)
Baseline 8.4 8.2 NS**
Change at FINAL VISIT -1.4 0.4 0.001
Body Weight (lbs)
Baseline 201.0 206.0 NS**
Change at FINAL VISIT -1.4 -2.4 NS**
*All patients on diet therapy at Baseline **Not statistically significant


A 29-week, double-blind, placebo-controlled study of GLUCOPHAGE and glyburide, alone and in combination, was conducted in obese patients with type 2 diabetes who had failed to achieve adequate glycemic control while on maximum doses of glyburide (baseline FPG of approximately 250 mg/dL) (see Table 3). Patients randomized to the combination arm started therapy with GLUCOPHAGE 500 mg and glyburide 20 mg. At the end of each week of the first four weeks of the trial, these patients had their dosages of GLUCOPHAGE increased by 500 mg if they had failed to reach target fasting plasma glucose. After week four, such dosage adjustments were made monthly, although no patient was allowed to exceed GLUCOPHAGE 2500 mg. Patients in the GLUCOPHAGE only arm (metformin plus placebo) followed the same titration schedule. At the end of the trial, approximately 70% of the patients in the combination group were taking GLUCOPHAGE 2000 mg/glyburide 20 mg or GLUCOPHAGE 2500 mg/glyburide 20 mg. Patients randomized to continue on glyburide experienced worsening of glycemic control, with mean increases in FPG, PPG, and HbA1c of 14 mg/dL, 3 mg/dL, and 0.2%, respectively. In contrast, those randomized to GLUCOPHAGE (up to 2500 mg/day) experienced a slight improvement, with me an reductions in FPG, PPG, and HbA1c of 1 mg/dL, 6 mg/dL, and 0.4%, respectively. The combination of GLUCOPHAGE and glyburide was effective in reducing FPG, PPG, and HbA1c levels by 63 mg/dL, 65 mg/dL, and 1.7%, respectively. Compared to results of glyburide treatment alone, the net differences with combination treatment were -77 mg/dL, -68 mg/dL, and -1.9%, respectively (see Table 3).

Table 3: Combined GLUCOPHAGE/Glyburide (Comb) vs Glyburide
(Glyb) or GLUCOPHAGE (GLU) Monotherapy: Summary of
Mean Changes from Baseline* in Fasting Plasma Glucose,
HbA1c, and Body Weight, at Final Visit (29-week study)


  p-values
  Comb
(n=213)
Glyb
(n=209)
GLU
(n=210)
Glyb vs
Comb
GLU vs
Comb
GLU vs
Glyb
Fasting Plasma Glucose (mg/dL)
Baseline 250.5 247.5 253.9 NS** NS** NS**
Change at FINAL VISIT -63.5 13.7 -0.9 0.001 0.001 0.025
Hemoglobin A1c (%)
Baseline 8.8 8.5 8.9 NS** NS** 0.007
Change at FINAL VISIT -1.7 0.2 -0.4 0.001 0.001 0.001
Body Weight (lbs)
Baseline 202.2 203.0 204.0 NS** NS** NS**
Change at FINAL VISIT 0.9 -0.7 -8.4 0.011 0.001 0.001
*All patients on glyburide, 20 mg/day, at Baseline **Not statistically significant



Brand Name: Glucophage
Generic Name: Metformin Hcl
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