"Jan. 29, 2013 -- The American Academy of Pediatrics has issued the first-ever guidelines for the management of type 2 diabetes in children and teens.
Type 2 diabetes is rising rapidly among children and teens because of soaring obesity "...
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Riomet (metformin hcl) is indicated as an adjunct to diet and exercise to improve glycemic controls in adults and children with type 2 diabetes mellitus.
DOSAGE AND ADMINISTRATION
There is no fixed dosage regimen for the management of hyperglycemia in patients with type 2 diabetes with RIOMET (metformin hcl) or any other pharmacologic agent. Dosage of RIOMET (metformin hcl) must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily doses. The maximum recommended daily dose of RIOMET (metformin hcl) is 2550 mg (25.5 mL) in adults and 2000 mg (20 mL) in pediatric patients (10-16 years of age).
RIOMET (metformin hcl) should be given in divided doses with meals. RIOMET (metformin hcl) should be started at a low dose, with gradual dose escalation, both to reduce gastrointestinal side effects and to permit identification of the minimum dose required for adequate glycemic control of the patient.
During treatment initiation and dose titration (see Recommended Dosing Schedule), fasting plasma glucose should be used to determine the therapeutic response to RIOMET (metformin hcl) and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately three months. The therapeutic goal should be to decrease both fasting plasma glucose and glycosylated hemoglobin levels to normal or near normal by using the lowest effective dose of RIOMET (metformin hcl) , either when used as monotherapy or in combination with sulfonylurea or insulin.
Monitoring of blood glucose and glycosylated hemoglobin will also permit detection of primary failure, i.e., inadequate lowering of blood glucose at the maximum recommended dose of medication, and secondary failure, i.e., loss of an adequate blood glucose lowering response after an initial period of effectiveness.
Short-term administration of RIOMET (metformin hcl) may be sufficient during periods of transient loss of control in patients usually well-controlled on diet alone.
Recommended Dosing Schedule
Adults — In general, clinically significant responses are not seen at doses below 1500 mg (15 mL) per day. However, a lower recommended starting dose and gradually increased dosage is advised to minimize gastrointestinal symptoms.
The usual starting dose of RIOMET (metformin hydrochloride oral solution) is 500 mg (5 mL) twice a day or 850 mg (8.5 mL) once a day, given with meals. Dosage increases should be made in increments of 500 mg (5 mL) weekly or 850 mg (8.5 mL) every 2 weeks, up to a total of 2000 mg (20 mL) per day, given in divided doses. Patients can also be titrated from 500 mg (5 mL) twice a day to 850 mg (8.5 mL) twice a day after 2 weeks.
For those patients requiring additional glycemic control, RIOMET (metformin hcl) may be given to a maximum daily dose of 2550 mg (25.5 mL) per day. Doses above 2000 mg (20 mL) may be better tolerated given three times a day with meals.
Pediatrics — The usual starting dose of RIOMET (metformin hcl) is 500 mg (5 mL) twice a day, given with meals. Dosage increases should be made in increments of 500 mg (5 mL) weekly up to a maximum of 2000 mg (20 mL) per day, given in divided doses.
Transfer From Other Antidiabetic Therapy
When transferring patients from standard oral hypoglycemic agents other than chlorpropamide to RIOMET (metformin hcl) , no transition period generally is necessary. When transferring patients from chlorpropamide, care should be exercised during the first two weeks because of the prolonged retention of chlorpropamide in the body, leading to overlapping drug effects and possible hypoglycemia.
Concomitant Metformin and Oral Sulfonylurea Therapy in Adult Patients
If patients have not responded to four weeks of the maximum dose of RIOMET (metformin hcl) monotherapy, consideration should be given to gradual addition of an oral sulfonylurea while continuing RIOMET (metformin hcl) at the maximum dose, even if prior primary or secondary failure to a sulfonylurea has occurred. Clinical and pharmacokinetic drug-drug interaction data are currently available only for metformin plus glyburide (glibenclamide).
With concomitant Metformin and sulfonylurea therapy, the desired control of blood glucose may be obtained by adjusting the dose of each drug. In a clinical trial of patients with type 2 diabetes and prior failure on glyburide, patients started on metformin 500 mg and glyburide 20 mg were titrated to 1000 mg/20 mg, 1500 mg/20 mg, 2000 mg/20 mg or 2500 mg/20 mg of metformin and glyburide, respectively, to reach the goal of glycemic control as measured by FPG, HbA1c and plasma glucose response (see CLINICAL PHARMACOLOGY: Clinical Studies). However, attempts should be made to identify the minimum effective dose of each drug to achieve this goal. With concomitant RIOMET (metformin hcl) and sulfonylurea therapy, the risk of hypoglycemia associated with sulfonylurea therapy continues and may be increased. Appropriate precautions should be taken. (See Package Insert of the respective sulfonylurea).
If patients have not satisfactorily responded to one to three months of concomitant therapy with the maximum dose of RIOMET (metformin hcl) and the maximum dose of an oral sulfonylurea, consider therapeutic alternatives including switching to insulin with or without RIOMET (metformin hcl) .
Concomitant Metformin and Insulin Therapy in Adult Patients
The current Insulin dose should be continued upon initiation of RIOMET (metformin hcl) therapy. RIOMET (metformin hcl) therapy should be initiated at 500 mg (5 mL) once daily in patients on insulin therapy. For patients not responding adequately, the dose of RIOMET (metformin hcl) should be increased by 500 mg (5 mL) after approximately 1 week and by 500 mg (5 mL) every week thereafter until adequate glycemic control is achieved. The maximum recommended daily dose for RIOMET (metformin hcl) is 2500 mg (25 mL). It is recommended that the insulin dose be decreased by 10% to 25% when fasting plasma glucose concentrations decrease to less than 120 mg/dL in patients receiving concomitant insulin and RIOMET (metformin hcl) . Further adjustment should be individualized based on glucose-lowering response.
Specific Patient Populations
RIOMET (metformin hcl) is not recommended for use in pregnancy. RIOMET (metformin hcl) is not recommended in patients below the age of 10 years.
The initial and maintenance dosing of RIOMET (metformin hcl) should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment should be based on a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of RIOMET (metformin hcl) . Monitoring of renal function is necessary to aid in prevention of lactic acidosis, particularly in the elderly. (See WARNINGS.)
Riomet (metformin hydrochloride oral solution) 500 mg/5 mL is a clear colorless liquid with characteristic flavor filled in 118 mL/473 mL HDPE bottles with induction sealed CRC cap.
NDC 10631-206-01 Bottles of 4 fl. oz. (118 mL)
NDC 10631-206-02 Bottles of 16 fl. oz. (473 mL)
Store at controlled room temperature 15° - 30° C (59° - 86° F) [See USP].
You may report side effects to FDA at 1-800-FDA-1088.
Manufactured for: Ranbaxy Laboratories Inc. Jacksonville, FL 32257 USA By: Ohm Laboratories Inc. Gloversville, NY 12078 USA. June 2010.
Last reviewed on RxList: 1/28/2011
This monograph has been modified to include the generic and brand name in many instances.
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