Radimet XR 500mg

✔️ Overdose Management

Overdoses of metformin (even up to 85 grams) typically do not cause hypoglycemia, but may lead to lactic acidosis, which requires emergency hospital treatment.

Hemodialysis is the most effective way to remove both metformin and lactic acid from the blood.

✔️ Immediate-Release Metformin:

Adults:
Start with 500 mg twice daily or 850 mg once daily, taken with meals.
Increase dose weekly (by 500 mg) or every two weeks (by 850 mg), up to 2000 mg/day in divided doses.
Some may require up to 2550 mg/day, ideally taken in three divided doses.

Children (≥10 years):
Begin with 500 mg twice daily, with meals.
Titrate weekly by 500 mg, up to a maximum of 2000 mg/day in divided doses.

✔️ Extended-Release (XR) Metformin:

Adults:
Begin with 500 mg once daily, preferably with the evening meal.
Increase by 500 mg weekly, up to a maximum of 2000 mg once daily or 1000 mg twice daily with meals.
Patients can be switched from immediate-release to extended-release, not exceeding the recommended maximum dose.

XR tablets must be swallowed whole—do not crush, cut, or chew.

Children:
Not recommended; extended-release has not been studied in pediatric patients.

✔️ Renal Impairment:

• Contraindicated in patients with eGFR <30 mL/min/1.73 m².
• Use with caution and regular assessment if eGFR is between 30–45 mL/min/1.73 m².

✔️ Elderly:

Adjust the dose based on kidney function. Monitor renal health regularly.

✔️ Children (10–12 years):

Use cautiously. Ensure the Type 2 diabetes diagnosis is accurate. Monitor growth and puberty with long-term use.

✔️ Kidney Function:

• Assess GFR before and during treatment.
• Test annually in patients with normal kidney function
• Test 2–4 times/year in those with borderline or declining renal performance
• Temporarily discontinue if renal function is compromised

✔️ Possible Side Effects

Very Common (especially at treatment start):
Nausea, vomiting, diarrhea, abdominal pain, loss of appetite

Common:
Taste disturbances

Rare/Unknown Frequency:

Lactic acidosis (medical emergency)

Decreased Vitamin B12 absorption → risk of megaloblastic anemia or peripheral neuropathy

Liver dysfunction (reversible upon discontinuation)

Skin reactions: Rash, itching, hives

Encephalopathy

Hemolytic anemia

Starting with a low dose and taking it with meals may reduce gastrointestinal side effects.

✔️ Drug Interactions

• Nifedipine: May increase metformin absorption.
• Cationic drugs (e.g., Digoxin, Morphine, Quinidine): May compete for renal excretion, possibly raising metformin levels.
• Drugs that may raise blood glucose (e.g., corticosteroids, diuretics, oral contraceptives, phenytoin): Can counteract metformin’s effects.
• Cimetidine: May reduce renal clearance of metformin—monitor carefully.

✔️ Avoid using Radimet XR in the following situations:

• Hypersensitivity to metformin or its components
• Acute metabolic acidosis (e.g., lactic acidosis or diabetic ketoacidosis)
• Severe renal impairment (eGFR <30 mL/min)
• Conditions that may affect kidney function (e.g., dehydration, infection, shock)
• Diseases causing tissue hypoxia (e.g., cardiac/respiratory failure, recent MI)
• Liver failure, alcohol abuse or acute alcohol intoxication

✔️ Pregnancy and Lactation

Pregnancy:
Metformin should generally be avoided during pregnancy. Insulin is preferred to maintain optimal blood sugar levels and reduce the risk of birth defects.

Breastfeeding:
Metformin is passed into breast milk. While no harm has been observed in breastfed infants, due to limited data, its use during breastfeeding is not recommended. Weigh risks and benefits with your doctor.

✔️ Warnings and Precautions

• Monitor renal function regularly due to the kidney-based excretion of metformin.
• Discontinue 2–3 days before surgeries or contrast-based imaging procedures, and resume only when kidney function is stable.
• Avoid use during dehydration, serious infections, or trauma.
• Long-term use may reduce Vitamin B12 levels; annual monitoring is advised.
• When used with sulfonylureas or insulin, monitor for hypoglycemia.
• Use with caution in combination with cimetidine, anticoagulants, or NSAIDs.

✔️ Storage:

Store below 30°C, protected from light and moisture

Keep out of reach of children