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Glucophage and insulin therapy in adult patients
The current insulin dose should be continued upon initiation of Glucophage - metformin therapy. Glucophage therapy should be initiated at 500 mg once daily in patients on insulin therapy. For patients not responding adequately, the dose of Glucophage should be increased by 500 mg after approximately 1 week and by 500 mg every week thereafter until adequate glycemic control is achieved. The maximum recommended daily dose is 2500 mg for Glucophage. 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 Glucophage. Further adjustment should be individualized based on glucose-lowering response.
Initially, one 850 mg tablet twice a day or one 500 mg tablet three times a day, with or after food. Good diabetic control may be achieved within a few days, but it is not usual for the full effect to be delayed for up to two weeks. If control is incomplete a cautious increase in dosage to a maximum of 3 g daily is justified. Once control has been obtained it may be possible to reduce the dosage of Glucophage.
Glucophage monotherapy and in combination with insulin for children and adolescents
Glucophage can be used in children from 10 years of age and adolescents. The usual starting dose is 500 mg or 850 mg metformin hydrochloride once daily, given during or after meals. After 10 to 15 days the dose should be adjusted on the basis of blood glucose measurements. A slow increase of dose may improve gastrointestinal tolerability. The maximum recommended dose of metformin hydrochloride is 2 g daily, taken as 2 or 3 divided doses.
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