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Renal or hepatic insufficiency may cause elevated drug levels of both glyburide and metformin hydrochlo-ride and the hepatic insufficiency may also diminish gluconeogenic capacity, both of which increase the risk of hypoglycemic reactions. Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects. Hypoglycemia may be difficult to recognize in the elderly, and in people who are taking beta-adrenergic blocking drugs. Metformin Hydrochloride Text Continues Below
Monitoring of renal function Metformin is known to be substantially excreted by the kidney, and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Thus, patients with serum creatinine levels above the upper limit of normal for their age should not receive GLUCOVANCE. In patients with advanced age, GLUCOVANCE should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function. In elderly patients, particularly those 80 years of age, renal function should be monitored regularly and, generally, GLUCOVANCE should not be titrated to the maximum dose (see WARNINGS and DOSAGE AND ADMINISTRATION). Before initiation of GLUCOVANCE therapy and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal dysfunction is anticipated, renal function should be assessed more frequently and GLUCOVANCE discontinued if evidence of renal impairment is present. ____Use of concomitant medications that may affect renal function or metformin disposition Concomitant medication( s) that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin, such as cationic drugs that are elimi-nated by renal tubular secretion (see PRECAUTIONS: Drug Interactions), should be used with caution. Page: << Prev | 1 | 2 | 3 | 4 | 5 | Next >>
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