Metformin Hydrochloride Tablets, USP is indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus.

2.1 Adult Dosage

• The recommended starting dose of Metformin Hydrochloride Tablet is 500 mg orally twice a day or 850 mg once a day, given with meals.
• Increase the dose in increments of 500 mg weekly or 850 mg every 2 weeks on the basis of glycemic control and tolerability, up to a maximum dose of 2550 mg per day, given in divided doses.
• Doses above 2000 mg may be better tolerated given 3 times a day with meals.

2.2 Pediatric Dosage for Metformin Hydrochloride Tablet

• The recommended starting dose of Metformin Hydrochloride Tablet for pediatric patients 10 years of age and older is 500 mg orally twice a day, given with meals.
• Increase dosage in increments of 500 mg weekly on the basis of glycemic control and tolerability, up to a maximum of 2000 mg per day, given in divided doses twice daily.

2.3 Recommendations for Use in Renal Impairment

• Assess renal function prior to initiation of Metformin Hydrochloride Tablet and periodically thereafter.
• Metformin Hydrochloride Tablet is contraindicated in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/minute/1.73 m 2.
• Initiation of Metformin Hydrochloride Tablet in patients with an eGFR between 30 – 45 mL/minute/1.73 m 2is not recommended.
• In patients taking Metformin Hydrochloride Tablet whose eGFR later falls below 45 mL/min/1.73 m 2, assess the benefit risk of continuing therapy.
• Discontinue Metformin Hydrochloride Tablet if the patient’s eGFR later falls below 30 mL/minute/1.73 m 2 [see Warnings and Precautions (5.1) ].

2.4 Discontinuation for Iodinated Contrast Imaging Procedures

Discontinue Metformin Hydrochloride Tablet at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m 2; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intraarterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart Metformin Hydrochloride Tablet if renal function is stable.

Metformin Hydrochloride Tablet is available as:

• 500 mg:white to off-white colored, film coated, round shaped tablet with beveled edges on both side and debossed with ‘134’ on one side and plain on other side.
• 850 mg:white to off-white colored, film coated, round shaped tablet with beveled edges on both side and debossed with ‘131’ on one side and plain on other side.
• 1000 mg:white to off-white colored, film coated, oval shaped tablet with ‘132’ debossed on one side and breakline on both sides.

Metformin Hydrochloride Tablets are contraindicated in patients with:

• Severe renal impairment (eGFR below 30 mL/min/1.73 m 2) [see Warnings and Precautions (5.1)].
• Hypersensitivity to metformin
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.

5.1 Lactic Acidosis
There have been postmarketing cases of metformin-associated lactic acidosis, including fatal cases. These cases had a subtle onset and were accompanied by nonspecific symptoms such as malaise, myalgias, abdominal pain, respiratory distress, or increased somnolence; however, hypotension and resistant bradyarrhythmias have occurred with severe acidosis. Metformin-associated lactic acidosis was characterized by elevated blood lactate concentrations (>5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), and an increased lactate: pyruvate ratio; metformin plasma levels were generally >5 mcg/mL. Metformin decreases liver uptake of lactate increasing lactate blood levels which may increase the risk of lactic acidosis, especially in patients at risk.
If metformin-associated lactic acidosis is suspected, general supportive measures should be instituted promptly in a hospital setting, along with immediate discontinuation of metformin hydrochloride tablets. In metformin hydrochloride tablets, treated patients with a diagnosis or strong suspicion of lactic acidosis, prompt hemodialysis is recommended to correct the acidosis and remove accumulated metformin (metformin hydrochloride is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions). Hemodialysis has often resulted in reversal of symptoms and recovery.

Educate patients and their families about the symptoms of lactic acidosis and, if these symptoms occur, instruct them to discontinue metformin hydrochloride tablets and report these symptoms to their healthcare provider.

For each of the known and possible risk factors for metformin-associated lactic acidosis, recommendations to reduce the risk of and manage metformin-associated lactic acidosis are provided below:

• Renal impairment—The postmarketing metformin-associated lactic acidosis cases primarily occurred in patients with significant renal impairment.

The risk of metformin accumulation and metformin-associated lactic acidosis increases with the severity of renal impairment because metformin is substantially excreted by the kidney. Clinical recommendations based upon the patient’s renal function include [ see Dosage and Administration (2.1),Clinical Pharmacology (12.3) ]:

O Before initiating metformin hydrochloride tablets, obtain an estimated glomerular filtration rate (eGFR)

O Metformin hydrochloride tablet is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m 2[see Contraindications (4) ] .

O Initiation of metformin hydrochloride tablet is not recommended in patients with eGFR between 30-45 mL/min/1.73 m 2.

O Obtain an eGFR at least annually in all patients taking metformin hydrochloride tablets. In patients at risk for the development of renal impairment (e.g., the elderly), renal function should be assessed more frequently.

O In patients taking metformin hydrochloride tablets whose eGFR falls below 45 mL/min/1.73 m 2, assess the benefit and risk of continuing therapy.

• Drug interactions—The concomitant use of metformin hydrochloride tablets with specific drugs may increase the risk of metformin-associated lactic acidosis: those that impair renal function, result in significant hemodynamic change, interfere with acid-base balance, or increase metformin accumulation. Consider more frequent monitoring of patients.
• Age 65 or greater—The risk of metformin-associated lactic acidosis increases with the patient’s age because elderly patients have a greater likelihood of having hepatic, renal, or cardiac impairment than younger patients. Assess renal function more frequently in elderly patients.
• Radiologic studies with contrast— Administration of intravascular iodinated contrast agents in metformin-treated patients has led to an acute decrease in renal function and the occurrence of lactic acidosis. Stop metformin hydrochloride tablets at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m 2; in patients with a history of hepatic impairment, alcoholism or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure, and restart metformin hydrochloride tablets if renal function is stable.
• Surgery and other procedures—Withholding of food and fluids during surgical or other procedures may increase the risk for volume depletion, hypotension, and renal impairment. Metformin hydrochloride tablets should be temporarily discontinued while patients have restricted food and fluid intake.
• Hypoxic states—Several of the postmarketing cases of metformin-associated lactic acidosis occurred in the setting of acute congestive heart failure (particularly when accompanied by hypoperfusion and hypoxemia). Cardiovascular collapse (shock), acute myocardial infarction, sepsis, and other conditions associated with hypoxemia have been associated with lactic acidosis and may cause prerenal azotemia. When such an event occurs, discontinue metformin hydrochloride tablets.
• Excessive alcohol intake—Alcohol potentiates the effect of metformin on lactate metabolism. Patients should be warned against excessive alcohol intake while receiving metformin hydrochloride tablets.
• Hepatic impairment—Patients with hepatic impairment have developed cases of metformin­ associated lactic acidosis. This may be due to impaired lactate clearance resulting in higher lactate blood levels. Therefore, avoid use of metformin hydrochloride tablets in patients with clinical or laboratory evidence of hepatic disease.

5.2Vitamin B 12Deficiency

In metformin hydrochloride tablets clinical trials of 29 weeks duration, a decrease to subnormal levels of previously normal serum vitamin B 12levels was observed in approximately 7% of patients. Such decrease, possibly due to interference with B 12absorption from the B 12-intrinsic factor complex, may be associated with anemia but appears to be rapidly reversible with discontinuation of metformin hydrochloride tablets or vitamin B 12supplementation. Certain individuals (those with inadequate vitamin B 12or calcium intake or absorption) appear to be predisposed to developing subnormal vitamin B 12levels. Measure of hematologic parameters on an annual basis vitamin B 12at 2 to 3 year intervals in patients on metformin hydrochloride tablets and manage any abnormalities [see Adverse Reactions (6.1) ].

5.3 Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues
Insulin and insulin secretagogues (e.g., sulfonylurea) are known to cause hypoglycemia. Metformin hydrochloride tablets may increase the risk of hypoglycemia when combined with insulin and/or an insulin secretagogue. Therefore, a lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with metformin hydrochloride tablets [see Drug Interactions (7)].
5.4Macrovascular outcomes
There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with metformin hydrochloride tablets.

The following adverse reactions are also discussed elsewhere in the labeling:

• Lactic Acidosis [ see Boxed Warning and Warnings and Precautions (5.1)]
• Vitamin B 12Deficiency [ see Warnings and Precautions (5.2)]
• Hypoglycemia [ see Warnings and Precautions (5.3)]

6.1 Clinical Studies Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Metformin Hydrochloride Tablets
In a U.S. clinical trial of metformin hydrochloride tablets in patients with type 2 diabetes mellitus, a total of 141 patients received metformin hydrochloride tablets up to 2550 mg per day. Adverse reactions reported in greater than 5% of metformin hydrochloride tablets treated patients and that were more common than in placebo-treated patients, are listed in Table 1.
Table 1: Adverse Reactions from Clinical Trial ofMetformin Hydrochloride Tablets Occurring >5% and More Common than Placebo in Patients with Type 2 Diabetes Mellitus

Diarrhea led to discontinuation of metformin hydrochloride tablets in 6% of patients. Additionally, the following adverse reactions were reported in ≥1% to ≤5.0% of metformin hydrochloride tablets treated patients and were more commonly reported with metformin hydrochloride tablets than placebo: abnormal stools, hypoglycemia, myalgia, lightheaded, dyspnea, nail disorder, rash, sweating increased, taste disorder, chest discomfort, chills, flu syndrome, flushing, palpitation.

In metformin hydrochloride tablets clinical trials of 29-week duration, a decrease to subnormal levels of previously normal serum vitamin B 12levels was observed in approximately 7% of patients.

Pediatric Patients

In clinical trials with metformin hydrochloride tablets in pediatric patients with type 2 diabetes mellitus, the profile of adverse reactions was similar to that observed in adults.

6.2 Postmarketing Experience

The following adverse reactions have been identified during post approval use of metformin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Cholestatic, hepatocellular, and mixed hepatocellular liver injury have been reported with postmarketing use of metformin.

Table 2 presents clinically significant drug interactions with metformin hydrochloride tablets.

Table 2: Clinically Significant Drug Interactions withMetformin Hydrochloride Tablets

8.1

Overdose of metformin hydrochloride has occurred, including ingestion of amounts greater than 50 grams. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin has been established. Lactic acidosis has been reported in approximately 32% of metformin overdose cases [see Warnings and Precautions (5.1) ] . Metformin is dialyzable with a clearance of up to 170 mL/min under good hemodynamic conditions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected.

Metformin Hydrochloride Tablets, USP contain the antihyperglycemic agent metformin, which is a biguanide, in the form of monohydrochloride. The chemical name of metformin hydrochloride is N, N-dimethylimidodicarbonimidic diamide hydrochloride. The structural formula is as shown below:

Metformin hydrochloride is a white to off-white crystalline compound with a molecular formula of C 4H 11N 5• HCl and a molecular weight of 165.63. It is freely soluble in water and is practically insoluble in acetone, ether, and chloroform. The pK aof metformin is 12.4. The pH of a 1% aqueous solution of metformin hydrochloride is 6.68.

Metformin Hydrochloride Tablets, USP contain 500 mg, 850 mg or 1000 mg of metformin hydrochloride, which is equivalent to 389.93 mg, 662.88 mg 779.86 mg metformin base, respectively.

Each tablet contains the inactive ingredients magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, povidone, talc and titanium dioxide.

14.1 Metformin Hydrochloride Tablets

Adult Clinical Studies

A double-blind, placebo-controlled, multicenter US clinical trial involving obese patients with type 2 diabetes mellitus whose hyperglycemia was not adequately controlled with dietary management alone (baseline fasting plasma glucose [FPG] of approximately 240 mg/dL) was conducted. Patients were treated with metformin hydrochloride tablets (up to 2550 mg/day) or placebo for 29 weeks. The results are presented in Table 6.

Table 6: Mean Change in Fasting Plasma Glucose and HbA1c at Week 29 ComparingMetformin Hydrochloride Tablets vs Placebo in Patients with Type 2 Diabetes Mellitus

*Not statistically significant

Mean baseline body weight was 201 lbs and 206 lbs in the metformin hydrochloride tablets and placebo arms, respectively. Mean change in body weight from baseline to week 29 was -1.4 lbs and -2.4 lbs in the metformin hydrochloride tablets and placebo arms, respectively. A 29-week, double-blind, placebo-controlled study of metformin hydrochloride tablets and glyburide, alone and in combination, was conducted in obese patients with type 2 diabetes mellitus who had failed to achieve adequate glycemic control while on maximum doses of glyburide (baseline FPG of approximately 250 mg/dL). Patients randomized to the combination arm started therapy with metformin hydrochloride tablets 500 mg and glyburide 20 mg. At the end of each week of the first 4 weeks of the trial, these patients had their dosages of metformin hydrochloride tablets increased by 500 mg if they had failed to reach target fasting plasma glucose. After week 4, such dosage adjustments were made monthly, although no patient was allowed to exceed metformin hydrochloride tablets 2500 mg. Patients in the metformin hydrochloride tablets only arm (metformin plus placebo) discontinued glyburide and followed the same titration schedule. Patients in the glyburide arm continued the same dose of glyburide. At the end of the trial, approximately 70% of the patients in the combination group were taking metformin hydrochloride tablets 2000 mg/glyburide 20 mg or metformin hydrochloride tablets 2500 mg/glyburide 20 mg. The results are displayed in Table 7.
Table 7: Mean Change in Fasting Plasma Glucose and HbA1c at Week 29 Comparing Metformin Hydrochloride Tablets/Glyburide (Comb) vs Glyburide (Glyb) vs Metformin Hydrochloride Tablets(GLU): in Patients with Type 2 Diabetes Mellitus with Inadequate Glycemic Control on Glyburide

* Not statistically significant

Mean baseline body weight was 202 lbs, 203 lbs, and 204 lbs in the metformin hydrochloride tablets /glyburide, glyburide, and metformin hydrochloride tablets arms, respectively. Mean change in body weight from baseline to week 29 was 0.9 lbs, -0.7 lbs, and -8.4 lbs in the metformin hydrochloride tablets /glyburide, glyburide, and metformin hydrochloride tablets arms, respectively.

Pediatric Clinical Studies

A double-blind, placebo-controlled study in pediatric patients aged 10 to 16 years with type 2 diabetes mellitus (mean FPG 182.2 mg/dL), treatment with metformin hydrochloride tablets (up to 2000 mg/day) for up to 16 weeks (mean duration of treatment 11 weeks) was conducted. The results are displayed in Table 8.
Table 8: Mean Change in Fasting Plasma Glucose at Week 16 ComparingMetformin Hydrochloride Tabletsvs Placebo in Pediatric Patients a with Type 2 Diabetes Mellitus

aPediatric patient mean age 13.8 years (range 10-16 years)

Mean baseline body weight was 205 lbs and 189 lbs in the metformin hydrochloride tablets and placebo arms, respectively. Mean change in body weight from baseline to week 16 was -3.3 lbs and -2.0 lbs in the metformin hydrochloride tablets and placebo arms, respectively.

16.1 How Supplied

500 mg Bottles of 100 NOC 49483-622-01
500 mg Bottles of 180 NOC 49483-622-81
500 mg Bottles of 500 NOC 49483-622-50
500 mg Bottles of 1000 NOC 49483-622-10

850 mg Bottles of 100 NOC 49483-621-01
850 mg Bottles of 180 NOC 49483-621-81
850 mg Bottles of 500 NDC 49483-621-50
850 mg Bottles of 1000 NOC 49483-621-10

1000 mg Bottles of 100 NDC 49483-620-01
1000 mg Bottles of 180 NDC 49483-620-81
1000 mg Bottles of 500 NDC 49483-620-50
1000 mg Bottles of 1000 NDC 49483-620-10

Metformin Hydrochloride Tablets, USP 500 mg are white to off-white colored, film coated, round shaped tablet with beveled edges on both side and debossed with '134' on one side and plain on other side.

Metformin Hydrochloride Tablets, USP 850 mg are white to off-white colored, film coated, round shaped tablet with beveled edges on both side and debossed with '131' on one side and plain on other side.

Metformin Hydrochloride Tablets, USP 1000 mg are white to off-white colored, film coated, oval shaped tablet with '132' dabossad on one side and braaklina on both sides.

16.2 Storage

Store at 20°-25° C (68°-77° F); excursions permitted to 15°-30° C (59°--86° F). [See USP Controlled Room Temperature.] Dispense in light-resistant containers.

Advise the patient to read the FDA-approved patient labeling (Patient Information).
Lactic Acidosis:
Explain the risks of lactic acidosis, its symptoms, and conditions that predispose to its development. Advise patients to discontinue metformin hydrochloride tablets immediately and to promptly notify their healthcare provider if unexplained hyperventilation, myalgias, malaise, unusual somnolence or other nonspecific symptoms occur. Counsel patients against excessive alcohol intake and inform patients about importance of regular testing of renal function while receiving metformin hydrochloride tablets Instruct patients to inform their doctor that they are taking metformin hydrochloride tablets prior to any surgical or radiological procedure, as temporary discontinuation may be required [see Warnings and Precautions (5.1)]

.
Hypoglycemia
Inform patients that hypoglycemia may occur when metformin hydrochloride tablets is coadministered with oral sulfonylureas and insulin. Explain to patients receiving concomitant therapy the risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development [see Warnings and Precautions (5.3)]

.
Vitamin B 12Deficiency:
Inform patients about importance of regular haematological parameters while receiving metformin hydrochloride tablets

[see Warnings and Precautions (5.2)]

.
Females of Reproductive Age:
Inform females that treatment with metformin hydrochloride tablets

may result in ovulation in some premenopausal anovulatory women which may lead to unintended pregnancy [see Use in Specific Populations (8.3)].

Metformin Hydrochloride Tablets

(met for' min hye '' droe klor' ide )

Rx only

Read the Patient Information that comes with Metformin Hydrochloride Tablets before you start taking it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your healthcare provider about your medical condition or treatment.

What is the most important information I should know aboutMetformin Hydrochloride Tablets?

Serious side effects can happen in people takingMetformin Hydrochloride Tabletsincluding:

Lactic Acidosis.Metformin hydrochloride, the medicine in Metformin hydrochloride tablets, can cause a rare, but serious, side effect called lactic acidosis (a build-up of lactic acid in the blood) that can cause death. Lactic acidosis is a medical emergency and must be treated in a hospital.

Stop takingMetformin Hydrochloride Tabletsand call your healthcare provider right away if you get any of the following symptoms of lactic acidosis:

• feel very weak and tired

• have unusual (not normal) muscle pain

• have trouble breathing

• have unusual sleepiness or sleep longer than usual

• have unexplained stomach or intestinal problems with nausea and vomiting, or diarrhea

• feel cold, especially in your arms and legs

• feel dizzy or lightheaded

• have a slow or irregular heartbeat

You have a higher chance of getting lactic acidosis if you:

• have kidney problems. People whose kidneys are not working properly should not take metformin hydrochloride tablets,

• have liver problems.

• have congestive heart failure that requires treatment with medicines.

• drink a lot of alcohol (very often or short-term “binge” drinking).

• get dehydrated (lose a large amount of body fluids). This can happen if you are sick with a fever, vomiting, or diarrhea. Dehydration can also happen when you sweat a lot with activity or exercise and do not drink enough fluids.

• have certain x-ray tests with injectable dyes or contrast agents.

• have surgery.

• have a heart attack, severe infection, or stroke.

• are 80 years of age or older and have not had your kidney function tested

What are Metformin Hydrochloride Tablets?

• Metformin Hydrochloride Tablets are prescription medicines that contain metformin hydrochloride. Metformin Hydrochloride Tablets are used with diet and exercise to help control high blood sugar (hyperglycemia) in adults with type 2 diabetes.

• Metformin Hydrochloride Tablets are not for people with type 1 diabetes.

• Metformin Hydrochloride Tablets are not for people with diabetic ketoacidosis (increased ketones in your blood or urine).

Metformin Hydrochloride Tablets and Metformin Hydrochloride Extended-Release Tablets have the same active ingredient. However, Metformin Hydrochloride Tablets work longer in your body. Both of these medicines help control your blood sugar in a number of ways.

These include helping your body respond better to the insulin it makes naturally, decreasing the amount of sugar your liver makes, and decreasing the amount of sugar your intestines absorb. Metformin hydrochloride tablets do not cause your body to make more insulin.

Who should not take Metformin Hydrochloride Tablets?

Some conditions increase your chance of getting lactic acidosis or cause other problems if you take these medicines. Most of the conditions listed below can increase your chance of getting lactic acidosis.

Do not take Metformin Hydrochloride Tabletsif you:

• have kidney problems
  • are allergic to the metformin hydrochloride in metformin hydrochloride tablets or any of the ingredients in metformin hydrochloride tablets. See the end of this leaflet for a complete list of ingredients in metformin hydrochloride tablets.
  • are going to get an injection of dye or contrast agents for an x-ray procedure or if you are going to have surgery and not able to eat or drink much. In these situations, metformin hydrochloride tablets will need to be stopped for a short time. Talk to your healthcare provider about when you should stop metformin hydrochloride tablets and when you should start metformin hydrochloride tablets again. See “ What is the most important information I should know aboutMetformin Hydrochloride Tablets?”

• What should I tell my healthcare provider before taking Metformin Hydrochloride Tablets?

Before taking metformin hydrochloride tablets, tell your healthcare provider if you:

• have type 1 diabetes. Metformin hydrochloride tablets should not be used to treat people with type 1 diabetes.

• have a history or risk for diabetic ketoacidosis (high levels of certain acids, known as ketones, in the blood or urine). Metformin hydrochloride tablets should not be used for the treatment of diabetic ketoacidosis.

• have kidney problems.

• have liver problems.

• have heart problems, including congestive heart failure.

• are older than 80 years. If you are over 80 years old you should not take metformin hydrochloride tablets unless your kidneys have been checked and they are normal.

• drink alcohol very often or drink a lot of alcohol in short-term “binge” drinking.

• are taking insulin.

• have any other medical conditions.

• are pregnant or plan to become pregnant. It is not known if metformin hydrochloride tablets will harm your unborn baby. If you are pregnant, talk with your healthcare provider about the best way to control your blood sugar while you are pregnant.

• are breast-feeding or plan to breast-feed. It is not known ifmetformin hydrochloride tablets passes into your breast milk. Talk with your healthcare provider about the best way to feed your baby while you take metformin hydrochloride tablets.

Tell your healthcare provider about all the medicines you take,including prescription and nonprescription medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

• Metformin hydrochloride tablets may affect the way other medicines work, and other medicines may affect how metformin hydrochloride tablets works.

CanMetformin Hydrochloride Tablets be used in children?

Metformin hydrochloride tablets has been shown to effectively lower glucose levels in children (ages 10-16 years) with type 2 diabetes. Metformin hydrochloride tablets has not been studied in children younger than 10 years old. Metformin hydrochloride tablets has not been studied in combination with other oral glucose-control medicines or insulin in children. If you have any questions about the use of metformin hydrochloride tablets in children, talk with your doctor or other healthcare provider.

How should I takeMetformin Hydrochloride Tablets?

• Take metformin hydrochloride tablets exactly as your healthcare provider tells you.

• Metformin hydrochloride tablets should be taken with meals to help lessen an upset stomach side effect.

• Swallow metformin hydrochloride tablets whole. Do not crush, cut, or chew metformin hydrochloride tablets .

• You may sometimes pass a soft mass in your stools (bowel movement) that looks like metformin hydrochloride tablets. This is not harmful and will not affect the way metformin hydrochloride tablets works to control your diabetes.

• When your body is under some types of stress, such as fever, trauma (such as a car accident), infection, or surgery, the amount of diabetes medicine that you need may change. Tell your healthcare provider right away if you have any of these problems.

• Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with metformin hydrochloride tablets.

• Your healthcare provider will check your diabetes with regular blood tests, including your blood sugar levels and your haemoglobin A1C.

• Follow your healthcare provider’s instructions for treating blood sugar that is too low (hypoglycemia). Talk to your healthcare provider if low blood sugar is a problem for you. See “What are the possible side effects ofMetformin Hydrochloride Tablets?”

• Check your blood sugar as your healthcare provider tells you to.

• Stay on your prescribed diet and exercise program while taking metformin hydrochloride tablets.

• If you miss a dose of metformin hydrochloride tablets, take your next dose as prescribed unless your healthcare provider tells you differently. Do not take an extra dose the next day.

• If you take too much metformin hydrochloride tablets, call your healthcare provider, local Poison Control Center, or go to the nearest hospital emergency room right away.

What should I avoid while takingMetformin Hydrochloride Tablets?

Do not drink a lot of alcoholic drinks while taking metformin hydrochloride tablets. This means you should not binge drink for short periods, and you should not drink a lot of alcohol on a regular basis. Alcohol can increase the chance of getting lactic acidosis.

What are the side effects ofMetformin Hydrochloride Tablets?

• Lactic Acidosis. Metformin, the active ingredient inmetformin hydrochloride tablets, can cause a rare but serious condition called lactic acidosis (a buildup of an acid in the blood) that can cause death. Lactic acidosis is a medical emergency and must be treated in the hospital.

Call your doctor right away if you have any of the following symptoms, which could be signs of lactic acidosis:

• you feel cold in your hands or feet
  • you feel dizzy or lightheaded
  • you have a slow or irregular heartbeat
  • you feel very weak or tired
  • you have trouble breathing
  • you feel sleepy or drowsy
  • you have stomach pains, nausea or vomiting

Most people who have had lactic acidosis with metformin have other things that, combined with the metformin, led to the lactic acidosis. Tell your doctor if you have any of the following, because you have a higher chance for getting lactic acidosis with metformin hydrochloride tablets if you:

• have severe kidney problems, or your kidneys are affected by certain x-ray tests that use

injectable dye

• have liver problems
• drink alcohol very often, or drink a lot of alcohol in short-term "binge" drinking
• get dehydrated (lose a large amount of body fluids). This can happen if you are sick with a fever, vomiting, or diarrhea. Dehydration can also happen when you sweat a lot with activity or exercise and do not drink enough fluids
• have surgery
• have a heart attack, severe infection, or stroke

Common side effects of metformin hydrochloride tablets include diarrhea, nausea, and upset stomach. These side effects generally go away after you take the medicine for a while. Taking your medicine with meals can help reduce these side effects. Tell your doctor if the side effects bother you a lot, last for more than a few weeks, come back after they’ve gone away, or start later in therapy. You may need a lower dose or need to stop taking the medicine for a short period or for good.

About 3 out of every 100 people who take metformin hydrochloride tablets have an unpleasant metallic taste when they start taking the medicine. It lasts for a short time.

Metformin hydrochloride tablets rarely cause hypoglycemia (low blood sugar) by themselves. However, hypoglycemia can happen if you do not eat enough, if you drink alcohol, or if you take other medicines to lower blood sugar.

How should I storeMetformin Hydrochloride Tablets?

Store Metformin Hydrochloride Tablets at 68°F to 77°F (20°C to 25°C).

KeepMetformin Hydrochloride Tabletsand all medicines out of the reach of children.

General information about the use ofMetformin Hydrochloride Tablets

If you have questions or problems, talk with your doctor or other healthcare provider. You can ask your doctor or pharmacist for the information about metformin hydrochloride tablets that is written for health care professionals. Medicines are sometimes prescribed for purposes other than those listed in a patient information leaflet. Do not use metformin hydrochloride tablets for a condition for which it was not prescribed. Do not share your medicine with other people.

What are the ingredients ofMetformin Hydrochloride Tablets?

Active ingredients of metformin hydrochloride tablets: metformin hydrochloride

Metformin hydrochloride tablets, USP contain 500 mg, 850 mg, or 1000 mg of metformin hydrochloride. Each tablet contains the inactive ingredients magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, povidone, talc and titanium dioxide.

What is type 2 diabetes?

Type 2 diabetes is a condition in which your body does not make enough insulin, and the insulin that your body produces does not work as well as it should. Your body can also make too much sugar. When this happens, sugar (glucose) builds up in the blood. This can lead to serious medical problems.

The main goal of treating diabetes is to lower your blood sugar to a normal level.

High blood sugar can be lowered by diet and exercise, and by certain medicines when necessary.

Talk to your healthcare provider about how to prevent, recognize, and take care of low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and problems you have because of your diabetes.

Manufactured for:

Time-Cap Labs, Inc.

7 Michael Avenue, Farmingdale, NY 11735, USA

Manufactured by:

Marksans Pharma Ltd.

Plot No.L-82, L-83, Vema Indl. Estate,

Vena, Goa-403 722, India

Rev. 07/18

​Metformin Hydrochloride Tablets USP, 1000 mg
100's Container pack

​Metformin Hydrochloride Tablets USP, 1000 mg
180's Container pack

​Metformin Hydrochloride Tablets USP, 850 mg
100's Container pack

​Metformin Hydrochloride Tablets USP, 850 mg
180's Container pack

​Metformin Hydrochloride Tablets USP, 850 mg
1000's Container pack

Metformin Hydrochloride Tablets USP, 500 mg
100's Container pack

Metformin Hydrochloride Tablets USP, 500 mg
180's Container pack

Metformin Hydrochloride Tablets USP, 500 mg
1000's Container pack