METFORMIN- metformin er 500 mg tablet

Metformin by

Drug Labeling and Warnings

Metformin by is a Prescription medication manufactured, distributed, or labeled by Legacy Pharmaceutical Packaging, LLC. Drug facts, warnings, and ingredients follow.

Drug Details [pdf]

  • BOXED WARNING (What is this?)

  • INDICATIONS & USAGE

    Metformin hydrochloride extended-release tablets are indicated as an adjunct to diet and exercise to
    improve glycemic control in adults 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 metformin hydrochloride extended-release tablets, USP or any other pharmacologic agent. Dosage of metformin hydrochloride extended-release tablets, USP 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 metformin hydrochloride extended-release tablets, USP in adults is 2000 mg.

    Metformin hydrochloride extended-release tablets, USP should generally be given once daily with the evening meal. Metformin hydrochloride extended-release tablets, USP 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 metformin hydrochloride extended-release tablets, USP and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately 3 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 metformin hydrochloride extended-release tablets, USP 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 metformin hydrochloride extended-release tablets, USP may be sufficient during periods of transient loss of control in patients usually well-controlled on diet alone.

    Metformin hydrochloride extended-release tablets, USP must be swallowed whole and never crushed or chewed. Occasionally, the inactive ingredients of metformin hydrochloride extended-release tablets, USP will be eliminated in the feces as a soft, hydrated mass. (See Patient Informationprinted below.)

    2.1 Adult Dosage

    Metformin Hydrochloride Extended-Release Tablets
    Swallow metformin hydrochloride extended-release tablets whole and never crush, cut or chew.
    The recommended starting dose of metformin hydrochloride extended-release tablets are
    500 mg orally once daily with the evening meal.
    Increase the dose in increments of 500 mg weekly on the basis of glycemic control and
    tolerability, up to a maximum of 2000 mg once daily with the evening meal.
    If glycemic control is not achieved with metformin hydrochloride extended-release tablets 2000 mg
    once daily, consider a trial of metformin hydrochloride extended-release tablets 1000 mg twice daily.
    If higher doses are required, switch to metformin hydrochloride tablets at total daily doses up to
    2550 mg administered in divided daily doses, as described above.
    Patients receiving metformin hydrochloride tablets may be switched to metformin hydrochloride
    extended-release tablets once daily at the same total daily dose, up to 2000 mg once daily.

    2.3 Recommendations for Use in Renal Impairment

    Assess renal function prior to initiation of metformin hydrochloride extended-release tablets and
    periodically thereafter.
    Metformin hydrochloride extended-release tablets are contraindicated in patients with an estimated
    glomerular filtration rate (eGFR) below 30 mL/minute/1.73 m 2.
    Initiation of metformin hydrochloride extended-release tablets in patients with an eGFR between
    30 to 45 mL/minute/ 1.73 m 2 is not recommended.
    In patients taking metformin hydrochloride extended-release tablets whose eGFR later falls below
    45 mL/min/1.73 m 2, assess the benefit risk of continuing therapy.
    Discontinue metformin hydrochloride extended- release tablets 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 Procedure

    Discontinue metformin hydrochloride extended-release 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 liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial
    iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart metformin
    hydrochloride extended-release tablets if renal function is stable.

  • DOSAGE FORMS AND STRENGTHS

    Metformin hydrochloride extended-release tablets, USP are available as:
    Extended-release tablets: 500 mg white to off-white uncoated, modified capsule shaped tablets
    debossed with "G7" on one side and plain on other side.

  • 4 CONTRAINDICATIONS

    Metformin hydrochloride extended-release 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 WARNINGS AND PRECAUTIONS

    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 extendedrelease
    tablets. In metformin hydrochloride extended- release 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 extended-release 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 extended-release tablets, obtain an estimated
    glomerular filtration rate (eGFR).
    o Metformin hydrochloride extended-release tablets are contraindicated in patients with an

    eGFR less than 30 mL/min/1.73 m2 [see Contraindications (4)].
    o Initiation of metformin hydrochloride extended-release tablets are not recommended in
    patients with eGFR between 30 to 45 mL/min/1.73 m 2.
    o Obtain an eGFR at least annually in all patients taking metformin hydrochloride extendedrelease
    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 extended-release 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 extended-release 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 extended-release 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 m2;
    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 extended- release 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 extended- release 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 extended- release 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
    extended-release tablets.


    Hepatic impairment — Patients with hepatic impairment have developed cases of metforminassociated
    lactic acidosis. This may be due to impaired lactate clearance resulting in higher lactate
    blood levels. Therefore, avoid use of metformin hydrochloride extended- release tablets in patients
    with clinical or laboratory evidence of hepatic disease.

    5.2 Vitamin B 12 Deficiency

    In metformin hydrochloride tablets clinical trials of 29-week duration, a decrease to subnormal levels of
    previously normal serum vitamin B 12 levels was observed in approximately 7% of patients. Such decrease,
    possibly due to interference with B 12 absorption 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 12 supplementation. Certain individuals (those with inadequate vitamin B 12 or calcium intake or
    absorption) appear to be predisposed to developing subnormal vitamin B 12 levels. Measure hematologic
    parameters on an annual basis and vitamin B 12 at 2 to 3 year intervals in patients on metformin
    hydrochloride extended-release 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 extended-release 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
    extended-release tablets [see Drug Interactions (7)].

    5.4 Macrovascular Outcomes

    There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with
    metformin hydrochloride extended-release tablets.

  • 6 ADVERSE REACTIONS

    The following adverse reactions are also discussed elsewhere in the labeling:
    Lactic Acidosis [see Boxed Warning and Warnings and Precautions (5.1)]
    Vitamin B12 Deficiency [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 Extended-Release Tablets


    In placebo-controlled trials, 781 patients were administered metformin hydrochloride extended-release
    tablets. Adverse reactions reported in greater than 5% of the metformin hydrochloride extended release
    tablets patients, and that were more common in metformin hydrochloride extended-release tablets-than
    placebo-treated patients, are listed in Table 2.

    Table 2: Adverse Reactions from Clinical Trials of Metformin Hydrochloride Extended-Release Tablets Occurring >5% and More Common than Placebo in Patients with Type 2 Diabetes Mellitus
    Metformin Hydrochloride Extended-
    Release Tablets (n=781)
    Placebo (n=195)
    Diarrhea10%3%
    Nausea/Vomiting7%2%

    Diarrhea led to discontinuation of metformin hydrochloride extended-release tablets in 0.6% of patients.
    Additionally, the following adverse reactions were reported in ≥1.0% to ≤5.0% of metformin hydrochloride
    extended-release tablets patients and were more commonly reported with metformin hydrochloride
    extended-release tablets than placebo: abdominal pain, constipation, distention abdomen,
    dyspepsia/heartburn, flatulence, dizziness, headache, upper respiratory infection, taste disturbance.

    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.

  • 7 DRUG INTERACTIONS

    Table 3 presents clinically significant drug interactions with metformin hydrochloride extended-release
    tablets.

    Table 3: Clinically Significant Drug Interactions with Metformin Hydrochloride Extended-Release Tablets
    Carbonic Anhydrase Inhibitors
    Clinical Impact:Carbonic anhydrase inhibitors frequently cause a decrease in serum bicarbonate
    and induce non-anion gap, hyperchloremic metabolic acidosis. Concomitant use
    of these drugs with metformin hydrochloride extended-release tablets may
    increase the risk for lactic acidosis.
    Intervention:Consider more frequent monitoring of these patients.
    Examples:Topiramate, zonisamide, acetazolamide or dichlorphenamide.
    Drugs that Reduce Metformin Hydrochloride Extended-Release Tablets Clearance
    Clinical Impact:Concomitant use of drugs that interfere with common renal tubular transport
    systems involved in the renal elimination of metformin (e.g., organic cationic
    transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors) could
    increase systemic exposure to metformin and may increase the risk for lactic
    acidosis [see Clinical Pharmacology (12.3)].
    Intervention:Consider the benefits and risks of concomitant use with metformin hydrochloride
    extended-release tablets.
    Examples:Ranolazine, vandetanib, dolutegravir, and cimetidine.
    Alcohol
    Clinical Impact:Alcohol is known to potentiate the effect of metformin on lactate metabolism.
    Intervention:Warn patients against excessive alcohol intake while receiving metformin
    hydrochloride extended-release tablets.
    Insulin Secretagogues or Insulin
    Clinical Impact:Coadministration of metformin hydrochloride extended-release tablets with an
    insulin secretagogue (e.g., sulfonylurea) or insulin may increase the risk of
    hypoglycemia.
    Intervention:Patients receiving an insulin secretagogue or insulin may require lower doses of
    the insulin secretagogue or insulin.
    Drugs Affecting Glycemic Control
    Clinical Impact:Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic
    control.
    Intervention:When such drugs are administered to a patient receiving metformin hydrochloride
    extended-release tablets, observe the patient closely for loss of blood glucose
    control. When such drugs are withdrawn from a patient receiving metformin
    hydrochloride extended-release tablets, observe the patient closely for
    hypoglycemia.
    Examples:Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products,
    estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics,
    calcium channel blockers, and isoniazid.

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Risk Summary
    Limited data with metformin hydrochloride extended-release tablets in pregnant women are not sufficient
    to determine a drug-associated risk for major birth defects or miscarriage. Published studies with
    metformin use during pregnancy have not reported a clear association with metformin and major birth
    defect or miscarriage risk [see Data]. There are risks to the mother and fetus associated with poorly
    controlled diabetes mellitus in pregnancy [see Clinical Considerations].
    No adverse developmental effects were observed when metformin was administered to pregnant
    Sprague Dawley rats and rabbits during the period of organogenesis at doses up to 2- and 5-times,
    respectively, a 2550 mg clinical dose, based on body surface area [see Data].
    The estimated background risk of major birth defects is 6 to 10% in women with pre-gestational diabetes
    mellitus with an HbA1C >7 and has been reported to be as high as 20 to 25% in women with a HbA1C >10.
    The estimated background risk of miscarriage for the indicated population is unknown. In the U.S. general
    population, the estimated background risk of major birth defects and miscarriage in clinically recognized
    pregnancies is 2 to 4% and 15 to 20%, respectively.


    Clinical Considerations
    Disease-associated maternal and/or embryo/fetal risk
    Poorly-controlled diabetes mellitus in pregnancy increases the maternal risk for diabetic ketoacidosis,
    pre-eclampsia, spontaneous abortions, preterm delivery, stillbirth and delivery complications. Poorly
    controlled diabetes mellitus increases the fetal risk for major birth defects, stillbirth, and macrosomia
    related morbidity.


    Data
    Human Data
    Published data from post-marketing studies have not reported a clear association with metformin and
    major birth defects, miscarriage, or adverse maternal or fetal outcomes when metformin was used during
    pregnancy. However, these studies cannot definitely establish the absence of any metformin-associated
    risk because of methodological limitations, including small sample size and inconsistent comparator
    groups.


    Animal Data
    Metformin hydrochloride did not adversely affect development outcomes when administered to pregnant
    rats and rabbits at doses up to 600 mg/kg/day. This represents an exposure of about 2 and 5 times a
    2550 mg clinical dose based on body surface area comparisons for rats and rabbits, respectively.
    Determination of fetal concentrations demonstrated a partial placental barrier to metformin.

    8.2 Lactation

    Risk Summary
    Limited published studies report that metformin is present in human milk [see Data]. However, there is
    insufficient information to determine the effects of metformin on the breastfed infant and no available
    information on the effects of metformin on milk production. Therefore, the developmental and health
    benefits of breastfeeding should be considered along with the mother's clinical need for metformin
    hydrochloride extended-release tablets and any potential adverse effects on the breastfed child from
    metformin hydrochloride extended-release tablets or from the underlying maternal condition.


    Data
    Published clinical lactation studies report that metformin is present in human milk which resulted in infant
    doses approximately 0.11% to 1% of the maternal weight-adjusted dosage and a milk/plasma ratio
    ranging between 0.13 and 1. However, the studies were not designed to definitely establish the risk of use
    of metformin during lactation because of small sample size and limited adverse event data collected in
    infants.

    8.3 Females and Males of Reproductive Potential

    Discuss the potential for unintended pregnancy with premenopausal women as therapy with metformin
    hydrochloride extended-release tablets may result in ovulation in some anovulatory women.

    8.4 Pediatric Use

    Metformin Hydrochloride Extended-Release Tablets


    Safety and effectiveness of metformin hydrochloride extended-release tablets in pediatric patients have
    not been established.

    8.5 Geriatric Use

    Controlled clinical studies of metformin hydrochloride extended-release tablets did not include sufficient
    numbers of elderly patients to determine whether they respond differently from younger patients. In
    general, dose selection for an elderly patient should be cautious, usually starting at the low end of the
    dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of
    concomitant disease or other drug therapy and the higher risk of lactic acidosis. Assess renal function
    more frequently in elderly patients [see Warnings and Precautions (5.1)].

    8.6 Renal Impairment

    Metformin is substantially excreted by the kidney, and the risk of metformin accumulation and lactic
    acidosis increases with the degree of renal impairment. Metformin hydrochloride extended-release
    tablets are contraindicated in severe renal impairment, patients with an estimated glomerular filtration rate
    (eGFR) below 30 mL/min/1.73 m 2[see Dosage and Administration (2.3), Contraindications (4), Warnings
    and Precautions (5.1), and Clinical Pharmacology (12.3)].

    8. 7 Hepatic Impairment

    Use of metformin in patients with hepatic impairment has been associated with some cases of lactic
    acidosis. Metformin hydrochloride extended-release tablets are not recommended in patients with hepatic
    impairment. [see Warnings and Precautions (5.1)].

  • 10 OVERDOSAGE

    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.

  • 11 DESCRIPTION

    Metformin hydrochloride extended-release 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:

    DESCRIPTION

    Metformin hydrochloride, USP is a white to off-white crystalline compound with a molecular formula of
    C 4H 11N 5 HCl and a molecular weight of 165.62. Metformin hydrochloride is freely soluble in water, slightly 4 11 5
    soluble in ethanol, practically insoluble in acetone and in methylene chloride. The pKa of metformin is 12.4. a
    The pH of a 1% aqueous solution of metformin hydrochloride is 6.35.
    Metformin hydrochloride extended-release tablets, USP contains 500 mg or 750 mg of metformin
    hydrochloride, which is equivalent to 389.93 mg, 584.90 mg metformin base, respectively.
    Metformin hydrochloride extended-release tablets USP, 500 mg tablets contain the inactive ingredients
    hypromellose, magnesium stearate, and polyvinyl pyrrolidone
    Metformin hydrochloride extended-release tablets USP, 750 mg tablets contain the inactive ingredients
    hypromellose, magnesium stearate, and polyvinyl pyrrolidone
    Meets USP Dissolution Test 10

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2
    diabetes mellitus, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic
    glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by
    increasing peripheral glucose uptake and utilization. With metformin therapy, insulin secretion remains
    unchanged while fasting insulin levels and day-long plasma insulin response may decrease.

    12.3 Pharmacokinetics

    Absorption

    Following a single oral dose of metformin hydrochloride extended-release tablets, C max is achieved with a max
    median value of 7 hours and a range of 4 to 8 hours. Peak plasma levels are approximately 20% lower
    compared to the same dose of metformin hydrochloride tablets, however, the extent of absorption (as
    measured by AUC) is comparable to metformin hydrochloride tablets.
    At steady state, the AUC and C max are less than dose proportional for metformin hydrochloride extended- max
    release tablets within the range of 500 to 2000 mg administered once daily. Peak plasma levels are
    approximately 0.6, 1.1, 1.4 and 1.8 mcg/mL for 500, 1000, 1500, and 2000 mg once-daily doses,
    respectively. The extent of metformin absorption (as measured by AUC) from metformin hydrochloride
    extended-release tablets at a 2000 mg once-daily dose is similar to the same total daily dose administered
    as metformin hydrochloride tablets 1000 mg twice daily. After repeated administration of metformin
    hydrochloride extended-release tablets, metformin did not accumulate in plasma.

    Effect of food: : Food decreases the extent of absorption and slightly delays the absorption of metformin,
    as shown by approximately a 40% lower mean peak plasma concentration (C max), a 25% lower area under max
    the plasma concentration versus time curve (AUC), and a 35-minute prolongation of time to peak plasma
    concentration (T max) following administration of a single 850 mg tablet of metformin hydrochloride tablets max
    with food, compared to the same tablet strength administered fasting.
    Although the extent of metformin absorption (as measured by AUC) from the metformin hydrochloride
    extended-release tablet increased by approximately 50% when given with food, there was no effect of
    food on C max and T max of metformin. Both high and low fat meals had the same effect on the max max
    pharmacokinetics of metformin hydrochloride extended-release tablets.

    Distribution

    The apparent volume of distribution (V/F) of metformin following single oral doses of metformin
    hydrochloride tablets 850 mg averaged 654 ± 358 L. Metformin is negligibly bound to plasma proteins.
    Metformin partitions into erythrocytes, most likely as a function of time.

    Metabolism

    Intravenous single-dose studies in normal subjects demonstrate that metformin is excreted unchanged in
    the urine and does not undergo hepatic metabolism (no metabolites have been identified in humans) nor
    biliary excretion.

    Elimination

    Renal clearance (see Table 4) is approximately 3.5 times greater than creatinine clearance, which
    indicates that tubular secretion is the major route of metformin elimination. Following oral administration,
    approximately 90% of the absorbed drug is eliminated via the renal route within the first 24 hours, with a
    plasma elimination half-life of approximately 6.2 hours. In blood, the elimination half-life is approximately
    17.6 hours, suggesting that the erythrocyte mass may be a compartment of distribution.

    Specific Populations

    Renal Impairment


    In patients with decreased renal function the plasma and blood half-life of metformin is prolonged and the
    renal clearance is decreased (see Table 3) [See Dosage and Administration (2.3), Contraindications (4),
    Warnings and Precautions (5.1) and Use in Specific Populations (8.6)].


    Hepatic Impairment


    No pharmacokinetic studies of metformin have been conducted in patients with hepatic impairment [see
    Warnings and Precautions (5.1) and Use in Specific Populations (8.7)].


    Geriatrics


    Limited data from controlled pharmacokinetic studies of metformin hydrochloride tablets in healthy elderly
    subjects suggest that total plasma clearance of metformin is decreased, the half-life is prolonged, and C max
    is increased, compared to healthy young subjects. It appears that the change in metformin
    pharmacokinetics with aging is primarily accounted for by a change in renal function (see Table 4). [see
    Warnings and Precautions (5.1) and Use in Specific Populations (8.5)].

    Table 4: Select Mean (± S.D.) Metformin Pharmacokinetic Parameters Following Single or Multiple Oral Doses of Metformin Hydrochloride Tablets
    Subject Groups: Metformin Hydrochloride Tablet dose a (number of subjects) Cmax b

    (mcg/mL)
    Tmax c

    (hrs)
    Renal

    Clearance (mL/min)
    Healthy, nondiabetic adults:
    500 mg single dose (24)1.03 (±0.33)2.75 (±0.81)600 (±132)
    850 mg single dose (74)d1.60 (±0.38)2.64 (±0.82)552 (±139)
    850 mg three times daily for 19 doses e (9) 2.01 (±0.42)1.79 (±0.94)642 (±173)
    Adults with type 2 diabetes mellitus:
    850 mg single dose (23)1.48 (±0.5)3.32 (±1.08)491 (±138)
    850 mg three times daily for 19 dosese (9)1.90 (±0.62)2.01 (±1.22)550 (±160)
    Elderly f , healthy nondiabetic adults:
    850 mg single dose (12)2.45 (±0.70)2.71 (±1.05)412 (±98)
    Renal-impaired adults:
    850 mg single dose
    Mild (CL crg 61-90 mL/min) (5) 1.86 (±0.52)3.20 (±0.45)384 (±122)
    Moderate (CL cr 31-60 mL/min) (4) 4.12 (±1.83)3.75 (±0.50)108 (±57)
    Severe (CL cr 10-30 mL/min) (6) 3.93 (±0.92)4.01 (±1.10)130 (±90)

    a All doses given fasting except the first 18 doses of the multiple dose studies

    b Peak plasma concentration

    c Time to peak plasma concentration

    d Combined results (average means) of five studies: mean age 32 years (range 23-59 years)

    e Kinetic study done following dose 19, given fasting

    f Elderly subjects, mean age 71 years (range 65-81 years)

    g CLcr = creatinine clearance normalized to body surface area of 1.73 m 2

    Gender

    Metformin pharmacokinetic parameters did not differ significantly between normal subjects and patients with type 2 diabetes when analyzed according to gender (males = 19, females = 16).

    Race

    No studies of metformin pharmacokinetic parameters according to race have been performed.

    Drug Interactions
    In Vivo Assessment of Drug Interactions

    Table 5: Effect of Coadministered Drug on Plasma Metformin Systemic Exposure
    Coadministered
    Drug
    Dose of
    Coadministered
    Drug*
    Dose of
    Metformin *
    Geometric Mean Ratio
    (ratio with/without Coadministered drug)
    No Effect= 1.00
    AUC†C max
    No dosing adjustments required for the following:
    Glyburide5 mg850 mgmetformin0.91‡0.93‡
    Furosemide40 mg850 mgmetformin1.09‡1.22‡
    Nifedipine10 mg850 mgmetformin1.161.21
    Propranolol40 mg850 mgmetformin0.900.94
    Ibuprofen400 mg850 mgmetformin1.05‡1.07‡
    Cationic drugs eliminated by renal tubular secretion may reduce metformin elimination
    [see Warnings and Precautions (5.9) and Drug Interactions (7.2).]
    Cimetidine400 mg850 mgmetformin1.401.61
    Carbonic anhydrase inhibitors may cause metabolic acidosis
    [see Warnings and Precautions (5.1) and Drug Interactions (7.1).]
    Topiramate100 mg§500 mg§metformin1.25§1.17

    * All metformin and coadministered drugs were given as single doses
    † AUC = AUC(INF)
    ‡ Ratio of arithmetic means
    § At steady state with topiramate 100 mg every 12 hours and metformin 500 mg every 12 hours;
    AUC = AUC 0-12h

    Table 6: Effect of Metformin on Coadministered Drug Systemic Exposure
    Coadministered
    Drug
    Dose of
    Coadministered
    Drug*
    Dose of
    Metformin *
    Geometric Mean Ratio
    (ratio with/without metformin)
    No Effect= 1.00
    AUC†C max
    No dosing adjustments required for the following:
    Glyburide5 mg850 mgglyburide0.78‡0.63‡
    Furosemide40 mg850 mgfurosemide0.87‡0.69‡
    Nifedipine10 mg850 mgnifedipine1.10§1.08
    Propranolol40 mg850 mgpropranolol1.01§1.02
    Ibuprofen400 mg850 mgibuprofen0.97¶1.01¶
    Cimetidine400mg850 mgcimetidine0.95§1.01

    * All metformin and coadministered drugs were given as single doses
    † AUC = AUC(INF) unless otherwise noted
    ‡ Ratio of arithmetic means, p-value of difference <0.05
    § AUC (0.24hr) reported
    ¶ Ratio of arithmetic means

  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

    Long-term carcinogenicity studies have been performed in rats (dosing duration of 104 weeks) and mice
    (dosing duration of 91 weeks) at doses up to and including 900 mg/kg/day and 1500 mg/kg/day,
    respectively. These doses are both approximately 3 times the maximum recommended human daily dose
    of 2550 mg based on body surface area comparisons. No evidence of carcinogenicity with metformin was
    found in either male or female mice. Similarly, there was no tumorigenic potential observed with metformin
    in male rats. There was, however, an increased incidence of benign stromal uterine polyps in female rats
    treated with 900 mg/kg/day.
    There was no evidence of a mutagenic potential of metformin in the following in vitro tests: Ames test
    (S. typhimurium), gene mutation test (mouse lymphoma cells), or chromosomal aberrations test (human
    lymphocytes). Results in the in vivo mouse micronucleus test were also negative.
    Fertility of male or female rats was unaffected by metformin when administered at doses as high as
    600 mg/kg/day, which is approximately 2 times the maximum recommended human daily dose of 2550 mg
    based on body surface area comparisons.

  • 14 CLINICAL STUDIES

    14.2 Metformin Hydrochloride Extended-Release Tablets

    A 24-week, double-blind, placebo-controlled study of metformin hydrochloride extended-release tablets,
    taken once daily with the evening meal, was conducted in patients with type 2 diabetes mellitus who had
    failed to achieve glycemic control with diet and exercise. Patients entering the study had a mean baseline
    HbA 1c of 8.0% and a mean baseline FPG of 176 mg/dL. The treatment dose was increased to 1500 mg
    once daily if at Week 12 HbA 1c was ≥7.0% but <8.0% (patients with HbA 1c ≥8.0% were discontinued from
    the study). At the final visit (24-week), mean HbA 1c had increased 0.2% from baseline in placebo patients
    and decreased 0.6% with metformin hydrochloride extended-release tablets.
    A 16-week, double-blind, placebo-controlled, dose-response study of metformin hydrochloride extendedrelease
    tablets, taken once daily with the evening meal or twice daily with meals, was conducted in
    patients with type 2 diabetes mellitus who had failed to achieve glycemic control with diet and exercise.
    The results are shown in Table 10.

    Table 10: Mean Changes from Baseline* in HbA1c and Fasting Plasma Glucose at Week 16 Comparing Metformin Hydrochloride Extended-Release Tablets vs Placebo in Patients with Type 2 Diabetes Mellitus
    Metformin Hydrochloride Extended-Release TabletsPlacebo
    500 mg
    Once Daily
    1000 mg
    Once Daily
    1500 mg
    Once Daily
    2000 mg
    Once Daily
    1000 mg
    Twice Daily
    Hemoglobin A1C (%)
    Baseline
    Change at FINAL VISIT
    p-valuea
    (n=115)
    8.2
    –0.4
    <0.001
    (n=115)
    8.4
    –0.6
    <0.001
    (n=111)
    8.3
    –0.9
    <0.001
    (n=125)
    8.4
    –0.8
    <0.001
    (n=112)
    8.4
    –1.1
    <0.001
    (n=111)
    8.4
    0.1
    FPG (mg/dL)
    Baseline
    Change at FINAL VISIT
    p-valuea
    (n=126)
    182.7
    –15.2
    <0.001
    (n=118)
    183.7
    –19.3
    <0.001
    (n=120)
    178.9
    –28.5
    <0.001
    (n=132)
    181.0
    –29.9
    <0.001
    (n=122)
    181.6
    –33.6
    <0.001

    (n=113)
    179.6
    7.6

    aAll comparisons versus Placebo

    Mean baseline body weight was 193 lbs, 192 lbs, 188 lbs, 196 lbs, 193 lbs and 194 lbs in the metformin
    hydrochloride extended-release tablets 500 mg , 1000 mg, 1500 mg, and 2000 mg once daily, 1000 mg
    twice daily and placebo arms, respectively. Mean change in body weight from baseline to week
    16 was -1.3 lbs, -1.3 lbs, -0.7 lbs, -1.5 lbs, -2.2 lbs and -1.8 lbs, respectively.
    A 24-week, double-blind, randomized study of metformin hydrochloride extended-release tablets, taken
    once daily with the evening meal, and metformin hydrochloride tablets, taken twice daily (with breakfast
    and evening meal), was conducted in patients with type 2 diabetes mellitus who had been treated with
    metformin hydrochloride tablets 500 mg twice daily for at least 8 weeks prior to study entry. The results are
    shown in Table 11.

    Table 11: Mean Changes from Baseline* in HbA1c and Fasting Plasma Glucose at Week 24 Comparing Metformin Hydrochloride Extended-Release Tablets vs Metformin Hydrochloride Tablets in Patients with Type 2 Diabetes Mellitus
    Metformin
    Hydrochloride Tablets
    500 mg
    Twice Daily
    Metformin Hydrochloride
    Extended–Release Tablets
    1000 mg
    Once Daily
    1500 mg
    Once Daily
    Hemoglobin A1c (%)
    Baseline
    Change at FINAL VISIT
    (95% CI)
    (n=67)
    7.06
    0.14a
    (-0.04, 0.31)
    (n=72)
    6.99
    0.27
    (0.11, 0.43)
    (n=66)
    7.02
    0.13
    (-0.02, 0.28)
    FPG (mg/dL)
    Baseline
    Change at FINAL VISIT
    (95% CI)
    ( n=69)
    127.2
    14.0
    (7.0, 21.0)
    (n=72)
    131.0
    11.5
    (4.4, 18.6)
    (n=70)
    131.4
    7.6
    (1.0, 14.2)

    †a n=68
    Mean baseline body weight was 210 lbs, 203 lbs and 193 lbs in the metformin hydrochloride tablets 500
    mg twice daily, and metformin hydrochloride extended-release tablets 1000 mg and 1500 mg once daily
    arms, respectively. Mean change in body weight from baseline to week 24 was 0.9 lbs, 1.1 lbs and 0.9 lbs,
    respectively.

  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    16.1 How Supplied

    Metformin Hydrochloride Extended-Release Tablets, USP 500mg - White to off white uncoated, modified
    capsule shaped tablets debossed with “G7” on one side and plain on other side.

    Unit of Use Bottles of 60 Tablets - 500mg - NDC: 68645-595-59

    16.2 Storage

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

  • 17 PATIENT COUNSELING INFORMATION

    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 extended-release 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 extended-release tablets. Instruct patients to inform their doctor that they are taking
    metformin hydrochloride extended-release 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 extended-release tablets are
    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 B12 Deficiency:
    Inform patients about importance of regular hematological parameters while receiving metformin
    hydrochloride extended-release tablets [see Warnings and Precautions (5.2)].


    Females of Reproductive Age:
    Inform females that treatment with metformin hydrochloride extended-release 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 Extended-Release Tablets Administration Information:
    Inform patients that metformin hydrochloride extended-release tablets must be swallowed whole and not
    crushed, cut, or chewed, and that the inactive ingredients may occasionally be eliminated in the feces as a
    soft mass that may resemble the original tablet.

    Dispense with Patient Information is also available at:
    http://www.granulesindia.com/U.S.ProductCatalog.php


    Manufactured by:
    Granules India Limited
    Hyderabad-500 081, India

    MADE IN INDIA


    Manufactured for:
    Granules Pharmaceuticals Inc.
    Chantilly, VA 20151

    Distributed by::
    Wal-Mart
    Bentonville, AR 72716


    Packaged by:
    Legacy Pharmaceutical Packaging, LLC
    Earth City, MO 63045

    Revision date: 10/2021

    21890

  • PATIENT INFORMATION

    PATIENT INFORMATION
    Metformin Hydrochloride Extended-Release Tablets
    (met-FOR-min HYE-droe-KLOR-ide)

    Read the Patient Information that comes with metformin hydrochloride extended-release 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 about metformin hydrochloride extendedrelease
    tablets?
    Serious side effects can happen in people taking metformin hydrochloride extended-release
    tablets, including:
    Lactic Acidosis. Metformin hydrochloride, the medicine in metformin hydrochloride extended-release
    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 taking metformin hydrochloride extended-release tablets and 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 extended-release 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 extended-release tablets?
    Metformin hydrochloride extended-release tablets are prescription medicines that contain metformin
    hydrochloride. Metformin hydrochloride extended-release tablets are used with diet and exercise to
    help control high blood sugar (hyperglycemia) in adults with type 2 diabetes.
    Metformin hydrochloride extended-release tablets are not for people with type 1 diabetes.
    Metformin hydrochloride extended-release 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 extended-release tablets works 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 and metformin
    hydrochloride extended-release tablets do not cause your body to make more insulin.

    Who should not take metformin hydrochloride extended-release tablets?
    Some conditions increase your chance of getting lactic acidosis, or cause other problems if you take either
    of these medicines. Most of the conditions listed below can increase your chance of getting lactic acidosis.

    Do not take metformin hydrochloride extended-release tablets if you:
    have kidney problems
    are allergic to the metformin hydrochloride in metformin hydrochloride extended-release tablets or any
    of the ingredients in metformin hydrochloride extended-release tablets. See the end of this leaflet for a
    complete list of ingredients in metformin hydrochloride extended-release 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 extendedrelease
    tablets will need to be stopped for a short time. Talk to your healthcare provider about when you
    should stop metformin hydrochloride extended-release tablets and when you should start metformin
    hydrochloride extended-release tablets again. See “What is the most important information I
    should know about metformin hydrochloride extended-release tablets"?


    What should I tell my healthcare provider before taking metformin hydrochloride extendedrelease
    tablet?

    Before taking metformin hydrochloride extended-release tablets, tell your healthcare provider if you:
    have type 1 diabetes. Metformin hydrochloride extended-release 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 extended-release 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
    extended-release 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 extended- release
    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 if metformin hydrochloride extended-release
    tablets passes into your breast milk. Talk with your healthcare provider about the best way to feed your
    baby while you take metformin hydrochloride extended-release 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 extended-release tablets may affect the way other medicines work, and other
    medicines may affect how metformin hydrochloride extended-release tablets works.


    Can metformin hydrochloride extended-release tablets be used in children?
    Metformin hydrochloride extended-release tablets has not been studied in children.

    How should I take metformin hydrochloride extended-release tablets?
    Take metformin hydrochloride extended-release tablets exactly as your healthcare provider tells you.
    Metformin hydrochloride extended-release tablets should be taken with meals to help lessen an upset
    stomach side effect.
    Swallow metformin hydrochloride extended-release tablets whole. Do not crush, cut, or chew
    metformin hydrochloride extended-release tablets.
    You may sometimes pass a soft mass in your stools (bowel movement) that looks like metformin
    hydrochloride extended-release tablets. This is not harmful and will not affect the way metformin
    hydrochloride extended-release 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 extended-release tablets.
    Your healthcare provider will check your diabetes with regular blood tests, including your blood sugar
    levels and your hemoglobin 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 side effects of metformin hydrochloride extended-release tablets?”

    Check your blood sugar as your healthcare provider tells you to.
    Stay on your prescribed diet and exercise program while taking metformin hydrochloride extendedrelease
    tablets.
    If you miss a dose of metformin hydrochloride extended-release 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 extended-release tablets, call your healthcare provider,
    local Poison Control Center, or go to the nearest hospital emergency room right away.

    What should I avoid while taking metformin hydrochloride extended-release tablets?
    Do not drink a lot of alcoholic drinks while taking metformin hydrochloride extended-release 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 of metformin hydrochloride extended-release tablets?
    Lactic acidosis. Metformin, the active ingredient in metformin hydrochloride extended-release
    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 extended-release 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 extended-release 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 extended-release tablets have an
    unpleasant metallic taste when they start taking the medicine. It lasts for a short time.
    Metformin hydrochloride extended-release 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 store metformin hydrochloride extended-release tablets?
    Store metformin hydrochloride extended-release tablet at 68°F to 77°F (20°C to 25°C).

    Keep metformin hydrochloride extended-release tablets and all medicines out of the reach of
    children.

    General information about the use of metformin hydrochloride extended-release 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 extended-release tablets that is
    written for healthcare professionals. Medicines are sometimes prescribed for purposes other than those
    listed in a patient information leaflet. Do not use metformin hydrochloride extended-release tablets for a
    condition for which it was not prescribed. Do not share your medicine with other people.


    What are the ingredients of metformin hydrochloride extended-release tablets?
    Active ingredients of metformin hydrochloride extended-release tablets: metformin hydrochloride.
    Inactive ingredients in each tablet of metformin hydrochloride extended-release tablet 500 mg:
    hypromellose, magnesium stearate, and polyvinyl pyrrolidone.
    Inactive ingredients in each tablet of metformin hydrochloride extended-release tablet 750 mg:
    hypromellose, magnesium stearate, and polyvinyl pyrrolidone

    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.


    Dispense with Patient Information is also available at:
    http://www.granulesindia.com/U.S.ProductCatalog.php

    Manufactured by:
    Granules India Limited
    Hyderabad-500 081, India
    MADE IN INDIA


    Manufactured for:
    Granules Pharmaceuticals Inc.
    Chantilly, VA 20151


    Distributed by:
    Wal-Mart
    Bentonville, AR 72716


    Packaged by:
    Legacy Pharmaceutical Packaging, LLC
    Earth City, MO 63045


    Unit of Use Bottles of 60 Tablets - 500mg - NDC: 68645-595-59

    Revision Date: 10/2021

    21890

  • PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

    PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

  • INGREDIENTS AND APPEARANCE
    METFORMIN 
    metformin er 500 mg tablet
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC: 68645-595(NDC:70010-491)
    Route of AdministrationORAL
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    METFORMIN HYDROCHLORIDE (UNII: 786Z46389E) (METFORMIN - UNII:9100L32L2N) METFORMIN HYDROCHLORIDE500 mg
    Inactive Ingredients
    Ingredient NameStrength
    POVIDONE (UNII: FZ989GH94E)  
    HYPROMELLOSES (UNII: 3NXW29V3WO)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    Product Characteristics
    Colorwhite (white to off-white) Scoreno score
    ShapeCAPSULESize18mm
    FlavorImprint Code G7
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC: 68645-595-5960 in 1 BOTTLE; Type 0: Not a Combination Product03/10/2022
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA20931303/10/2022
    Labeler - Legacy Pharmaceutical Packaging, LLC (143213275)

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