Daomin 500 mg

Description

Indications
Daomin tablets are prescribed for managing type 2 diabetes mellitus, especially in overweight individuals when diet and exercise alone fail to provide adequate blood sugar control.

• Adults: Daomin can be used as a single therapy (monotherapy) or in combination with other oral antidiabetic medications or insulin.
• Children (10 years and older) and adolescents: Daomin may be prescribed as monotherapy or in combination with insulin.

Clinical studies have demonstrated that overweight adults with type 2 diabetes experience a reduction in diabetes-related complications when metformin is used as the first-line treatment following diet failure.

Take this medication only as directed by a registered physician.

Pharmacology
Metformin, the active ingredient in Daomin, is a biguanide-class oral antihyperglycemic agent used for type 2 diabetes management. It effectively lowers both fasting and post-meal blood glucose levels. Unlike sulfonylureas, metformin does not stimulate insulin secretion and thus does not cause hypoglycemia.

Its mechanism of action includes:

• Reducing glucose production in the liver
• Decreasing glucose absorption in the intestines
• Enhancing insulin sensitivity, leading to improved glucose uptake and utilization in peripheral tissues

Dosage & Administration

Immediate-Release Tablets:
Dosage should be individualized based on effectiveness and tolerance without exceeding the maximum recommended daily dose.

• Adults: The usual starting dose is 500 mg twice daily or 850 mg once daily with meals. The dosage may be increased in increments of 500 mg per week or 850 mg every two weeks, up to a total of 2000 mg per day, divided into multiple doses. If further glycemic control is needed, the dosage may be increased to a maximum of 2550 mg per day. Doses exceeding 2000 mg should be taken in three divided doses with meals.
• Children (10 years and older): The typical starting dose is 500 mg twice daily with meals, with dose adjustments in 500 mg increments weekly up to a maximum of 2000 mg per day, divided into multiple doses.

Extended-Release Tablets:
The tablet must be swallowed whole—do not crush, cut, or chew.

• Adults: The usual starting dose is 500 mg once daily with the evening meal. The dose may be increased weekly by 500 mg up to a maximum of 2000 mg taken once daily with the evening meal or divided into 1000 mg twice daily. Patients switching from immediate-release metformin may transition to extended-release formulations up to the maximum recommended dose.
• Children: Extended-release metformin has not been studied in pediatric patients.

For Patients with Impaired Kidney Function:

• Daomin should not be used in patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m².
• If eGFR falls below 45 mL/min/1.73 m², the benefits and risks should be carefully assessed before continuing treatment.

Take this medication only as directed by a registered physician.

Drug Interactions

• The effects of Daomin when taken long-term with furosemide are unknown.
• Nifedipine may enhance Daomin absorption, but Daomin has minimal impact on nifedipine.
• Certain cationic drugs (e.g., amiloride, digoxin, morphine, quinidine, triamterene, trimethoprim, vancomycin) may compete with Daomin for renal tubular transport, potentially leading to interactions.
• No significant interaction has been observed between Daomin and cimetidine.
• Some medications, such as corticosteroids, diuretics, thyroid hormones, estrogen-based oral contraceptives, calcium channel blockers, and isoniazid, may induce hyperglycemia, potentially affecting blood sugar control.

Contraindications
Daomin is not recommended in the following conditions:

• Allergy to metformin or any of its components
• Acute metabolic acidosis, including lactic acidosis or diabetic ketoacidosis
• Severe kidney impairment (eGFR <30 mL/min)
• Conditions that may affect kidney function, such as dehydration, severe infection, or shock
• Acute or chronic conditions that cause tissue oxygen deficiency, such as heart failure, respiratory failure, recent heart attack, or liver failure
• Acute alcohol intoxication or alcoholism

Side Effects

Common Side Effects:

• Taste disturbances
• Gastrointestinal issues, including nausea, vomiting, diarrhea, abdominal pain, and appetite loss (most common at the start of therapy but usually subside)

Rare or Severe Side Effects:

• Metabolism-related: Very rarely, metformin may cause lactic acidosis. Long-term use may reduce vitamin B12 absorption, possibly leading to megaloblastic anemia and peripheral neuropathy.
• Liver-related: Rare cases of abnormal liver function tests and hepatitis have been reported, typically resolving upon discontinuation.
• Skin-related: Infrequent reports of skin reactions, such as redness, itching, and hives.

Use During Pregnancy & Lactation

• Pregnancy: Uncontrolled diabetes during pregnancy increases the risk of birth defects and perinatal mortality. Insulin is preferred over metformin for managing diabetes during pregnancy to maintain optimal blood sugar levels.
• Breastfeeding: Metformin passes into breast milk. While no adverse effects have been noted in breastfed infants, data remains limited, so breastfeeding is not recommended during treatment. A decision should be made weighing the benefits of breastfeeding against any potential risks.

Precautions & Warnings

• Daomin is primarily excreted by the kidneys; therefore, impaired kidney function increases the risk of lactic acidosis. Regular monitoring of kidney function is recommended.
• Prolonged use may reduce vitamin B12 levels; annual B12 level checks are advised.
• When used with insulin or insulin secretagogues, the risk of hypoglycemia increases.
• Discontinue Daomin 2–3 days before surgical procedures or diagnostic tests involving contrast agents and restart only after normal kidney function is confirmed.
• Patients with dehydration, severe infections, or trauma should avoid Daomin.
• If taken with sulfonylureas, blood sugar should be monitored due to the risk of hypoglycemia.
• Patients stabilized on Daomin and insulin should undergo hospital monitoring during initial combination therapy.
• Cimetidine may reduce Daomin clearance, requiring a dose adjustment.
• Potential interactions with anticoagulants should be monitored.

Use in Special Populations

• Elderly Patients: Kidney function may decline with age, so dosage adjustments based on kidney function are necessary. Regular kidney assessments are recommended.
• Children & Adolescents: Type 2 diabetes diagnosis should be confirmed before initiating metformin. Though short-term studies show no impact on growth or puberty, long-term effects remain unknown. Careful monitoring, particularly in prepubescent children, is advised.
• Children Aged 10–12 Years: Extra caution is needed when prescribing metformin in this age group.
• Renal Function Monitoring: Kidney function should be evaluated before starting treatment and periodically afterward.
  • At least annually for patients with normal kidney function
  • Two to four times a year for those with borderline kidney function or elderly patients
  • Daomin is contraindicated in patients with eGFR <30 mL/min and should be temporarily discontinued in conditions that impact kidney function.

Overdose Effects
Metformin overdose does not typically cause hypoglycemia but may lead to lactic acidosis, which is a medical emergency requiring immediate hospital treatment. Hemodialysis is the most effective method for removing excess lactate and metformin from the body.

Therapeutic Class
Biguanides (Oral Antidiabetic Medication)

Storage Conditions

• Store below 30°C, away from light and moisture.
• Keep out of reach of children.

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