Daomin 500 mg

Description

Indications Daomin tablet is prescribed for managing type 2 diabetes mellitus, particularly in overweight patients when dietary control and exercise alone do not achieve sufficient glycemic control.

• In adults: Daomin can be used as a standalone treatment or in combination with other oral antidiabetic medications or insulin.
• In children (from 10 years old) and adolescents: Daomin may be administered alone or alongside insulin therapy.

Studies have shown that metformin, as a first-line treatment, reduces diabetic complications in overweight adults with type 2 diabetes following diet failure.

Pharmacology Metformin, the active ingredient in Daomin, is an oral antihyperglycemic agent belonging to the biguanide class. It effectively lowers both fasting and postprandial blood glucose levels through a mechanism distinct from sulfonylureas, thereby minimizing the risk of hypoglycemia. Metformin works by:

• Reducing hepatic glucose production
• Decreasing intestinal glucose absorption
• Enhancing insulin sensitivity by increasing peripheral glucose uptake and utilization

Dosage & Administration Dosage should be personalized based on effectiveness and patient tolerance, without exceeding the maximum recommended daily dose.

• Immediate-release tablets:
  • Adults: The initial dose is 500 mg twice daily or 850 mg once daily, taken with meals. The dosage may be increased by 500 mg weekly or 850 mg every two weeks, up to 2000 mg per day in divided doses. In cases requiring further glycemic control, the dose may be raised to a maximum of 2550 mg per day, divided into three meals.
  • Children (10 years and older): The starting dose is 500 mg twice daily with meals. The dose may be gradually increased by 500 mg weekly to a maximum of 2000 mg per day, divided into multiple doses.
• Extended-release tablets:
  • Adults: The initial dose is 500 mg once daily with the evening meal. The dose can be increased weekly by 500 mg up to 2000 mg once daily with the evening meal or alternatively, 1000 mg twice daily. Patients transitioning from immediate-release to extended-release tablets can take up to the maximum recommended daily dose.
  • Children: Extended-release formulations have not been studied in pediatric patients.
  • Patients with renal impairment: Daomin should not be used if the estimated glomerular filtration rate (eGFR) is below 30 mL/min/1.73 m². If eGFR falls below 45 mL/min/1.73 m², the risk-benefit ratio should be assessed before continuing treatment.

Drug Interactions

• No specific long-term interaction data are available between Daomin and Furosemide.
• Nifedipine may enhance Daomin absorption, while Daomin has little effect on Nifedipine.
• Cationic drugs (e.g., Amiloride, Digoxin, Morphine, Procainamide, Quinine, Trimethoprim, Vancomycin) may interact with Daomin due to renal tubular secretion competition.
• Daomin does not affect Cimetidine pharmacokinetics.
• Certain medications (e.g., diuretics, corticosteroids, oral contraceptives, phenytoin, sympathomimetics, and calcium channel blockers) may induce hyperglycemia and reduce glycemic control.

Contraindications Daomin should not be used in patients with:

• Hypersensitivity to metformin or any excipient in the formulation
• Acute metabolic acidosis, including lactic acidosis and diabetic ketoacidosis
• Severe renal failure (eGFR <30 mL/min/1.73 m²)
• Acute conditions that may impair renal function (e.g., dehydration, severe infection, or shock)
• Diseases causing tissue hypoxia (e.g., cardiac or respiratory failure, recent myocardial infarction, shock)
• Liver failure, acute alcohol intoxication, or chronic alcoholism

Side Effects

• Blood and Lymphatic System Disorders: Rare cases of hemolytic anemia
• Metabolism and Nutrition Disorders: Very rare cases of lactic acidosis; decreased vitamin B12 absorption with prolonged use, which may lead to megaloblastic anemia
• Nervous System Disorders: Common occurrence of taste disturbances; rare cases of encephalopathy
• Gastrointestinal Disorders: Frequently reported nausea, vomiting, diarrhea, abdominal pain, and appetite loss, mostly at the start of therapy and typically resolving with continued use
• Hepatobiliary Disorders: Very rare reports of liver enzyme abnormalities or hepatitis, reversible upon discontinuation
• Skin Disorders: Very rare allergic reactions, including erythema, pruritus, and urticaria

Pregnancy & Lactation

• Pregnancy: Uncontrolled diabetes during pregnancy increases the risk of birth defects and perinatal mortality. It is recommended to use insulin instead of metformin during pregnancy to maintain optimal blood glucose levels.
• Breastfeeding: Metformin is excreted in breast milk, but adverse effects in nursing infants have not been observed. However, due to limited data, breastfeeding during metformin treatment is not recommended.

Precautions & Warnings

• As Daomin is primarily excreted through the kidneys, its accumulation can increase the risk of lactic acidosis. Regular renal function assessment is necessary.
• Daomin may lower vitamin B12 levels, and prolonged use warrants periodic monitoring.
• When used with insulin or insulin secretagogues, the risk of hypoglycemia increases.
• Treatment should be discontinued 2-3 days before surgery or contrast imaging procedures and restarted only after normal kidney function is confirmed.
• Infections, dehydration, or serious trauma may necessitate temporary discontinuation of Daomin.
• Vitamin B12 levels should be monitored annually due to potential absorption reduction.
• Combination therapy with sulfonylureas or insulin requires close blood glucose monitoring due to hypoglycemia risks.

Use in Special Populations

• Elderly: Due to potential renal impairment, dose adjustments based on kidney function are required.
• Pediatric Patients: Type 2 diabetes diagnosis should be confirmed before initiating treatment. Long-term effects on growth and puberty remain unknown, requiring careful monitoring.
• Children (10-12 years old): Special caution is advised when prescribing to this age group.
• Renal Function Monitoring: Kidney function should be assessed before treatment initiation and periodically thereafter:
  • At least annually for patients with normal renal function
  • 2-4 times per year for those with borderline renal function or elderly patients

Overdose Effects

• Hypoglycemia is unlikely even with high doses (up to 85 g); however, lactic acidosis may occur in overdose cases and requires immediate hospital treatment.
• Hemodialysis is the most effective method for removing lactate and metformin from the body in severe cases.

Therapeutic Class Biguanides

Storage Conditions

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