Chemical- Metformin Hydrochloride 

Classification- Metforal is an anti-diabetic preparation. The main active ingredient is Metformin, a biguanide that reduces glycemia and improves insulin action. 

Recommendations- Metforal is recommended for advanced diabetes with no ketosis tendency. 

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Contraindications           
Individual hypersensitivity to Metformin, ketonuria, diabetes with previous episodes of lactic acidosis, serious hepatic and renal problems (serious creatine higher than 12mg/L), serious cardiocirculatory problems (cardiac decompensation, cardiogenic or toxinfectious shock, disorders in peripheral arterial circulation), serious respiratory problems, suprarenal insufficiency, chronic alcoholism, notably hypocaloric diets and lack of nourishment, serious dystrophic illness, acute hemorrhaging, gangrene, pregnancy. Metforal treatment is discouraged in the course of treatment with thiazide diuretics or other anti-hypertensive pharmaceutical products, which could cause renal malfunctioning. Treatment should be stopped 48 hours before intravenous urography or angiography and resumed 48 hours following the examination. 

Precautions- In the case of traumas, surgery and febrile and infectious illness it may be necessary to stop treatment, substituting it with the temporary administration of insulin in order to control the diabetes adequately. The patient must be taught by the physician to recognize the first signs of hypoglycemia (headache, excessive perspiration, irritability, trembling) and of lactic acidosis (loss of appetite, nausea, vomiting, fever, breathing difficulty, discomfort, abdominal pains, diarrhea, confusion or loss of consciousness) so that he may call a physician should the need arise. 

Interactions- Metformin can stimulate the action of anticoagulants.

Other Side Effects- The effects of Metformin on the patients ability to drive or operate machinery are unnoticeable. 

Directions for Use- The daily dosage must be established by the physician for each individual patient, on the basis of a metabolic examination. 

The average dosage unless the physician indicates otherwise is the following- 1 or 2 tablets following each of the three main meals. Treatment usually begins with a low dosage (1 or 2 tablets per day), progressively increasing the dosage, if necessary. In any case, the dosage should not surpass 3 grams of Metformin per day. The patient must rigorously follow his physician's instructions not only concerning the use of this product, but also with regard to diet and physical activity. 

Overdose- Overdose may cause symptoms of hypoglycemia, which may require the taking of sugar. Should lactic acidosis symptoms also occur, call a physician (see precautions). 

Unpleasant Side Effects
Symptoms of hypoglycemia may occur, although this is more frequent in elderly or weak patients, or those suffering from trauma. Although rare, lactic acidosis symptoms may appear in patients with a predisposition to renal insufficiency or serious cardiocirculatory problems. Should this occur, see a physician (see precautions). The patient may also suffer from gastroenteric disorders (nausea, loss of appetite, stomach pain, vomiting and diarrhea) and allergic reactions of varying intensity. Should you note any unpleasant side effect not described here, consult your physician. The expiry date is shown. Do not use the product after this date. Store in a dry place. Keep out of the reach of children.

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