Metformin

From Pubdrug

Non-certified

You are reading a non-certified PubDrug document. This document is incomplete and not ready for final editing, review, and certification. Until this document is certified, any registered PubDrug user may edit its content.

Authored by: Rlweber 08:48, 28 March 2007 (PDT)

Metformin Quick Reference

IUPAC Name
N,N-dimethylimidocarbonimidic
Chemical Information
Empirical Formula	C4H11N5HCl
Molecular Weight	165.53
General Drug Information
Classification	Biguanide; Antihyperglycemic Agents
Schedule	Legend
How Supplied	Oral Tablets: Regular-release: 500mg, 850 mg, 1000mg; Extended-release: 500mg, 750 mg Oral Solution: 100mg/ml
Trade Names	Glucophage, Glucophage XR, Riomet, Fortamet, Glumetza
Pregnancy Category	B No well-controlled studies in humans have been performed; Metformin is not recommended for use in pregnancy, and should only be used if necessary
Breast Feeding	Studies with lactating rats show that metformin is excreted into breast milk. No studies have been conducted in lactating female humans. Infant hypoglycemia is a concern, and the risks and benefits of using metformin during nursing should be carefully discussed with your primary medical physician
Generic Availability	Generic Available for Regular-release and Extended-release Tablets
Patent Expiration Date	Metformin Solution (Riomet): September 14, 2023; Tablets: no unexpired patents
Administration Information
Route(s)	Oral
Method(s)	Oral Tablets: Take with meals, extended-release tablets should not be chewed or crushed Oral Solution: Take with meals
Pharmacokinetic Information
Absorption	F = 50-60% (500 mg tablets under fasting state) Food delays the absorption and decreases the extent of absorption. There is a lack of dose proportionality with increasing dose.
	Cmax = 0.6 mcg/dL, 1.1 mcg/dL, 1.4 mcg/dL, and 1.8mcg/dL (corresponding doses: 500, 1000, 1500 and 2000 mg once-daily doses)
	Tmax = 2-4 (regular-release); 4-8 hours (extended-release)
Distribution	Vd = 654 +/- 358 L (following single dose of 850 mg metformin)
	Negligibly protein bound
Metabolism	Metformin does not undergo biliary excretion or hepatic metabolism. Tubular secretion is the major route of elimination
Excretion	t1/2 = 17.6 hours (blood), 6.2 hours (plasma)
	Tubular secretion

Contents 1 Brand/Trade Names of Drug 2 Generic Name of Drug 3 Description 4 Mechanism of action 5 Time Required for Therapeutic Response 6 Pharmacokinetics 6.1 Absorption 6.2 Distribution 6.3 Metabolism 6.4 Excretion 7 Special Population Pharmacokinetics 8 Indications 8.1 FDA Approved Indications 8.2 Non-FDA Approved Indications 9 Dosage 10 Administration 11 Monitoring Parameters 12 Contraindications/Precautions 12.1 Contraindications 12.2 Precautions/Warnings 12.3 Pregnancy indications 12.4 Breast-feeding indications 13 Drug-Drug Interactions 14 Drug-Food-Herb Interactions 15 Adverse Reactions/Side Effects 16 Overdosage Measures 17 Product Information and Distribution 18 Pharmacogenomic information 19 Patient Information 20 References 21 Efficacy Trial and Drug Overview Articles 22 Combination Therapy Articles 23 Pharmacokinetics Articles 24 Drug Interaction Articles 25 Images 26 External Links

Brand/Trade Names of Drug

Glucophage, Glucophage XR, Riomet, Fortamet, Glumetza.

Generic Name of Drug

Metformin (met-FOR-min)

Click Here

Back to top

Description

Metformin is an oral anti-hyperglycemic agent used in type II diabetes mellitus. It is the only biguanide medication to date, and is similar to phenformin- a biguanide medication that was taken off the market in 1977 due to its ability to induce lactic acidosis.^[1] Full Text Here^[2] Full Text Here Diabetes mellitus is defined as a group of metabolic disorders involving hyperglycemia and abnormalities in fat, protein and carbohydrate metabolism.^[3] Diabetes mellitus can be caused by defects in insulin sensitivity, defects in insulin secretion, or both.^[3] Diabetes mellitus type II is more prevalent, accounting for approximately 90% of cases.^[3] It is characterized by insulin resistance and insulin deficiency, where diabetes mellitus type I is characterized by pancreatic beta-cell death and an absolute insulin deficiency.^[3] Diabetes mellitus type I most often occurs in childhood or early adulthood, whereas diabetes mellitus type II occurs in adulthood.^[3] Patients with diabetes mellitus type I are often insulin-dependant, and patients with diabetes mellitus type II are often non-insulin dependant.^[3] Metformin aids in lowering/controlling blood glucose by reducing hepatic gluconeogenesis[1]and increasing peripheral glucose utilization. Insulin must be present for metformin to work.^{[3] [4]} Metformin also has a favorable effect on the lipid panel, as it helps to reduce fasting triglycerides and low-density lipoprotein cholesterol and increase high-density lipoprotein cholesterol.^{[4] [3]}

The only FDA-approved indication for metformin is diabetes mellitus type II, although it can be used for polycystic ovary syndrome (PCOS), infertility and precocious puberty.^[4] It received its FDA approval on December 30, 1994.^[4] It acts to lower fasting and postprandial hyperglycemia, and is used in conjunction with insulin, sulfonylureas or alpha-glucosidase inhibitors.^{[5] [3]} It lowers fasting plasma glucose by approximately 25-30%.^[4] Metformin is as effective as sulfonylureas in controlling blood glucose.^[4] When compared to glyburide, the efficacy of metformin in achieving glycemic control was similar, but metformin was associated with a higher incidence of digestive complaints.^[6] Although there is similar efficacy in glycemic control between the regular release and extended-release tablets, the extended-release tablets increase patient compliance due to their once-daily dosing.

Back to top

Mechanism of action

Unlike other oral antihyperglycemic agents, metformin does not cause hypoglycemia or hyperinsulinemia.^[5] Metformin acts to lower basal and postprandial glucose by decreasing intestinal absorption of glucose and by decreasing hepatic glucose production.^[5] It also improves insulin sensitivity by increasing peripheral glucose uptake and utilization.^[5]

Back to top

Time Required for Therapeutic Response

• Initial: EX: within days
• Maximum: Ex: within 2 weeks

Back to top

Pharmacokinetics

Absorption

Metformin is incompletely and slowly absorbed from the small intestine after oral administration.^[7] Complete absorption occurs within six hours. Metformin exhibits a saturable absorption process, evidenced by the lack of dose proportionality seen with increasing dose.^{[7] [5]} Food can delay and decrease the extent of absorption, as seen by a 40% lower Cmax, and a 25% lower AUC, and a 35 minute increase in time to reach Tmax, following administration of an 850 mg dose with food.^{[7] [5]}

Distribution

Metformin rapidly distributes into peripheral body tissues and fluids, especially the gastrointestinal tract.^[7] It also slowly distributes slowly into a deep tissue compartment and into erythrocytes.^[7] The highest tissue concentration of metformin occurs in the gastrointestinal tract, with lower concentrations seen in the liver, kidney and salivary glands.^[7] The metallic taste that often occurs in patients after taking metformin is due to the metformin’s salivary gland tissue half-life of nine hours and its ten-fold lower saliva concentration when compared to plasma.^[7] The average volume of distribution is 654 +/- 358 L (following a single dose of 850 mg metformin).^[5] Metformin is negligibly protein bound, and equilibrates freely between plasma and erythrocytes.^[7]

Metabolism

No metabolites of metformin have been identified, and the drug is not metabolized by the gastrointestinal tract of liver.^{[7] [5]} Tubular secretion is the major route of elimination, involving glomerular filtration and secretion by the proximal tubules. ^{[7] [5]}

Excretion

The plasma concentration of metformin declines in a triphasic manner (assuming regular release tablets in a type II diabetic or healthy adult).^[7] Approximately 90% of metformin is eliminated in 24 hours (in patients with normal renal function).^[7] Slower declines in plasma metformin concentrations occur after oral administration, indicating that elimination is absorption rate-limited.^[7] The average plasma half-life is 6.2 hours, and the average blood half-life is 17.6 hours.^[5]

Back to top

Special Population Pharmacokinetics

• Renal insufficiency

Patients with renal dysfunction will experience prolonged blood and plasma half-life of metformin. These patients will also experience decreased renal clearance in proportion to the decrease in creatinine clearance.^[5] Dose adjustments are necessary in patients with renal insufficiency.

• Hepatic insufficiency

No PK studies have been performed in patients with hepatic dysfunction.^[5]

• Hemodialysis

Metformin is removed by hemodialysis, and is dialyzable with a clearance up to 170 ml/min.^{[5] [7]}

• Geriatric

Studies conducted in healthy elderly subjects show decreased plasma metformin clearance, increased metformin half-life and increased Cmax.^[5] The change in renal function appears to be the major factor for these pharmacokinetic changes.

• Pediatric

The mean Cmax and AUC differed less than 5% between the pediatric population and healthy adults with normal renal function after ingestion of a single 500 mg regular release metformin tablet with food.^[5]

• Gender

The efficacy and pharmacokinetics of metformin do not significantly differ between males and females.^[5]

• Race

No PK studies have been performed according to race. Studies have shown similar antihyperglycemic effects in the African American, Caucasian and Hispanic population.^[5]

Back to top

Indications

FDA Approved Indications

• The only FDA-approved indication for metformin is type II diabetes mellitus.^[5]

Back to top

Non-FDA Approved Indications

• Polycystic Ovary Syndrome (PCOS)^{[4] [8] [9]}

• Infertility^{[4] [10] [11]}

• Precocious Puberty^[4]

• Gestational Diabetes Mellitus (GDM)

• Treatment of HIV lipodystrophy syndrome

Back to top

Dosage

• Diabetes Mellitus Type II (Adults- Regular Release Tablets/Oral Solution)
  • Starting Dose: 500 mg po BID or 850 po QD
  • Titration Schedule: Increase by 500 mg every week or 850 mg every 2 weeks. Can also titrate from 500 mg po BID to 850 mg po BID after 2 weeks.
  • Maintenance Dose: Dose titration is based on patient response. Dose can be titrated up to 2000 mg daily, given in divided doses.

• Diabetes Mellitus Type II (Adults- Extended Release Tablets)
  • Starting Dose: 500 mg po QD with evening meal
  • Titration Schedule: Increase by 500 mg every week.
  • Maintenance Dose: Dose titration is based on patient response. Dose can be titrated up to 2000 mg once daily.

• Diabetes Mellitus Type II (Children > 10 years and adolescents-Regular Release Tablets/Oral Solution)
  • Starting Dose: 500 mg po BID
  • Titration Schedule: If necessary, can increase dose by 500 mg every week.
  • Maintenance Dose: No defined maintenance dose. Dose titration is based on patient response, and can be titrated up to 2000 mg/day, given in divided doses.

• Diabetes Mellitus Type II (Children > 10 years and adolescents-Extended Release Tablets)
  • Safety and efficacy has not been established in children less than 17 years of age.

• Polycystic Ovary Syndrome
  • Starting Dose: 500 mg po TID
  • Titration Schedule: no titration necessary
  • Maintenance Dose: 500 mg po TID

• Infertility
  • Starting Dose: 500 mg po TID
  • Titration Schedule: no titration necessary
  • Maintenance Dose: 500 mg po TID

• Maximum Dosage Limits
  • Adults: Regular-release tablets and oral solution: 2550 mg/day, Extended-Release Tablets: 2000—2500 mg/day
  • Elderly: It is not recommended to titrate the dose to the maximum dose.

• • Adolescents and children >=10 years: Regular-release and oral solution: 2000 mg/day, Extended-release tablets: Safety and efficacy has not been established for this formulation
  • Children < 10 years: Safety and efficacy has not been established in this population.

• Dosage Adjustment
  • Renal insufficiency: Metformin is contraindicated in patients with CrCl less than 60 ml/min.
  • Hepatic insufficiency: The manufacturer recommends that metformin be avoided in patients with hepatic dysfunction, as there is an increased risk of lactic acidosis in this population.
  • Hemodialysis: Metformin is removed by hemodialysis, with a clearance up to 170 ml/min.
  • Geriatric: Start at lowest possible effective dose. The manufacturer warns against using metformin in patients greater than 80 years of age (unless patient has normal renal function), and against titrating to maximum dose.
  • Pediatric: In children 10-17 years of age: Start at 500 mg po BID (regular-release tablets and oral solution). Extended-release tablets are not to be used in this population.
  • Gender: No dose adjustment needed.

Back to top

Administration

• Route: Oral (Regular-Release Tablets)
• Method: Take tablets with a glass of water and with meals.
• Special considerations: Take with meals.

• Route: Oral (Extended-Release Tablets)
• Method: Take tablet with a glass of water and with your evening meal.
• Special considerations: Do not crush or chew tablet. Take with evening meal.

• Route: Oral (Solution)
• Method: Swallow solution with a glass of water. Take with meals.
• Special considerations: Use calibrated measuring device to accurately measure proper volume.

Back to top

Monitoring Parameters

• Serum creatinine (SrCr)
• Blood Urea Nitrogen (BUN)
• Blood Glucose
• Hemoglobin A1C
• CBC

Back to top

Contraindications/Precautions

Contraindications

• Patients with renal dysfunction/renal disease. Patients with serum creatinine levels greater than 1.4 mg/dL (females) or greater than 1.5 mg/dL (males) should not use metformin.
• Congestive Heart Failure (CHF)
• Chronic/Acute Metabolic Acidosis
• Diabetic Ketoacidosis (with or without coma)
• Lactic Acidosis

• Metformin should also be temporarily discontinued in patients undergoing radiologic studies involving intravascular iodinated contrast materials, due to risk of acute renal function alteration.

Back to top

Precautions/Warnings

• Renal Insufficiency/Renal Dysfunction: Due to the risk of metformin accumulation and lactic acidosis
• Hypoxic States: Acute Myocardial Infarction, Acute Congestive Heart Failure and cardiovascular collapse have been associated with lactic acidosis and pre-renal azotemia. Occurrence of these events during metformin therapy warrants prompt discontinuation of therapy.
• Alcohol Consumption: Alcohol has been shown to potentiate the effect of metformin on lactate metabolism. Chronic and acute alcohol intake should be avoided while on metformin therapy.
• Surgery: The manufacturer recommends that metformin be stopped for any surgical procedure (except minor procedures), and should be restarted when the patient's renal function has returned to normal, and when the patient's oral intake was resumed.
• Hepatic Dysfunction: Since hepatic dysfunction has been associated with lactic acidosis, metformin should be avoided in those with evidence of hepatic disease.
• Vitamin B12 levels: Although a low occurrence, controlled clinical trials have shown that Vitamin B12 levels decreased to subnormal levels after 29 weeks of metformin therapy, and returned to normal upon discontinuation of metformin.
• Hypoglycemia: Although metformin does not cause hypoglycemia, poor diet, other antihyperglycemic agents, alcohol and strenuous exercise may all contribute to hypoglycemia.
• Medications which can alter renal function or metformin disposition: These type of drugs should be used cautiously with metformin.

Back to top

Pregnancy indications

• Pregnancy category: B. Although category B, metformin is not recommended for routine use in pregnant patients.
• Teratogenicity: There are no well-controlled studies with metformin in pregnant patients. Metformin failed to show any teratogenic effects in rabbits and rats, at doses up to 600 mg/kg/day. This dose corresponds to approximately 2-6 times the recommended human dose of 2000 mg/day.

• Many experts recommend that insulin be used during pregnancy if necessary.

Back to top

Breast-feeding indications

• Secretion into breast milk: Studies with metformin have not been conducted in nursing mothers. Studies in lactating rats show that metformin is excreted into milk and reaches levels comparable to those in the plasma. There is still the risk of infantile hypoglycemia with metformin, and the decision to use metformin while nursing should be thoroughly discussed with your primary medical physician/OB-GYN.

Back to top

Drug-Drug Interactions

Metformin Drug/Drug Interaction Chart

Severity Level	Increased Effect/Toxicity	Decreased Effect
4	Dofetilide[12] Radiopaque contrast media[13]	None
3	None	None
2	Adefovir[14] Amiloride[15] Androgens[16] ACE Inhibitors[17] Antihyperglycemic Agents[5] Beta-blockers[16] Clonidine[18] Cephalexin[19] Entecavir[20] Cimetidine[21] Lamivudine[22] Midodrine[23]Fibric Acid Derivatives[24]Fluoxetine[24]Trospium[25] Dexfenfluramine[26] Digoxin[27] Guanethidine[28]Procainamide[29] Triamterene[30] Trimethoprim[31] Vancomycin[32] Ranitidine[33] Quinidine[34] Quinine[35] Disopyramide[36]	Atypical Antipsychotics[37] Clonidine[18] Corticosteroids[38] Cyclosporine[39] Niacin[40]
1	Quinolones[41]	Bumetanide[42] Furosemide[43] Torsemide[44] Quinolones[41] Estrogens/Progestins[13] Fosphenytoin/Phenytoin[13] Isoniazid[13]

Effect of Niacin on Lipid Levels and Glycemic Control in Patients With Diabetes: The ADMIT Study

Back to top

Drug-Food-Herb Interactions

Metformin Drug/Food/Herb Interaction Chart

Severity Level	Increased Effect/Toxicity	Decreased Effect
4	None.	None.
3	None.	None
2	Chromium[45] Garlic[46]	Food[47]
1	None.	None

Back to top

Adverse Reactions/Side Effects

Metformin is generally well-tolerated in patients, with the most common side effects being gastrointestinal in nature. Gastrointestinal side effects are seen in approximately 30% of patients, but decrease with continued use of metformin. These side effects include, but are not limited to, dyspepsia, anorexia, nausea/vomiting, diarrhea, dysgeusia and flatulence. Low doses of metformin, administering the medication with food, and slow dose titration are also possible ways to minimize gastrointestinal side effects.

Although metformin itself does not cause hypoglycemia, co-administration of metformin with other anti-diabetic medications, in patients with poor diets and in those undergoing strenuous exercise can lead to hypoglycemia. Patients with poor diets, those on other hypoglycemia-inducing anti-diabetic medications and those with vigorous exercise regimens should closely monitor blood sugar on a daily basis and be counseled on the signs/symptoms of hypoglycemia.

A serious, but rare side effect that can occur with metformin use is Lactic Acidosis.^[48] [2]. Lactic acidosis can occur in patients on metformin therapy who have evidence of acidosis, but lack of evidence of ketoacidosis. It often occurs when there is significant tissue hypoperfusion and hypoxemia. Lactic acidosis with metformin therapy warrants the immediate discontinuation of metformin. Hemodialysis is a treatment option. Since the risk of lactic acidosis increases with age and degree of renal impairment, close monitoring of renal function is essential in patients on metformin therapy.

Metformin Adverse Reactions Chart

Incidence	Body System	Adverse Reactions
> 10 %	GI	Nausea/Vomiting (6-25%), Diarrhea (10-53%), Flatulence (12%)
1-10%	Neuromuscular	Weakness (9%, Myalgia
	CV	Flushing, Palpitation, Chest Discomfort
	CNS	Headache (6%), Chills, Lightheadedness, Dizziness
	Dermatologic	Rash
	GI	Indigestion (7%), Abdominal Discomfort (6%), Abdominal Distention, Abnormal Stools, Constipation, Dyspepsia/Heartburn, Taste Disorder
	Endocrine and Metabolic	Hypoglycemia
	Respiratory	Upper respiratory tract infection, Dyspnea
	Misc	Increases diaphoresis, Nail Disorder, Flu-like syndrome, Dereased vitamin B12 levels (7%)
< 1%	All	Lactic Acidosis, Megaloblastic Anemia

Back to top

Overdosage Measures

Hypoglycemia was noted in 10% of cases and lactic acidosis was reported in 32% of cases where patients overdosed on metformin.^[5] Hemodialysis is an option in patients who overdose, as metformin is dialyzable with a clearance up to 170 ml/min.^{[5] [7] [49]} Venovenous haemofiltration and sodium bicarbonate are two additional options for metformin overdose.^[50]

Back to top

Product Information and Distribution

Metformin Product Availability Information- Oral Tablets- Regular Release

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Ivax Pharmaceuticals	Oral Tablets	500 mg	100	00172-4331-10	20-25°C (68-77°F)
				100	00172-4331-60
				500	00172-4331-70
				1000	00172-4331-80

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Eon Labs	Oral Tablets	500 mg	100	00185-0213-01	20-25°C (68-77°F)
				500	00185-0213-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Purepac Pharmaceutical Co.	Oral Tablets	500 mg	100	00228-2657-11	20-25°C (68-77°F)
				500	00228-2657-50

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Mylan Pharmaceuticals.	Oral Tablets	500 mg	100	00378-0234-01	20-25°C (68-77°F)
				500	00378-0234-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Zypharma Pharmaceuticals.	Oral Tablets	500 mg	100	00406-2028-01	20-25°C (68-77°F)
				500	00406-2028-05
				1000	00406-2028-10

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Barr Laboratories.	Oral Tablets	500 mg	100	00555-0385-02	20-25°C (68-77°F)
				500	00555-0385-04

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Watson Pharmaceuticals.	Oral Tablets	500 mg	100	00591-2713-01, 62037-0674-01	20-25°C (68-77°F)
				500	00591-2713-05
				1000	62037-0674-10

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Sandoz Pharmaceuticals.	Oral Tablets	500 mg	100	00781-5050-01	20-25°C (68-77°F)
				500	00781-5050-05
				1000	00781-5050-10

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Major Pharmaceuticals.	Oral Tablets	500 mg	60	00904-5601-52)	20-25°C (68-77°F)
				90	00904-5601-89
				120	00904-5601-18
				180	00904-5601-93
				450	00904-5601-54
				1000	00904-5601-80

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	UDL Laboratories.	Oral Tablets	500 mg	100 (10x10) BOXUD	51079-0972-20	20-25°C (68-77°F)
				10 x 30 BOXUD	51079-0972-57

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Mutual Pharmaceutical Co. Inc.	Oral Tablets	500 mg	100 (	53489-0467-01	20-25°C (68-77°F)
				500	53489-0467-05
				1000	53489-0467-10

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Caraco Pharmaceuticals Laboratories Ltd.	Oral Tablets	500 mg	100	57664-0397-88	20-25°C (68-77°F)
				100	57664-0397-51
				100	57664-0397-53
				100	57664-0397-58
				500	57664-0397-13
				1000	57664-0397-18

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Apotex Corp.	Oral Tablets	500 mg	100	60505-0190-00)	20-25°C (68-77°F)
				500	60505-0190-01
				100	57664-0397-53
				1000	60505-0190-08
				4500	60505-0190-04

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Wockhardt Americas Inc.	Oral Tablets	500 mg	100	NDC: 64679-0528-04	20-25°C (68-77°F)
				500	64679-0528-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	AuroBindo Pharma, Ltd.	Oral Tablets	500 mg	90	NDC: 65862-0008-90	20-25°C (68-77°F)
				100	65862-0008-01
				500	65862-0008-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Zydus Pharmaceuticals (USA) Inc	Oral Tablets	500 mg	100	NDC: 68382-0028-01	20-25°C (68-77°F)
				500	68382-0028-05)
				1000	68382-0028-10

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	AuroBindo Pharma, Ltd.	Oral Tablets	500 mg	90	NDC: 65862-0008-90	20-25°C (68-77°F)
				100	65862-0008-01
				500	65862-0008-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Ivax Pharmaceuticals Inc	Oral Tablets	850 mg	100	NDC: 00172-4330-60	20-25°C (68-77°F)
				10 X 10 BOXUD	00172-4330-10)
				1000	00172-4330-80

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	AuroBindo Pharma, Ltd.	Oral Tablets	850 mg	90	NDC: 65862-0008-90	20-25°C (68-77°F)
				100	65862-0008-01
				500	65862-0008-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Eon Labs Inc	Oral Tablets	850 mg	100	NDC: 00185-0215-01	20-25°C (68-77°F)
				500	00185-0215-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	AuroBindo Pharma, Ltd.	Oral Tablets	500 mg	90	NDC: 65862-0008-90	20-25°C (68-77°F)
				100	65862-0008-01
				500	65862-0008-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Ivax Pharmaceuticals Inc	Oral Tablets	850 mg	10 X 10 BOXUD	NDC: 00172-4330-10	20-25°C (68-77°F)
				500	00185-0215-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Purepac Pharmaceutical Co	Oral Tablets	850 mg	100	NDC: 00228-2715-11	20-25°C (68-77°F)
				500	00228-2715-50

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Ivax Pharmaceuticals Inc	Oral Tablets	850 mg	10 X 10 BOXUD	NDC: 00172-4330-10	20-25°C (68-77°F)
				500	00185-0215-05

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Mylan Pharmaceuticals Inc	Oral Tablets	850 mg	100	NDC: 00378-0240-01	20-25°C (68-77°F)

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Zypharma Pharmaceuticals	Oral Tablets	850 mg	100	NDC: 00406-2029-01)	20-25°C (68-77°F)
				500	00406-2029-05
				1000	00406-2029-10

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Barr Laboratories Inc	Oral Tablets	850 mg	100	NDC: 00555-0386-02	20-25°C (68-77°F)

Name	Manufacturer	Dosage Form	Strength	Quantity	NDC	Storage
Metformin[4]	Watson Pharmaceuticals Inc	Oral Tablets