Riomet

Riomet is a prescription medication used to treat type 2 diabetes. Riomet belongs to a group of drugs called biguanides, which work by 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.

This medication comes in liquid form. It is taken up to 3 times daily, with meals.

Common side effects of Riomet include diarrhea, nausea, and upset stomach.

Riomet is a prescription medication used to treat type 2 diabetes.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

• Ranbaxy Pharmaceuticals, Inc.

Serious side effects have been reported including:

Lactic Acidosis. In rare cases, Riomet can cause a serious side effect called lactic acidosis. This is caused by a buildup of lactic acid in your blood. This build-up can cause serious damage. Lactic acidosis caused by Riomet is rare and has occurred mostly in people whose kidneys were not working normally. Lactic acidosis has been reported in about one in 33,000 patients taking Riomet
over the course of a year. Although rare, if lactic acidosis does occur, it can be fatal in up to half the people who develop it.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• beta-blockers
• cough and cold products containing decongestants
• calcium channel blockers
• cimetidine (Tagamet)
• corticosteroids
• digoxin (Lanoxin)
• diuretics such as furosemide (Lasix)
• estrogens
• insulins or other medicines for diabetes
• isoniazid (INH, Nydrazid)
• morphine
• niacin (nicotinic acid, Niaspan)
• nifedipine
• oral contraceptives
• oral steroids
• phenothiazines such as promethazine (Phenergan)
• phenytoin (Dilantin)
• procainamide
• quinidine
• quinine
• ranitidine
• thyroid medicines such as levothyroxine (Levothroid, Levoxyl, Synthroid, Tirosint)
• triamterene
• trimethoprim
• vancomycin

This is not a complete list of Riomet drug interactions. Ask your doctor or pharmacist for more information.

A small number of people who have taken Riomet have developed a serious condition called lactic acidosis. Lactic acidosis is caused by a buildup of lactic acid in the blood. This happens more often in people with kidney problems. Most people with kidney problems should not take Riomet. See "Side Effects".

Some conditions increase your chance of getting lactic acidosis, or cause other problems if you take Riomet. Most of the conditions listed below can increase your chance of getting lactic acidosis.

Do not take Riomet if you:

• have kidney problems
• have liver problems
• have heart failure that is treated with medicines, such as Lanoxin (digoxin) or Lasix (furosemide)
• drink a lot of alcohol. This means you binge drink for short periods or drink all the time.
• are seriously dehydrated (have lost a lot of water from your body)
• are going to have an x-ray procedure with injection of dyes (contrast agents)
• are going to have surgery
• develop a serious condition, such as heart attack, severe infection, or a stroke
• are 80 years or older and you have NOT had your kidney function tested

Do not drink a lot of alcohol drinks while taking this medication. 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.

Follow dietary (food) recommendations made by your doctor and dietitian which should include a healthy diet. Skipping meals should be avoided as this can cause problems maintaining blood sugar control. There are no specific foods to avoid while using Riomet.

Before receiving Riomet, tell your doctor if you:

• have kidney problems
• have liver problems
• have heart failure that is treated with medicines, such as Lanoxin (digoxin) or Lasix (furosemide)
• drink a lot of alcohol. This means you binge drink for short periods or drink all the time.
• are seriously dehydrated (have lost a lot of water from your body)
• are going to have an x-ray procedure with injection of dyes (contrast agents)
• are going to have surgery
• develop a serious condition, such as heart attack, severe infection, or a stroke
• are 80 years or older and you have NOT had your kidney function tested
• are pregnant or breastfeeding

While taking Riomet, tell your doctor if you

• have an illness that causes severe vomiting, diarrhea or fever, or if you drink a much lower amount of liquid than normal. These conditions can lead to severe dehydration (loss of water in your body). You may need to stop taking Riomet for a short time.
• plan to have surgery or an x-ray procedure with injection of dye (contrast agent). You may need to stop taking Riomet
  for a short time.
• start to take other medicines or change how you take a medicine. Riomet can affect how well other drugs work, and some drugs can affect how well Riomet works. Some medicines may cause high blood sugar.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if Riomet will harm your unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if Riomet is excreted in human breastmilk or if it will harm your nursing baby.

Riomet comes in liquid form. It is taken up to 3 times daily, with meals. Riomet should be taken at the same times each day. 

Your doctor will tell you how much medicine to take and when to take it. You will probably start out with a low dose of the medicine. Your doctor may slowly increase your dose until your blood sugar is better controlled. 

Your doctor may have you take other medicines along with Riomet to control your blood sugar. These medicines may include insulin shots. Taking Riomet with insulin may help you better control your blood sugar while reducing the insulin dose.

Continue your exercise and diet program and test your blood sugar regularly while taking Riomet.

Your doctor will monitor your diabetes and may perform blood tests on you from time to time to make sure your kidneys and your liver are functioning normally. There is no evidence that Riomet causes harm to the liver or kidneys.

Take Riomet exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The usual starting dose of Riomet in adults is 500 mg (5 mL) twice a day or 850 mg (8.5 mL) once a day, given with meals. 

The usual starting dose of Riomet in children is 500 mg (5 mL) twice a day, given with meals.

The maximum daily dose is 2500 mg (25.5 mL) for adults and 2000 mg (20 mL) for pediatric patients (10 to 16 years of age). 

If you take too much Riomet, call your local Poison Control Center or seek emergency medical attention right away.

Store Riomet at room temperature away from excess light and humidity.

Keep this and all medicines out of the reach of children.

WARNING: LACTIC ACIDOSIS

• Lactic acidosis is a rare but serious complication that can occur due to metformin accumulation. The risk increases with conditions such as sepsis, dehydration, excess alcohol intake, hepatic impairment, renal impairment, and acute congestive heart failure.
• The onset is often subtle accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress. Laboratory abnormalities include low pH, increased anion gap, and elevated blood lactate.
• If acidosis is suspected Riomet should be discontinued and the patient hospitalized immediately.