Glucophage
Metformin
Metformin, an FDA-approved oral medication, effectively manages type 2 diabetes by controlling blood sugar levels. Available in immediate and extended-release forms, it primarily works by enhancing insulin sensitivity and reducing glucose production in the liver. Adults typically start with a dosage of 500 mg twice daily or 850 mg once daily, which can be adjusted based on the patient’s response. It’s suitable for adults and children over 10 years, with caution advised for seniors over 80 and those with kidney impairments. Common side effects include gastrointestinal issues, while serious side effects like lactic acidosis are rare. Patients should follow their doctor’s instructions, take the medication with meals, and store it properly at room temperature. Regular monitoring of blood sugar levels and adherence to prescribed dosages are crucial for safe and effective treatment with Metformin.
Product Overview
Metformin is an oral medication primarily used to manage type 2 diabetes, a condition characterized by high blood sugar levels. It contains the active ingredient Metformin hydrochloride, which improves the body’s response to insulin and reduces the amount of glucose produced by the liver. This helps control blood sugar levels and prevent complications such as kidney damage and heart disease. Metformin is FDA-approved and is often recommended as the first-line treatment for type 2 diabetes. It is available in both immediate-release and extended-release tablet forms, with strengths ranging from 500 mg to 1,000 mg.
The recommended dosage of Metformin varies depending on the patient’s age and the severity of their condition. Adults typically start with a dosage of 500 mg twice daily or 850 mg once daily with meals for immediate-release tablets or 500 mg once daily with the evening meal for extended-release tablets. The dosage may be adjusted over time based on the patient’s response to the medication. Metformin is suitable for adults and children aged 10 years and older, but it should be used with caution in seniors over 80 years of age and those with kidney impairments.
Common side effects of Metformin include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. More serious side effects include lactic acidosis, a rare but potentially life-threatening condition. Patients should follow their doctor’s instructions carefully, taking the medication as prescribed and monitoring their blood sugar levels regularly. If a dose is missed, it should be taken as soon as possible unless it is close to the time for the next dose. In case of an overdose, immediate medical attention is necessary. Metformin should be stored at room temperature in a sealed container, away from heat and moisture, and out of reach of children. Patients should consult their healthcare provider for advice on side effects, precautions, and proper use of Metformin to ensure safe and effective treatment.
Uses
Targeted Treatment
- Type 2 diabetes
Benefits
- Controls high blood sugar levels
- Prevents kidney damage
- Reduces risk of heart attack
[Note: Do not take Metformin without consulting your doctor. They will determine whether you need this medication based on your conditions.]
Metformin Dosage
Forms & Strengths
Form 1: Immediate-release oral tablet
Strengths: 500 mg, 850 mg, 1,000 mg
Form 2: Extended-release oral tablet
Strengths: 500 mg, 750 mg, 1,000 mg
Recommended Dosages
For Type 2 Diabetes Adults (Ages 18–79 Years)
Immediate-release Tablets:
- Starting Dosage: 500 mg twice daily or 850 mg once daily with meals.
- Dosage Adjustments: Increase by 500 mg weekly or 850 mg every 2 weeks, up to a total of 2,550 mg daily in divided doses. If the dose exceeds 2,000 mg daily, it may be taken three times a day.
- Maximum Dosage: 2,550 mg daily.
Extended-release Tablets:
- Starting Dosage: 500 mg once daily with the evening meal (except for Fortamet, which starts at 500–1,000 mg daily).
- Dosage Adjustments: Increase by 500 mg weekly. If needed, the total daily dose can be divided and taken twice daily.
- Maximum Dosage: 2,000 mg daily (Fortamet’s maximum is also 2,000 mg daily).
For Type 2 Diabetes Child (Ages 10–17 Years)
Immediate-release Tablets:
- Starting Dosage: 500 mg twice daily.
- Dosage Adjustments: Increase by 500 mg weekly in divided doses.
- Maximum Dosage: 2,000 mg daily.
Extended-release Tablets:
- Not studied in children under 18 years of age.
For Type 2 Diabetes Child (Ages 0–9 Years)
- Not studied in children under 10 years of age and should not be used.
For Type 2 Diabetes Senior (Ages 80 Years and Older)
- Individuals 80 years and older should only start Metformin if they have normal kidney function due to a higher risk of lactic acidosis. This age group should not take the maximum dose.
[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]
How to Take It?
- Swallow Tablets Whole: Metformin comes in tablet form. Swallow the tablets whole with a full glass of water; do not crush, break, or chew them.
- Take with Meals: To reduce the risk of stomach upset, take Metformin with a meal, usually once or twice daily or as directed by your doctor.
- Extended-Release Tablets: If you are prescribed extended-release Metformin, take it once daily with your evening meal. Do not crush or chew the extended-release tablets.
- Regular Monitoring: Your doctor may adjust your dose based on your blood sugar levels. Regular monitoring of your blood sugar levels is essential while taking Metformin.
- Stay Hydrated: Drink plenty of fluids while taking Metformin unless otherwise directed by your doctor.
Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]
How Does Metformin Work?
Metformin works by improving the body’s sensitivity to insulin, a hormone that regulates blood sugar levels. It reduces the amount of glucose produced by the liver and increases the uptake of glucose by muscle cells. This action helps lower blood sugar levels and improves overall glucose control in people with type 2 diabetes, making it a commonly prescribed medication for managing the condition.
Important Safety Information
Side Effects
Common side effects of Metformin may include:
- Headache
- Gas
- Nausea or vomiting
- Indigestion
- Diarrhea
- Stomach pain
Serious side effects of Metformin may include:
- weakness
- tiredness
- unusual muscle pain
- unusual sleepiness
- stomach pains, nausea, or vomiting
- trouble breathing
- dizziness or lightheadedness
- slow or irregular heart rate
- weakness
- headache
- confusion
- shaking or feeling jittery
- drowsiness
- dizziness
- irritability
- sweating
- hunger
- fast heart rate
- muscle weakness
- low energy
- loss of appetite
- tingling or numbness in the hands or feet
[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]
Warnings
- Do not use Metformin if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis. Contact your doctor for alternative treatments.
- If you require an x-ray or CT scan involving dye injection, you may need to temporarily discontinue Metformin.
- While very rare, there is a risk of developing lactic acidosis, a severe accumulation of lactic acid in the blood.
Boxed Warning
- This medication carries a black box warning, the highest level of warning issued by the FDA, indicating potential serious risks.
- Lactic acidosis is a rare but severe side effect of this drug, characterized by an accumulation of lactic acid in the blood.
- This condition is a medical emergency requiring hospital treatment and is fatal in approximately 50% of cases.
- Immediately stop taking the medication and seek medical attention if you experience symptoms of lactic acidosis.
- Symptoms of lactic acidosis include:
- Weakness
- Unusual muscle pain
- Difficulty breathing
- Excessive sleepiness
- Stomach pains
- Nausea or vomiting
- Dizziness or lightheadedness
- Slow or irregular heartbeat.
Precautions
- Do not use Metformin if you are allergic to it, have severe kidney disease, or have metabolic acidosis or diabetic ketoacidosis.
- If undergoing surgery or certain imaging procedures with dye, you may need to temporarily stop Metformin.
- Inform your caregivers that you are using Metformin.
- Discuss with your doctor if you have a history of kidney disease, high ketone levels, heart disease, liver disease, or if you use insulin or other diabetes medications.
- Lactic acidosis, a dangerous condition, can occur with Metformin use, especially in those with other medical conditions, severe infections, chronic alcoholism, or those aged 65 or older.
- Follow your doctor’s advice on using Metformin during pregnancy, as controlling diabetes is crucial for both mother and baby.
- Metformin may increase the risk of unintended pregnancy by stimulating ovulation in premenopausal women.
- Do not breastfeed while taking Metformin.
- Metformin should not be used in children under 10 years old, and some forms are not approved for anyone under 18 years old.
Contraindications
- Kidney Function Impairment: Metformin should not be used in patients with high serum creatinine levels (above 136 mmol/L in men and 124 mmol/L in women) or abnormal creatinine clearance.
- Congestive Heart Failure (CHF): Patients with CHF who require medication treatment are generally advised not to use Metformin.
Missed Dose
- Missed doses of Metformin can impact blood sugar control.
- If you forget a dose, take it as soon as you remember.
- If it’s close to the next scheduled dose, skip it.
- Do not double up.
- Consult your doctor for specific guidance.
[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]
Overdose
Metformin overdose can lead to symptoms like nausea, vomiting, and hypotension. Severe cases may cause lactic acidosis, a dangerous condition. Prompt medical attention is crucial if an overdose is suspected. Always follow prescribed dosages and prioritize safety when using Metformin.
[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]
Storage
- Store Metformin in a sealed container at room temperature.
- Keep it away from heat, moisture, and direct sunlight.
- Do not allow the medication to freeze.
- Store it in a location inaccessible to children.
- Dispose of any expired medication or medication that is no longer required.
[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]
Metformin Interactions
- Iodinated Contrast Media: Used in some X-ray and imaging procedures, these agents can increase the risk of lactic acidosis when used with Metformin.
- Diuretics: Especially loop diuretics, can increase the risk of lactic acidosis and affect blood sugar control.
- Corticosteroids: Can reduce the effectiveness of Metformin in controlling blood sugar levels.
- Beta-2 agonists, Such as albuterol, can affect blood sugar levels and may require adjustments in Metformin dosage.
- Nifedipine: A calcium channel blocker, can increase the absorption and concentration of Metformin in the blood.
- Cimetidine: Can increase the levels of Metformin in the blood, potentially leading to a higher risk of side effects.
- Insulin and other diabetes medications: When used with Metformin, dosage adjustments may be required to prevent low blood sugar (hypoglycemia).
- Alcohol: Heavy alcohol use can increase the risk of lactic acidosis when taken with Metformin.
[Note: This isn’t a complete list, and there could be other drugs that interact with Metformin. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]
Metformin Alternatives
- Glucophage XR (Metformin extended-release)
- Glumetza (Metformin hydrochloride)
- Fortamet (Metformin hydrochloride)
- Invokamet (canagliflozin/Metformin)
- Janumet (sitagliptin/Metformin)
- Kombiglyze XR (saxagliptin/Metformin)
- Jentadueto (linagliptin/Metformin)
- Synjardy (empagliflozin/Metformin)
- Xigduo XR (dapagliflozin/Metformin)
- Segluromet (ertugliflozin/Metformin)
[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]
Frequently Asked Questions
1. What happens if you discontinue Metformin?
Discontinuing Metformin may lead to an increase in blood sugar levels, as the medication is responsible for controlling them. If you’re experiencing significant side effects or have concerns, consult your healthcare provider before ceasing the medication. Often, side effects are temporary or can be mitigated by switching to the long-acting version of Metformin.
2. How quickly does Metformin start to lower blood sugar levels?
Metformin typically begins to reduce blood sugar levels within the first week of starting treatment. However, it may take up to 2 to 3 months to observe its full effect. Metformin is often the preferred initial oral medication for individuals with type 2 diabetes and is usually taken for the long term. It can be used alone or in combination with other treatments to lower blood glucose levels.
3. Why does Metformin cause stomach upset?
Stomach issues with Metformin can occur when the dose is increased too quickly or if the doses are high. Doctors typically increase the dose gradually to minimize these effects. The exact cause is unclear, but it may be related to increased gut mobility or impact on serotonin and GLP-1. Usually, these side effects subside within a few weeks. If they persist or are severe, consult your healthcare provider.
4. Does Metformin lead to low blood sugar?
Metformin typically does not cause hypoglycemia (low blood sugar) as it does not significantly affect insulin secretion or levels. However, hypoglycemia may occur in cases of Metformin overdose, leading to lactic acidosis, or when combined with a poor diet or other medications like sulfonylureas that can lower blood sugar. When used as prescribed, Metformin does not usually result in hypoglycemia.
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