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Metformin Patient Tips

Medically reviewed on Sep 19, 2017 by C. Fookes, BPharm

How it works

  • Metformin is used in the treatment of Type 2 diabetes. It increases the ability of cells to uptake glucose by improving their sensitivity to insulin. It also decreases the amount of glucose made by the liver and decreases the absorption of glucose from the intestine.
  • Metformin belongs to the class of drugs known as biguanides.

Upsides

  • Metformin is the preferred therapy for people with Type 2 diabetes. May be used in combination with other medications for Type 2 diabetes.
  • May be used off-label (not an FDA-approved use, but still a recognized use of the drug) in polycystic ovary syndrome. Metformin decreases androgen hormone levels, improves menstrual cycles, ovulation regularity, and insulin sensitivity.
  • Metformin rarely produces hypoglycemia (low blood sugar levels).
  • Metformin does not change how much insulin is secreted and it does not cause hyperinsulinemia (high insulin levels). Fasting insulin levels and the base-line insulin response may actually decrease.
  • Metformin has a unique mechanism of action and is like no other drug used for diabetes.
  • Less likely to increase body weight (in fact body weight may decrease while on metformin), in contrast to many other medications used for diabetes, including sulfonylureas.
  • May be used in children older than ten years.
  • Generic metformin is available.

Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Diarrhea, nausea, flatulence, indigestion, headache, lack of energy, and taste disturbance are the most commonly reported side effects.
  • Rarely, can cause lactic acidosis, a condition that can be fatal. The risk is higher in older people, those with kidney disease, taking other medications that may decrease kidney function, undergoing radiologic studies using contrast media, with liver disease or in those with other medical conditions such as congestive heart failure.
  • May impair vitamin B12 absorption but rarely results in anemia.
  • Excessive alcohol intake should be avoided because it can potentiate the risk of lactic acidosis.
  • Should not be used in people with severe renal impairment. Metformin should not be initiated in people with an estimated glomerular filtration rate (eGFR) of less than 45 mL/min. The eGFR should be measured at least annually in people taking metformin.
  • Should not be used in people with liver disease.
  • Metformin may need to be temporarily discontinued in people with restricted food or fluid intake because continued use may increase the likelihood of dehydration, low blood pressure and kidney damage.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

Metformin improves how the body responds to insulin and is effective for the treatment of type 2 diabetes. Taste disturbances, diarrhea, and other stomach-related side effects are common.

Tips

  • Take with a meal to reduce the risk of stomach upset. Once-daily doses should be taken with the evening meal.
  • Low dosages are usually used initially before being titrated up. Dosages may vary between individuals.
  • Splitting dosages throughout the day (rather than taking a single dose) may improve gastric side effects such as nausea, diarrhea, and indigestion.
  • Swallow slow-release tablets whole; do not crush, break, or chew.
  • Do not drink large amounts of alcohol or drink alcohol daily while taking metformin because this may increase your risk of lactic acidosis.
  • Monitoring of blood sugars and other regular laboratory tests including kidney function are needed.
  • May need to be temporarily discontinued before undergoing investigations requiring contrast media, or if dehydrated.
  • The outer case of some slow release metformin tablets may be visible in the stools; this does not mean the drug has not been absorbed.
  • Ensure you are educated about the importance of diet and exercise in the management of type 2 diabetes because it is important to use lifestyle measures to improve your condition in addition to medications.
  • Tell your doctor if you become unwell with severe vomiting, diarrhea or a fever because these types of illnesses may lead to severe dehydration and you may need to temporarily stop metformin. Also, talk to your doctor if you develop cold hands or feet, muscle pain, dizziness, a slow heartbeat, have trouble breathing, stomach pains or severe nausea or vomiting.
  • Talk to your doctor or pharmacist before taking any other medications, including those bought over-the-counter, to check that they will be compatible with metformin.

Response and Effectiveness

  • The peak effects of metformin are seen within 2-3 hours for immediate-release forms or 4 to 8 hours with slow-release forms. May take up to 2 weeks of regular dosing for the maximum effects of metformin to develop.

References

Metformin [Package Insert]. Revised 06/2017 Torrent Pharma Inc. https://www.drugs.com/pro/metformin.html

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use metformin only for the indication prescribed.

  • Disclaimer: Every effort has been made to ensure that this information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This drug information does not endorse drugs, diagnose patients or recommend therapy. It is an informational resource designed as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of this information. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Drugs.com. Revision Date: 2017-09-18 23:52:12

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