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Why it's used

Metformin is used to reduce the high blood sugar level due to improper production or use of insulin in the body (also called, type 2 diabetes mellitus). It is a prescription medicine. It works by lowering the amount of glucose in the body. It also increases the response of the body to insulin.
Metformin may also be taken in combination with other medicines to treat certain conditions as recommended by the doctor. Metformin is used together with sulphonylureas to lower the total cholesterol levels in the blood and may increase the risk of low blood sugar levels (hypoglycemia).
When not to use
Metformin cannot be used to treat high blood sugar level due to the absence of insulin production (type 1 diabetes mellitus).
Anti-Diabetic
Metformin belongs to a class of medicines called Anti-Diabetic. Anti-diabetic drugs are a class of medicines used to treat diabetes mellitus. It control diabetes by lowering the sugar level in the blood. Antidiabetic drugs include insulin and the oral hypoglycemic agents.

How to use

Follow directions on the product label, information guide, and provided by your doctor before using Metformin. Consume this medicine as per your doctor's instructions.
Metformin is consumed with food. This medicine should be taken with meals two or three times a day. Metformin is consumed usually in the evening.
The typical adult dose of Metformin is initial dose of 850 mg once a day or 500 mg twice a day with food (not more than 2550 mg in a day). The typical dose for children is initial dose of 500 mg twice a day (not more than 2000 mg in children 10-16 years). The maximum dose for adults of Metformin is 2550 mg per day. There are no known habit-forming tendencies with this medicine.
Metformin is to be used for longer periods of time. You should continue to use this medicine as directed by the doctor even if you feel well.
Tell your doctor if you develop new symptoms. If you have any kidney disease, dosage will usually be adjusted according to the functioning of kidney parameter (glomerular filtration rate).
To see the impact of Metformin on the body, your doctor may recommend a lower initial dose. Please follow your doctor's instructions carefully. A lower dose of Metformin may be recommended to reduce the risk of side-effects. Older patients may see an increase in the risk of side-effects. Hence, a lower dose may be recommended.
When stopping this medicine, it is possible that you may experience withdrawal symptoms such as low sugar level.
If you are giving Metformin to a child, be sure to use a product that is meant for use in children. Before giving this medicine, use the child's weight or age to find the right dose from the leaflet or product package. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.
To decrease the possibility of side-effects, you might be recommended to use the extended-release form of this medicine by your dcotor. The extended-release medicine helps in maintaining a steady level of the medicine in your body for a longer period of time. Do not crush or chew the medicine, unless indicated on the package or by your doctor.
Limit drinking alcohol with Metformin.
Your doctor may require that certain tests be performed before using Metformin. The doctor may ask you to have Estimated Glomerular Filtration Rate test. A glomerular filtration rate should be tested before this medicine because the dosage of Metformin depends on this test.
Medicines may be given for uses other than those listed in the medicine guide. Do not use Metformin for symptoms for which it was not prescribed. Do not give Metformin to others who may have similar symptoms as you. Self-medication can cause harm.
Store Metformin at room temperature 20°–25° C (68°–77° F), away from moisture, and away from light. Keep this medicine away from children and pets.

How to take Metformin

Your dose and how often you take Metformin will depend on the following factors:
  • age
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • medicines recommended by the doctor
  • any other medicines being used
  • herbal supplements in use

Metformin Dosage

Dosage for high blood sugar levels (type 2 diabetes mellitus)

Adult
  • Initial: 500 mg twice a day or 850 mg once a day with food
  • Maximum: 2550 mg/day once daily in evening with food
Children (10-16 years)
  • Initial: 500 mg twice a day with food
  • Maximum: 2000 mg/day

Minimum Age

10 years

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Tablets
Strength: 500 mg, 850 mg, and 1000 mg
Extended-Release Tablets
Strength: 500 mg and 750 mg
Sustained-Release Tablets
Strength: 500 mg, 750 mg, and 1000 mg
Oral solution
Strength: 500 mg/5 ml

Special Instructions

Extended-release tablet
Swallow this medicine whole, without splitting, chewing or crushing them. This medicine is usually taken once daily with the evening food.
Oral solution

Missed Dose

A missed dose should be taken with food as soon as you remember it. Avoid taking a double dose to make up for a missed dose.

Overdose

What to do if you overdose on Metformin?
The most useful and effective method to remove excessive amounts of lactate and Metformin is hemodialysis. Hemodialysis is a process used to purify the blood by removing harmful substances from the body.
Symptoms of an overdose of Metformin
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • abnormal heart rate
  • buildup of lactate in the body
  • difficulty in breathing
  • drowsiness
  • fatal
  • feeling of discomfort
  • low blood pressure
  • muscle pain
  • reduced body temperature
  • severe tiredness
  • stomach pain
  • vomiting
If you think you have overdosed on Metformin, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Metformin

Before you use Metformin, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information.
Before you use Metformin, tell your doctor of your medical history including abnormal functioning of the kidney, abnormal functioning of the liver, high acid level in the body (long-term metabolic acidosis), high ketone acids in the blood (diabetic ketoacidosis), alcoholism, heart failure, patients taking iodinated contrast agents through arteries, dehydration, severe infection heart attack, stroke, or prior exposure to surgery. Taking Metformin in patients with alcoholism, abnormal functioning of kidney and liver may lead to the buildup of lactate in the body. Also, the use of Metformin before or at the time of surgery may increase the risk for fluid loss, low blood pressure, and abnormal functioning of the kidney. Before having any surgery, discuss with your doctor and dentist about medicines you use including prescription medicines, non-prescription medicines, and herbal supplements.
The use of Metformin may change hematologic parameters (hemoglobin/hematocrit and red blood cell). Patients using this medicine may experience red blood cell deficiency.
Metformin is not safe for use in women who are pregnant. If you are pregnant or planning to become pregnant, you should discuss the impact on the fetus with your doctor before you start using this medicine. Metformin is not safe for use in women who are breastfeeding. If you are breastfeeding, discuss with your doctor if you should either discontinue breastfeeding, or stop using this medicine during this period. This medicine may pass into breast milk. Consult with your doctor on the use of Metformin, if you are trying to conceive.
Limit drinking alcohol with Metformin. Consumption of alcohol may cause buildup of lactate in the body.
Older patients may have a higher incidence of side-effects when using Metformin. Elderly patients may see an increased risk of build up of lactate in the body.

Metformin Side-effects

The following side-effects may commonly occur when using Metformin. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in older patients on the use of Metformin. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • build up of lactate in the body (lactic acidois)
Rarely, the use of Metformin may cause the following side-effects:
The following severe side-effects may also occur when using Metformin:
  • liver disorder
    Symptoms: inflammation of the liver (hepatitis)
  • skin reactions
    Symptoms: redness of the skin (erythema)
  • Symptoms: upper respiratory infection
Your doctor has prescribed Metformin because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Metformin.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Elderly patients (65 years old or greater)

Metformin may increase the risk of lactate buildup in the body in elderly patients. Proper monitoring of the functioning of the kidneys is recommended in elderly patients. Avoid the use of Metformin in these patients.

Alcohol consumption

Excessive alcohol consumption may lead to an increased risk of the build-up of lactate in the body (lactic acidosis). Avoid the consumption of alcohol while taking Metformin.

Heart failure

Patients with heart failure are at an increased risk when using this medicine. Such patients may see an increased risk of the low level of oxygen in the blood (hypoxemia) and abnormal functioning of the kidney. In patients with stable long-term heart failure, appropriate monitoring of the functioning of the heart and kidney is required while using this medicine. The use of Metformin is not recommended in patients with unstable heart failure.

Surgery

Patients at the time of surgery under anesthesia are at an increased risk when using Metformin. Discontinue the use of Metformin at the time of surgery for at least 48 hours. Restart the use of this medicine after the resumption of oral nutrition or if the functioning of the kidney becomes stable.

Patients using iodinated contrast agents

Use of iodinated contrast agents which are taken through the blood vessels (intravascular) may increase the risk of the build-up of lactate inside the body, decrease the functioning of the kidney. Discontinue the use of Metformin before or at the time of treatment with iodinated contrast agents for at least 48 hours. Restart the use of this medicine if the functioning of the kidney becomes stable.

Patients with severe conditions of vomiting, diarrhea, fever or reduced fluid intake

Such patients may experience severe loss of water in the body (severe dehydration). Discontinue the use of Metformin for a shorter time duration and consultation with a doctor is advised.

Build up of lactate in the body (lactic acidosis)

Patients with diabetes, prolonged fasting, alcohol intake, serious infections, liver problems, dehydration, and decreased supply of oxygen (such as acute severe heart disease) are at increased risk when using this medicine. Patients using Metformin are at an increased risk of low body temperature, low blood pressure, abnormal heartbeat, and fatal conditions. These patients may see an increased level of lactate, abnormal levels of negatively charged ions (anion acidosis), increased levels of Metformin and elevated lactate/pyruvate ratio in the blood. Such patients may also develop symptoms of lactic acidosis such as a feeling of discomfort, muscle pain, respiratory distress, sleepiness, and stomach pain. Discontinue the use of Metformin in these conditions, and supportive measures should be provided. If this happens, immediate use of a therapy that purifies the blood (hemodialysis) is also recommended.

Interactions with Metformin

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Metformin interacts with multidrug and toxin extrusion inhibitors (ranolazine, vandetanib, dolutegravir, isavuconazole, trimethoprim, and cimetidine), which are used to treat chest pain, ulcer, cancer, bacterial, viral, and fungal infections. Use of Metformin with multidrug and toxin extrusion inhibitors (MATE), increases the level of Metformin in the body. It may also increase the risk of lactate buildup in the body. Dose adjustment is needed while using these medicines in combination.
There may be an interaction of Metformin with nifedipine, which is used to treat high blood pressure, and chest pain. When Metformin is used with nifedipine, the level of Metformin gets increased in the blood.
Metformin may interact with furosemide, which is used to treat fluid build-up in patients with heart failure or kidney disease and conditions of high blood pressure. Use of furosemide with Metformin increases the level of Metformin in the blood. Proper monitoring of the functioning of the kidney and blood glucose levels test is required to adjust the dose of Metformin.
Your doctor's guidelines may need to be followed while taking this medicine along with thyroid products, oral contraceptives, estrogens, corticosteroids, phenothiazines, phenytoin and nicotinic acid which are used to treat hormone imbalance, central nervous system disorders, seizures and vitamin B deficiency. When Metformin is used with these medicines, may lead to loss of blood glucose control. Proper monitoring of low blood sugar levels is required in such patients.
Special instructions need to be followed while taking this medicine along with thiazides, diuretics, sympathomimetics, and calcium channel blockers, which are used to treat blood pressure. When Metformin is used with thiazides, diuretics, sympathomimetics or calcium channel blockers, may lead to loss of blood glucose control. These patients should be observed closely for low blood sugar levels.
Your doctor's guidelines may need to be followed while taking this medicine along with inducers of organic cationic transporter-1 (rifampicin), which are used to treat bacterial infections. When Metformin is used with organic cation transporter-1 inducer, may increases the absorption in stomach and intestine and alters the effectiveness of Metformin. Appropriate adjustment of dosage is required while taking both drugs.
Special instructions need to be followed while taking this medicine along with inhibitors of organic cationic transporter-1 and organic cationic transporter- 2 (crizotinib, olaparib), which are used to treat cancer. When Metformin is used with crizotinib, olaparib may alter the effectiveness and removal of Metformin from the kidney. Appropriate adjustment of dosage is required while taking both drugs.
Metformin interacts with nonsteroidal anti-inflammatory drugs including selective cyclooxygenase-2 inhibitors, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors which are used to treat pain, fever, inflammation and high blood pressure. Use of Metformin with these drugs may affect the functioning of the kidney which further leads to the risk of lactate build-up in the body. Close monitoring of the functioning of the kidney is required when using these drugs with Metformin.
There may be an interaction of Metformin with iodinated contrast agents, which are used during X-ray procedure. Use of iodinated contrast agents which are given through the blood vessels may increase the risk of acid build up inside the body and decrease the functioning of the kidney. Do not take this medicine in patients with abnormal functioning of the liver or kidney, alcoholism or heart failure and in the patients who are taking iodinated contrast through arteries. Discontinue the use of Metformin before or at the time of treatment with iodinated contrast agents.
Metformin may interact with carbonic anhydrase inhibitors (topiramate, zonisamide, acetazolamide, dichlorphenamide), which are used to treat damaged optic nerve (glaucoma). Use of Metformin with carbonic anhydrase inhibitors may increase the risk of lactate build-up in the body. Frequent monitoring is required in these patients.
This page does not contain all the possible interactions of Metformin. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Metformin is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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