Metformin

GENERIC NAME: Metformin

BRAND NAME: Glucophage, Glumetza, Glucophage XR, Riomet, Fortamet

Drug class: Metformin belong to biguanide class of antidiabetic agents that helps to lower the blood glucose level.

Mechanism of action:

Metformin is an oral anti diabetic drug that lowers blood glucose (sugar) by the following mechanism

It increases the body's sensitivity to insulin and is used for treatment of type 2 diabetes.Insulin is a hormone secreted from the pancreas that brings down the glucose level in blood. Metformin increases the sensitivity of liver, muscle, fat, and other tissues to the uptake and actions of insulin. 

Metformin use doesnot increases the concentration of insulin in the blood so there is less chance for hypoglycemia which is a major side effect of sulfonyl urea.

Uses of metformin

1.Metformin is used for treatment of type 2 diabetes in adults and children.It may be used as a single agent or  in combination with other oral hypoglycemic agents.Metformin by lowering the blood sugar level helps to prevent the complications of diabetes such as kidney damage, blindness, nerve problems, decreased blood flow to limbs and sexual function problems.Proper control of diabetes may also lessen your risk of a heart attack or stroke.

2.Metformin is used for treatment of polycystic ovaries because it may regularize the menstrual cycles and more increases the  fertility rate.

3.Helps to control excessive weight gain.

Precautions before starting metformin

1.Some people may experience  a life-threatening complication called lactic acidosis while they are on metformin. Following people are at risk for lactic acidosis ,those have liver or kidney disease, heart failure, a severe infection, dehydration, excessive consumption of  alcohol or diabetic keto acidosis. 

2.Some people may develop  allergic reaction to metformin the drug should not be used in them. This product may contain certain inactive ingredients which predispose to allergic reaction

3.You need to temporarly stop metformin If you are undergoing any type of x-ray or CT scan whch requires dye injection.

Complications due to metformin are more in people with liver disease or heart disease

Role of metformin in pregnancy and lactation

Metformin belong to FDA pregnancy category B. 

Metformin usually doesnot harm an unborn baby.

It is not known to be passed into breast milk.

It is not be given to a child younger than 10 years old. 

How to take  the drug metformin?

Always follow your doctors prescription,do not increase or decrease the dose as yourown.

It is usually advised to take  with a meal. Certain forms of metformin are to be taken only once daily with the evening meal. 

For maximum benefit with metformin it shold be taken along with diet control and exercise.

For maximum results use it regularly.

You are not supposed to crush, chew, or break the extended-release metformin tablet.Because this will result in too much of the drug to be released at single time

You should frequently monitor your blood sugar value.

During stress, exertion, alcohol intake and skip meals your blood sugar value will change so dose adjustment is required.

If you are very sick or undergoing surgery or during any medical emergency your doctor may ask you to stop metformin.

How to store metformin?

You should store metformin at room temperature away from moisture, heat and light.

You should not consume alcohol while on metformin.

What do do if you miss a dose?

If you miss a dose take the missed dose of metformin as soon as you remember.You are advised not to take the medicine if it is near the time for next scheduled dose. Always avoid extra medicine to make up your missed dose.

What to do if drug overdosage is suspected?

If you suspect poisoning call for immediate help call to control center at 1-800-222-1222.One of the dangerous side effect is lactic acidosis.

Following are the symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling,shortness of breath, muscle pain ,stomach pain, feeling light-headed, and fainting.

Metformin drug dosage.

500 mg of metformin is advised orally twice a day 

Extended Release:they are available are

500 to 2000 mg orally once a day.

Maximum daily dose is 2500 mg.

Side effects of metformin

The most common side effects that are experienced by people on metformin are

Gastrointestinal side effects such as 

Nausea

Vomiting

Bloating sensation

Diarrhea 

Loss of appetite

Gastro intestinal side effects may be seen in approximately 30 percentage of people on metformin.Thse are dose related and symptoms decreases with reduction of dose of metformin.

Uncommon side effects with it are 

Weakness

Respiratory tract infections

Low blood glucose

Low levels of vitamin B-12

Chills

Heartburn

A dangerous, rare side effect of metformin is lactic acidosis.which is manifested with the following symptoms

Muscle pain or weakness;

Numb or cold feeling in your arms and legs

Stomach pain, nausea with vomiting

Difficulty in breathing

Slow or uneven heart rate

feeling light-headed, tired.

Serious side effects of lactic acidosis are following you should immediately seek medical care if these symptoms are present.

Feeling short of breath, even with mild exertion;

Rapid weight gain or swelling

fever, chills, body aches, flu symptoms.

Some people may experience allergic reaction to metformin,which is manifested as difficult in breathing swelling of your face, lips, tongue or throat.

What are the other drugs that will affect metformin?

Following drugs are more likely to interact with metformin

Furosemide (Lasix);

Nifedipine (Procardia);

Quinidine (Quin-G) or quinine (Qualaquin);

Amiloride (Midamor) or triamterene (Dyrenium);

Digoxin (Lanoxin);

Cimetidine (Tagamet) or ranitidine (Zantac);

Procainamide (Procan, Pronestyl, Procanbid);

Trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra); or

Vancomycin (Vancocin, Lyphocin).

Morphine (MS Contin, Kadian, Oramorph);

The following drugs are known to increase your blood sugar if you take them with metformin

Isoniazid

Diuretics 

Steroids (prednisone and others)

Birth control pills and other hormones

Niacin (Advicor, Niaspan)

Phenothiazines (Compazine and others)

Thyroid medicine (Synthroid);

Diet pills or medicines to treat asthma, colds or allergies.

Seizure medicines (Dilantin)