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Glucophage

Glucophage is an antidiabetic medication containing the active ingredient Metformin Hydrochloride, which the FDA approves to treat type 2 diabetes. It reduces liver glucose production, improves insulin sensitivity, and lowers intestinal glucose absorption. It is available in 500-1000 mg strengths and is taken orally with meals to minimize gastrointestinal side effects. The dosage starts low and increases based on blood sugar levels. Common Glucophage side effects include gastrointestinal issues, typically resolved with dose adjustment. Missed doses should be taken promptly, but overdoses can lead to lactic acidosis. You should store it at room temperature, away from moisture and heat. Always consult your healthcare provider regarding proper usage, dosage, and medication interactions.

Product Overview

Glucophage is an FDA-approved antidiabetic medication containing the active ingredient Metformin Hydrochloride. It belongs to the class of biguanide drugs and is used for the treatment of type 2 diabetes mellitus, a metabolic disorder characterized by insulin resistance and high blood sugar levels. It works by decreasing glucose production in the liver, improving insulin sensitivity in peripheral tissues, and reducing intestinal glucose absorption, ultimately leading to better blood sugar control.

It is available in various strengths ranging from 500 mg to 1000 mg and is taken orally with meals to reduce gastrointestinal side effects. It is suitable for adults diagnosed with type 2 diabetes, including those who are overweight or obese. The dosage is often initiated at a low level and gradually increased based on blood glucose levels and tolerance. While generally well-tolerated, Glucophage can cause side effects such as gastrointestinal disturbances, which often resolve over time or with dose adjustment. 

In case of a missed dose, it should be taken as soon as remembered unless it’s close to the next dose, in which case the missed dose should be skipped. Overdose may lead to lactic acidosis, a serious condition that requires immediate medical attention. It should be stored at room temperature, away from moisture and heat, and kept out of reach of children. Patients should be informed about potential interactions with other medications and advised to consult healthcare providers before starting or stopping any medication. 

Uses of Glucophage

Glucophage is used for the management of type 2 diabetes mellitus.

How to Use Glucophage?

Dosage

Forms and Strengths 

  1. Immediate Release Tablets: Available in strengths ranging from Glucophage 500mg to 1000 mg.
  2. Extended Release Tablets: Available in strengths of Glucophage XR 500mg, 750 mg, and 1000 mg.

Recommended Dosage for Glucophage

For Adults with Type 2 Diabetes 

Immediate-Release

The initial dose is 500 mg twice a day or 850 mg daily. Adjust dosage in 500 mg increments every week or 850 mg every two weeks as tolerated. As a maintenance dose, take 2000 mg daily divided into two doses. The maximum daily dose is 2550 mg. You can take 2 to 3 divided doses with meals each day; titrate slowly to minimize gastrointestinal side effects. Generally, doses below 1500 mg/day do not produce significant responses.

Extended-Release

Initially, 500 to 1,000 mg per day should be taken orally. Increase the dose to 500 mg weekly increments as tolerated. The maintenance dose is 2000 mg per day. The maximum daily dose is 2500 mg. Taking 2000 mg once a day may not result in glycemic control; you could consider 1000 mg twice a day of extended-release tablets.

For Children (10 Years or Older) with Type 2 Diabetes 

Immediate-Release

A dose of 500 mg should be taken twice a day at first. As tolerated, increase the dose by 500 mg every week. A maintenance dose of 2000 mg per day is recommended. The maximum daily dose is 2000 mg. Take two to three times a day with meals. Slowly titrate to minimize gastrointestinal side effects.

Extended-Release

There is no clinical evidence that Glucophage extended-release is safe and effective in pediatric patients younger than 18.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your Glucophage dosage accordingly.]

How to Take It?

You should take Glucophage as your doctor prescribes, usually with a meal unless instructed otherwise. If you’re using Glucophage XR, take it once daily with your evening meal. Swallow the extended-release tablet whole; do not crush, chew, or break it. If you experience symptoms of low blood sugar, such as hunger, dizziness, or confusion, consume a fast-acting source of sugar. Your doctor may prescribe a glucagon injection kit for severe hypoglycemia. If your doctor recommends extra vitamin B12 while taking metformin, follow their instructions precisely.

[Note: Your doctor will decide the right amount of Glucophage for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Glucophage Work?

Glucophage works primarily by decreasing glucose production in the liver and increasing insulin sensitivity in peripheral tissues like muscle and fat. It inhibits the liver’s ability to release stored glucose into the bloodstream while enhancing the uptake and utilization of glucose by cells. Additionally, it may reduce the absorption of glucose from the gastrointestinal tract. By addressing these mechanisms, Glucophage helps to lower blood sugar levels in individuals with type 2 diabetes, ultimately improving glycemic control and reducing the risk of complications associated with high blood sugar levels.

Important Safety Information

Side Effects

Common Side Effects

  • Gastrointestinal discomfort (such as nausea, vomiting, diarrhea, abdominal discomfort)
  • Loss of appetite
  • Metallic taste in the mouth

Mild Side Effects

  • Headache
  • Dizziness
  • Weakness or fatigue
  • Muscle pain
  • Skin rash or itching

Adverse/Serious Side Effects

  • Lactic acidosis (a rare but severe condition characterized by buildup of lactic acid in the bloodstream)
  • Hypoglycemia (low blood sugar levels)
  • Vitamin B12 deficiency (long-term use may affect B12 absorption)
  • Liver problems (elevated liver enzymes)
  • Kidney complications (rarely, metformin can cause acute kidney injury)
  • Heart-related issues (rare cases of heart failure)
  • Allergic reactions (rare but can include symptoms like swelling, itching, or difficulty breathing)

[Note: This list may not cover all possible Glucophage side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

Renal Function: Glucophage is primarily eliminated by the kidneys, and impaired renal function can lead to increased levels of metformin in the bloodstream, raising the risk of lactic acidosis. Therefore, renal function should be assessed before initiating treatment and regularly after that, particularly in elderly patients and those with pre-existing renal impairment. Dosage adjustments may be necessary based on renal function.

Hepatic Function: Glucophage should be used with caution in patients with impaired hepatic function due to the potential for decreased clearance of metformin. Liver function tests should be monitored periodically, and dosage adjustments may be required.

Cardiovascular Risk: Some studies suggest a potential association between metformin use and reduced cardiovascular risk. However, patients with a history of cardiovascular disease should be monitored closely while taking Glucophage.

Hypoglycemia: When used alone, glucose rarely causes hypoglycemia (low blood sugar levels). However, hypoglycemia may occur when combined with other antidiabetic medications or insulin. Patients should be educated about the signs and symptoms of hypoglycemia and instructed on appropriate management.

Vitamin B12 Deficiency: Long-term use of metformin has been associated with vitamin B12 deficiency, which may manifest as megaloblastic anemia, neuropathy, or other neurological symptoms. Periodic monitoring of vitamin B12 levels and supplementation may be necessary, especially in patients with risk factors for deficiency.

Radiological Contrast Agents: Glucophage should be temporarily discontinued before or when administering iodinated contrast materials for radiological studies, as these agents may increase the risk of acute kidney injury and lactic acidosis in patients with renal impairment. Renal function should be assessed before resuming Glucophage therapy.

Surgery and Other Stressful Situations: Glucophage XR 500mg may need to be temporarily discontinued during surgery, significant stress, or situations associated with hypoxia, as these conditions can increase the risk of lactic acidosis. Glucophage therapy can usually be resumed once the patient’s condition stabilizes.

Boxed Warning (Lactic Acidosis)

Glucophage carries a boxed warning regarding the risk of lactic acidosis, a rare but severe condition characterized by the buildup of lactic acid in the bloodstream. Lactic acidosis can be fatal and typically occurs in individuals with impaired kidney function or other predisposing factors. Patients should be monitored for symptoms suggestive of lactic acidosis, such as muscle pain, difficulty breathing, stomach discomfort, or unusual tiredness. If lactic acidosis is suspected, Glucophage should be discontinued immediately, and prompt medical attention should be sought.

Precautions

  1. You should not take Glucophage if you are allergic to metformin or if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis.
  2. Be sure your doctor is aware of low red blood cell count, hypertension, small intestine surgery, diabetic ketoacidosis, and lung, heart, or kidney diseases.
  3. You may need to temporarily stop taking Glucophage if you need surgery or an x-ray or CT scan using a dye injected into your veins.
  4. Avoid taking too much alcohol while taking Glucophage 500mg, either acutely or chronically.
  5. Regularly monitor your renal function while taking Glucophage.

Glucophage Contraindications

Glucophage is contraindicated in people with:

  • Severe renal impairment (GFR < 30 ml/min/1.73 m²)
  • Hepatic impairment or acute metabolic acidosis
  • Known hypersensitivity to Glucophage or its components
  • Acute or chronic metabolic acidosis, including diabetic ketoacidosis
  • History of hypersensitivity or lactic acidosis

Missed Dose

Take the missed dose as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and continue your regular dosing schedule. Refrain from doubling up on doses to make up for a missed dose.

[Note: If you have missed a dose of Glucophage and are still determining when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

An overdose of Glucophage can lead to severe complications, including lactic acidosis, a potentially life-threatening condition characterized by a buildup of lactic acid in the bloodstream. Symptoms may include nausea, vomiting, abdominal pain, difficulty breathing, confusion, and extreme weakness.

[Note: If you consumed more than the recommended dose of Glucophage, get medical help immediately or call the Poison Help line at 1-800-222-1222.]

Storage

Glucophage should be stored at room temperature between 68°F and 77°F, away from moisture, heat, and light. It should be kept in its original tightly closed container, out of reach of children and pets. Avoid storing it in the bathroom or kitchen where humidity can affect its stability. Additionally, do not freeze Glucophage. Always check the expiration date before using; if the medication has expired or is no longer needed, dispose of it correctly according to local regulations or guidelines.

[Note: Discuss with your healthcare professional the proper disposal of unused Glucophage medicine and any questions you may have regarding its storage.]

Glucophage Interactions

Glucophage interacts with 363 drugs, four diseases, and one food/drug interaction. Among the total drug interactions, 20 are primary, 334 are moderate, and nine are minor.

Some of the drug interactions include:

  • Cimetidine
  • Carbonic Anhydrase Inhibitors (acetazolamide)
  • Diuretics (furosemide)
  • Corticosteroids
  • Nifedipine
  • Antipsychotics (clozapine, olanzapine, risperidone)
  • Iodinated Contrast Agents
  • Medications for Heart Failure (digoxin)
  • Anticonvulsants (topiramate)
  • Beta-2 Agonists (albuterol)

[Note: This isn’t a complete list, and there could be other drugs that interact with Glucophage. Tell your doctor about prescription, over-the-counter medicines, and herbal products.]

Glucophage Alternatives

[Note: Your doctor will choose which alternative is best for you. Only use these alternative medications after consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Does Glucophage cause weight loss?

Glucophage might lead to weight loss for some people. It works by helping your body use insulin better and decreasing the amount of sugar your liver makes. This can result in reduced appetite and calorie intake. However, not everyone experiences weight loss with Glucophage, and its effects can vary from person to person. Always consult your doctor for personalized advice.

Is Glucophage safe for children?

Children with type 2 diabetes can be prescribed Glucophage, but following the doctor’s instructions is essential. Depending on their needs, children may receive specific doses. It helps manage blood sugar levels, but only a healthcare professional can determine if it’s right for a child. Before starting or adjusting any medication, consult your child’s doctor.

Do I need a prescription for Glucophage?

Yes, Glucophage requires a prescription from a doctor. It’s a medication used to treat type 2 diabetes; the correct dosage depends on individual health conditions. Only a healthcare professional can determine if Glucophage suits a person, considering factors like overall health and potential interactions with other medications. Always follow your doctor’s advice when using prescription medications.

Can I use Glucophage to treat type 1 diabetes?

No, Glucophage is not typically used to treat type 1 diabetes. It is primarily prescribed for individuals with type 2 diabetes to help manage blood sugar levels. Type 1 diabetes requires insulin therapy as the pancreas does not produce insulin. Always follow your healthcare provider’s recommendations for the appropriate treatment for your type of diabetes.

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