Metformin

Metformin is an FDA-approved antidiabetic medicine containing the active ingredient Metformin Hydrochloride. It is one of the most commonly prescribed medications for type 2 diabetes. It works by lowering blood sugar levels in the body. Metformin helps the body respond better to insulin, a hormone that regulates blood sugar. It is available in tablet form and is taken orally. You may also experience stomach upset, diarrhea, and, in rare cases, lactic acidosis (an accumulation of lactic acid in your bloodstream). The most effective results can be achieved when Metformin is taken according to instructions and a healthy lifestyle is followed. To maintain the safety and effectiveness of your medication, always buy Metformin from Canada.

Metformin is an oral medication with the active ingredient Metformin Hydrochloride, used to treat type 2 diabetes mellitus. It helps lower blood sugar levels by decreasing glucose production in the liver and improving insulin sensitivity in the body’s cells. It is typically used as a first-line treatment for type 2 diabetes, either alone or in combination with other antidiabetic medications. It is taken orally as tablets or extended-release tablets, usually once or twice daily, with meals to reduce the risk of gastrointestinal side effects. 

The dosage of Metformin varies depending on individual factors such as age, kidney function, and blood sugar levels. It is usually started at a low dose and gradually increased to achieve optimal blood sugar control. The typical starting dose for adults is 500 mg to 1000 mg, taken once or twice daily with meals. Extended-release formulations may be taken once daily. Dosage adjustments may be necessary for elderly patients or those with kidney impairment.

Metformin is generally considered safe and well-tolerated. However, it may cause side effects such as gastrointestinal upset (e.g., diarrhea, nausea, abdominal discomfort), which can often be minimized by taking the medication with meals or using extended-release formulations. Rare but serious side effects may include lactic acidosis. Regular monitoring of blood sugar levels and periodic medical check-ups are recommended to ensure the safe and effective use of Metformin for diabetes management.

This medication has the following purposes:

• Treatment of type 2 diabetes mellitus.
• Prescribed off-label for conditions like Polycystic Ovary Syndrome (PCOS) symptoms, weight loss, and gestational diabetes.

Forms & Strengths of Metformin?

Metformin is available in various forms and strengths:

• Immediate-release (IR) tablets (available in strengths ranging from 500 mg to 1000 mg)
• Extended-release (ER) tablets (available in strengths ranging from 500 mg to 1000 mg)
• Metformin is also available in a liquid solution for those who have difficulty swallowing tablets. The liquid form is typically available in a concentration of 500 mg/5 mL.
• Metformin is sometimes combined with other diabetes medications, such as sulfonylureas or DPP-4 inhibitors, to enhance its effectiveness. 

The dose of Metformin will vary from patient to patient and these are the average doses for this medicine. Make sure you follow your doctor’s instructions if your dose is different.

What Are the Recommended Metformin Doses for Different Patients?

The recommended doses can vary depending on factors like the patient’s age, kidney function, and treatment goals. Usually, your doctor will prescribe you a starting dose and gradually titrate the dose according to your response to the treatment. The following section also included only average doses for different patients. If you have been prescribed a different dose, do not change it unless your doctor advises otherwise.

Standard Adult Dose for Type 2 Diabetes

• Immediate-Release: The initial dose is 500 mg orally twice a day or 850 mg orally once a day. It can be increased weekly by 500 mg or every 2 weeks by 850 mg as tolerated. A maintenance dose of 2000 mg/day should be taken in divided doses. The maximum daily dose is 2550 mg.
• Extended-Release: The initial dose should be 500 to 1000 mg taken orally once daily. Gradually increase the dose to 500 mg increments every week as tolerated. The maximum daily dose is 2000 mg.
• Switching to Extended-Release: When receiving immediate-release, patients may switch to extended-release once a day at the same total daily dose (up to 2000 mg).

Standard Pediatric Dose for Type 2 Diabetes (10 Years or Older)

• Immediate-Release: The initial dose is 500 mg, twice daily. During dosage titration, doses should be increased by 500 mg each week as tolerated. Take daily doses with meals two to three times per day in divided doses. The maximum daily dose is 2000 mg.
• Extended-Release Oral Suspension: The initial dose is 500 mg orally once a day with dinner. The dose should be titrated in 500 mg increments based on glycemic control and tolerability. The maximum daily dose is 2000 mg. Ensure that you titrate slowly to minimize side effects on your gastrointestinal system.

Additional Dosage Information

• • Kidney Disease (Renal Impairment): Metformin dosage based on estimated glomerular filtration rate (eGFR):
    • If eGFR ≥ 60 mL/min/1.73 m², dosage adjustment is not required.
    • If eGFR 45-59 mL/min/1.73 m², use with caution; monitor renal function closely. The maximum daily dose is typically reduced to 1000-1700 mg.
    • If eGFR is 30-44 mL/min/1.73 m², Metformin should be avoided due to the increased risk of lactic acidosis.
    • If eGFR < 30 mL/min/1.73 m², Metformin is contraindicated due to the risk of lactic acidosis. In some cases, Canadian pharmacy Metformin extended-release formulations may be preferred because they may be better tolerated in patients with renal impairment.
• Liver Disease (Hepatic Impairment): A liver problem can increase the risk of lactic acidosis. Metformin may not be recommended if you have liver problems. However, the use of Metformin in those with liver issues should be decided on an individual basis, weighing the potential benefits against the risks.

Metformin is a widely used medication for managing type 2 diabetes. It comes in different forms, and each has its way of administration. Here is a detailed information on how to take Metformin safely:

Immediate-Release Formulation

• It should be taken two to three times each day with meals.
• Titrate slowly to minimize side effects on the gastrointestinal tract.
• Generally, significant responses do not occur with doses below 1500 mg per day and doses above 2000 mg are associated with little additional efficacy and poorer tolerability.

Extended-Release Formulation

• Swallow ER tablets whole; do not crush, cut, dissolve, or chew them.
• Take once a day with dinner; if glycemic control is not achieved with 2000 mg twice a day, divide the dose to 1000 mg twice daily.
• If it is still not achieved, switch to immediate-release tablets.
• When using ER oral suspension, measure the dose in the provided dose cup and shake well for at least 10 seconds before each use.

Liquid Solution

• As your doctor instructed, take the solution with meals once or twice a day.
• To measure the liquid, use a measuring spoon, medicine cup, or an oral syringe.
• Do not use a household spoon to measure the liquid, as it may not hold the appropriate amount of medication.
• If you do not have a dosing cup, ask your pharmacist.
• Use the same brand of medication, as different brands may have different effects on the body.

Metformin works primarily by decreasing glucose production in the liver and improving insulin sensitivity in peripheral tissues. It activates AMP-activated protein kinase (AMPK), a cellular enzyme that regulates energy metabolism, inhibiting hepatic gluconeogenesis and enhancing glucose uptake in skeletal muscles. Additionally, Metformin may also decrease intestinal glucose absorption. These actions reduce blood glucose levels, making Metformin a cornerstone therapy for type 2 diabetes mellitus. Moreover, it has been associated with various pleiotropic effects, such as anti-inflammatory and anti-aging properties, contributing to its potential benefits beyond glycemic control.

What Are the Side Effects of Metformin?

Common Side Effects: While the medication effectively controls glucose levels, Metformin can cause several side effects, which vary in frequency and are common among individuals. Such effects do not require immediate medical attention and may disappear within a few days or weeks. However, contact your doctor if any of them start bothering you or intensify over time. Some of the common side effects of Metformin may include:

• Heartburn: One common side effect experienced by patients taking Metformin is heartburn, a burning sensation in the chest that can extend up to the throat. This discomfort is typically caused by stomach acid rising back into the esophagus, which may be more pronounced after consuming food or drinks that increase stomach acidity.
• Stomach pain: Stomach pain is another frequent complaint among those on Metformin. This discomfort can range from mild to severe and is often associated with other gastrointestinal issues caused by the medication. Patients might experience sharp, stabbing pains or a persistent dull ache in their abdomen. 
• Nausea or vomiting: This condition is also reported by some individuals taking Metformin. This can occur especially in the initial stages of treatment as the body adjusts to the medication. In some cases, eating smaller, more frequent meals can help alleviate these symptoms.
• Bloating: Bloating is a common side effect that involves a feeling of fullness or swelling in the abdomen. This sensation is often accompanied by a distended abdomen, which can be uncomfortable and may affect appetite.
• Diarrhea: Diarrhea is perhaps one of the most well-known side effects of Metformin. It can occur suddenly and may persist for a prolonged period. Diarrhea can lead to dehydration and electrolyte imbalance if not managed properly, so it is important to stay hydrated and consult a healthcare provider if symptoms are severe.
• Constipation: Constipation, though less common than diarrhea, can also occur in patients taking Metformin. This involves infrequent bowel movements or difficulty passing stools. Increasing fiber intake and staying hydrated can help alleviate constipation.
• Weight loss: It is a side effect that some users of Metformin may experience. While it can be a beneficial side effect for those looking to lose weight, it can also be a concern if it is unintended or excessive. Monitoring weight changes and discussing them with a healthcare provider is crucial to ensure they are within a healthy range.

Mild Side Effects: Unlike common side effects, these reactions can become dangerous if left untreated or overlooked. Therefore, if you are experiencing any unwanted signs, reach out to your doctor immediately. Mild side effects of Metformin may include:

• Abdominal Discomfort or Cramping: One of the more common mild side effects of Metformin is abdominal discomfort or cramping. This gastrointestinal issue is often characterized by a feeling of fullness, bloating, or general discomfort in the stomach area. The discomfort can range from mild to moderate and may sometimes include a sensation of cramps or spasms. These symptoms are typically transient, often occurring when starting the medication or increasing the dosage. The body’s adjustment to Metformin can lead to these side effects, but they usually subside as the treatment continues. 
• Metallic Taste in the Mouth: Another mild side effect associated with Metformin use is a metallic taste in the mouth. This unusual taste sensation can be bothersome for some patients, presenting as a persistent, metallic, or bitter taste that may affect the enjoyment of food and drink. The exact cause of this side effect is not well understood, but it is believed to be related to the way Metformin interacts with the body’s metabolism and taste receptors. This side effect is generally harmless and often reduces over time as the body acclimates to the medication. When you buy Metformin from Canada, you need to consider this important side effect.

Serious Side Effects: While rare, these side effects can cause serious complications in patients with certain medical problems or those who do not follow proper administration steps. Therefore, if you plan to buy Metformin online from Canada or any other pharmacy, inform your doctor beforehand to avoid potential risks. Some of the serious side effects may include: 

• Lactic Acidosis: Although rare, lactic acidosis is Metformin’s most serious side effect. There is a boxed warning on Metformin about this risk. Lactic acidosis is caused by a pH imbalance caused by a buildup of Metformin. This medical emergency needs to be treated in the hospital immediately. The following symptoms may occur:
  • Experiencing extreme fatigue
  • Decreased appetite
  • A fast or slow heart rate
  • Nausea and vomiting
  • Trouble breathing
  • Muscle pain
  • Dizziness and lightheadedness
  • A cold feeling
  • Stomach pain
  • Flushing or sudden reddening and warmth in your skin combined with any of these other symptoms
• Anemia: Metformin can decrease your body’s level of vitamin B12. Rarely, this can result in anemia (low red blood cell count). You may have a higher risk of having very low levels of vitamin B12 if you don’t get enough of it through your diet. Make an appointment with your doctor if you think you may have anemia. Stopping Metformin or taking vitamin B12 supplements may improve your vitamin B12 levels. Talk with the healthcare provider who prescribed Metformin before you stop taking it. Some of the more common symptoms of anemia are:
  • Fatigue
  • Feeling dizzy
  • Feeling lightheaded
• Hypoglycemia: Metformin rarely causes low blood sugar (hypoglycemia). You should consult your doctor if you have any of these symptoms of hypoglycemia:
  • Weakness and tiredness
  • Nausea and vomiting
  • Stomach pain
  • Dizziness or lightheadedness
  • Unusually fast or slow heartbeat

While it is generally well-tolerated, there are several important warnings to be aware of when you buy Metformin from Canada:

• Hypoglycemia: While hypoglycemia is rare with Metformin alone, it may occur in combination with other glucose-lowering agents, especially in elderly, debilitated, or malnourished patients. Caution is advised during concurrent use with sulfonylureas, insulin, or ethanol.
• Kidney Problems: It is your kidneys that remove Metformin from your body. You will have higher Metformin levels if your kidneys aren’t working properly. As a result, you are more likely to develop lactic acidosis. Depending on your kidney problems, your doctor may prescribe you a lower dose of Metformin. Metformin may not be right for you if you have severe kidney problems or are 80 years old or older. It is likely that your kidney function will be tested before you begin taking Metformin and then every year afterward.
• Liver Issues: If you suffer from severe liver problems, you should not take Metformin from the Canadian pharmacy. If you suffer from severe liver problems, you may develop lactic acidosis due to a buildup of lactic acid. Metformin also raises your risk of liver disease, so taking it can be harmful.

What Is the Boxed Warning for Metformin?

Metformin treatment can lead to a rare but serious condition called lactic acidosis, which can be fatal in approximately 50% of cases. Lactic acidosis may occur due to Metformin accumulation, particularly in patients with kidney disease, hypoxemia, or significant tissue hypoperfusion. Monitoring of renal function is crucial to minimize the risk, and Metformin should be discontinued in patients with impaired renal function (creatinine clearance levels below normal for age).

The risk of lactic acidosis increases with factors such as advanced age, congestive heart failure, and the use of multiple medications. Prompt discontinuation of Canadian pharmacy Metformin and supportive measures are essential if lactic acidosis is suspected.

When you plan to buy Metformin from Canada, it’s important to be aware of the following precautions:

• Monitoring of Renal Function: Metformin is excreted by the kidneys, so renal function should be assessed before starting treatment and annually after that. Patients with elevated serum creatinine levels should not receive Metformin. Close monitoring is essential in elderly patients, especially those aged 80 years and above.
• Concomitant Medications: Caution is advised when using medications that may affect renal function or interfere with Metformin disposition. Cationic drugs eliminated by renal tubular secretion should be used cautiously.
• Radiologic Studies: Intravascular contrast studies can lead to acute renal function alteration and have been associated with lactic acidosis in Metformin-treated patients. Therefore, Metformin should be temporarily discontinued before such procedures and reinstituted only after normal renal function is confirmed.
• Hypoxic States: Conditions like shock, acute congestive heart failure, or acute myocardial infarction can lead to lactic acidosis and should prompt discontinuation of Metformin.
• Surgical Procedures: Metformin should be suspended temporarily for surgical procedures, except for minor ones that do not affect food and fluid intake.
• Alcohol Intake: Excessive alcohol consumption can potentiate Metformin’s effects on lactate metabolism, so patients should be cautioned against it.
• Impaired Hepatic Function: Metformin should generally be avoided in patients with clinical or laboratory evidence of hepatic disease due to its association with lactic acidosis.
• Vitamin B12 Levels: Metformin use may lead to decreased serum vitamin B12 levels, particularly in elderly patients. Regular monitoring of hematologic parameters is advised, and vitamin B12 supplementation may be necessary.
• Hypoglycemia: Elderly, debilitated, or malnourished patients are particularly susceptible to hypoglycemic effects, especially when using other glucose-lowering agents concurrently with Metformin.
• Loss of Glycemic Control: During periods of stress, such as illness or surgery, temporary loss of glycemic control may occur, necessitating temporary insulin therapy and discontinuation of Metformin until the acute episode resolves.

Metformin is contraindicated in those with,

• Severe renal dysfunction, defined as a GFR >30 mL/min/1.73m²
• Serum creatinine levels greater than or equal to 1.5 in men and 1.4 in women
• Abnormal creatinine clearance (CrCl)
• Hypersensitivity to Metformin
• Lactic acidosis
• GFR <60 mL/min/1.73m²
• Risk factors for lactic acidosis
• Hepatic impairment
• Unstable heart failure

When you remember that you missed a Metformin dose, take it right away. If your next dose is almost due, skip the one you missed and get back on schedule. Taking two doses to compensate for a missed one is not a good idea.

[Note: It’s important to follow your prescribed dosing schedule for Metformin. If you have questions or concerns about missed doses, consult your healthcare provider for guidance].

Taking too much Metformin can cause diarrhea, nausea, and stomach pain. Metformin alone isn’t as likely to cause hypoglycemia (low blood glucose). You should check your blood glucose if you feel weak, shaky, or sweaty. Follow the instructions to bring it back up to normal if it’s less than 70 mg/dL. Metformin may cause lactic acidosis in some people if they take too much of it. People with kidney or liver problems, as well as older adults, are examples. Symptoms like trouble breathing, muscle aches, and stomach pain require immediate medical attention.

[Note: You can contact Poison Control at 1-800-222-1222 if you believe you have taken too much Metformin. Visit your nearest emergency room if you are experiencing any symptoms that feel life-threatening].

If you plan to buy Metformin from Canada, you need to follow the below storage guidelines to maintain the safety and effectiveness of your medication:

• Keep the medicine in a closed container at room temperature, away from sunlight and heat. Don’t let it freeze.
• Make sure this product is not accessible to children.
• The use of outdated or unnecessary medicines should be avoided.
• Do not discard any medicine you no longer need without consulting your healthcare professional.

[Note: Proper storage of Metformin helps maintain its effectiveness and safety. If you have any questions about storing your medication, ask your pharmacist or healthcare provider for advice].

There are 364 drugs known to interact with Metformin, as well as 5 disease interactions and 1 alcohol/food interaction. A total of 23 drug interactions are major, 332 are moderate, and 9 are minor.

Some of the drugs include:

• Amiloride (midamor)
• Beta-blockers:
  • Tenormin (atenolol)
  • Trandate (labetalol)
  • Lopressor, Toprol XL (metoprolol)
  • Corgard, Corzide (nadolol)
  • Hemangeol, Inderal, InnoPran (propranolol)
• Angiotensin-converting enzyme (ACE) inhibitors:
  • Zestoretic (lisinopril)
  • Univasc (moexipril)
  • Captopril
  • Vasotec, Vaseretic (enalapril)
  • Fosinopril
  • Altace (ramipril)
  • Mavik (trandolapril)
  • Aceon (perindopril)
  • Accupril (quinapril)
  • Lotensin, Lotrel (benazepril)
• Cimetidine (tagamet)
• Digoxin (lanoxin)
• Diuretics (water pills):
  • Lasix (furosemide)
• Laniazid, Rifamate, Rifater (isoniazid)
• Calcium channel blockers:
  • Norvasc (amlodipine)
  • Cardizem, Cartia, Diltzac (diltiazem)
  • Felodipine
  • Isradipine
  • Cardene (nicardipine)
  • Adalat, Afeditab CR, Procardia (nifedipine)
  • Nymalize (nimodipine)
  • Sular (nisoldipine)
  • Calan, Covera, Verelan, Tarka (verapamil)
• MS Contin (morphine)
• Niacin
• Oral contraceptives
• Oral steroids:
  • Dexamethasone
  • Medrol (methylprednisolone)
  • Rayos (prednisone)
• Dilantin, Phenytek (phenytoin)
• Procainamide
• Nuedexta (quinidine)
• Quinine
• Zantac (ranitidine)
• Dyrenium, Maxzide (triamterene)
• Primsol (trimethoprim)
• Vancocin (vancomycin)

What Are the Other Metformin Interactions?

Alcohol: Avoid excessive alcohol intake as it can increase this risk, especially if you have kidney or liver disease, congestive heart failure, or dehydration. Alcohol can also affect blood sugar levels, leading to hypoglycemia or hyperglycemia. Limit alcohol consumption if your diabetes is not well controlled or if you have certain complications. Talk to your doctor or pharmacist for more guidance before you plan to buy Metformin online from Canada.

Diseases: Certain medical conditions can also have severe interactions. If you have the following medical problems, you should remain cautious before taking Metformin or consult a medical practitioner to avoid potential risks:

• Lactic acidosis
• Liver disease
• Renal dysfunction
• Hypoglycemia
• B12 deficiency

[Note: Discuss with your healthcare provider or pharmacist if you have concerns about how Metformin may interact with other drugs or conditions. They can provide guidance on managing these interactions and adjusting your treatment regimen as needed].

Metformin may not be an ideal treatment option for every patient due to various reasons, including expensive prices, medical problems, and different body needs. If you are not getting the desired results from your existing medication, you can change your treatment option only after consulting a medical professional. Here are some of the popular drugs that you can use as a substitute for Metformin:

• Amaryl (glimepiride)
• Januvia (sitagliptin)
• Actos (pioglitazone)
• Jardiance (empagliflozin)
• Farxiga (dapagliflozin)
• Tradjenta (linagliptin)
• Diabeta, Glynase (glyburide)
• Prandin (repaglinide)
• Avandia (rosiglitazone)
• Precose (acarbose)
• Onglyza (saxagliptin)
• Invokana (canagliflozin)

[Note: These alternative medications work through different mechanisms to help control blood sugar levels. It’s important to consult with your healthcare provider to determine the most suitable treatment option for you]

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The content provided on the Polar Bear Meds website serves to increase knowledge about healthcare products and medical conditions and is strictly for informational purposes. It should not replace professional medical advice. We urge you to consult with a qualified healthcare professional prior to utilizing any prescription or over-the-counter medication. Our platform grants access to an extensive array of products, sourced internationally, including Canada. We collaborates with a licensed pharmacy partner in Canada and trusted dispensing pharmacies globally. All affiliated fulfillment centers are accredited by the regulatory authorities of their respective countries.