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Metformin Hydrochloride

Metformin XR

Metformin XR is an FDA-approved medicine for type 2 diabetes that contains Metformin Hydrochloride as the active ingredient. It can be taken once every day, usually with dinner, in strengths ranging from 500mg to 1000mg for both adults and adolescents. Taking it with food minimizes side effects such as nausea and diarrhea. People with kidney or liver problems should exercise caution when dealing with lactic acidosis. You should take missed doses unless you are close to your next scheduled dose. Ensure that Metformin XR is stored in a sealed container at room temperature. If you are not sure about proper usage or precautions, consult your healthcare provider.

Product Overview

Metformin XR is an antidiabetic medication approved by the FDA, containing the active ingredient Metformin Hydrochloride. It is widely used to manage type 2 diabetes mellitus. It belongs to the biguanide class of drugs and works by decreasing glucose production in the liver while increasing insulin sensitivity in peripheral tissues and lowering blood sugar levels. It is prescribed for treating type 2 diabetes alongside dietary modifications and exercise to achieve glycemic control. 

Metformin XR is available in various strengths, typically 500 mg to 1000 tablets. The extended-release formulation allows for once-daily dosing, often taken with the evening meal, to minimize gastrointestinal side effects. It is crucial to follow the dosage instructions a healthcare professional provides, as the dosage may vary depending on individual medical conditions and response to treatment. Generally, it is suitable for adults and adolescents over 17 with type 2 diabetes. 

Common side effects of Metformin XR may include gastrointestinal discomforts such as nausea, diarrhea, or abdominal pain. It is advised to take the medication with food to reduce these side effects. Patients should also be aware of the risk of lactic acidosis, a rare but serious complication associated with metformin use, particularly in individuals with kidney or liver impairment. 

If a dose is missed, it should be taken soon unless it’s nearly time for the next dose. Storage of Metformin XR should be in a tightly closed container at room temperature, away from moisture and heat. Patients should always consult their healthcare provider for guidance on proper usage, precautions, and any concerns regarding this medication.

Uses of Metformin XR

  • Metformin XR is used to treat type 2 diabetes mellitus.

How to Use Metformin XR?

Dosage

Forms and Strengths 

Metformin Extended-release tablets are available in strengths of Metformin XR 500mg, 750 mg, and 1000 mg. 

Recommended Dosage for Metformin XR

500 mg should be taken orally once every evening with dinner as a starting dose. If you need to lower your blood sugar more, your provider might increase your weekly dose. Once a day, 2,000 mg is the maximum dose.

For Adults

Metformin Alone or Fortamet: First, take 1000 milligrams (mg) once a day with dinner. You may need to increase your dose until your blood sugar is under control. The dose is usually not higher than 2500 mg per day, however.

Metformin Alone or Glumetza: To begin with, take Metformin XR 500mg once a day with dinner. When your blood sugar is controlled, your doctor may increase your dose. A daily dose of 2000 mg is usually within the maximum.

For Children

Metformin XR 500mg cannot be recommended because it has not been studied in children. Only IR tablets and oral suspension are approved for children. 

Extended-Release Oral Suspension: In the beginning, 500 mg is taken orally daily with dinner. The dose should be titrated in 500 mg increments depending on glycemic control and tolerability. It is recommended to take no more than 2000 mg per day. Titrate slowly to minimize gastrointestinal side effects.

Dosage Modifications

    • Hepatic Impairment: Avoid use if you have hepatic impairment due to the risk of lactic acidosis.
  • Renal Impairment:
    • Before starting Metformin, obtain your eGFR
    • If GFR is 30 ml/min/1.73 m2, Metformin is contraindicated.
    • Do not initiate treatment if eGFR is 30-45 ml/min/1.73 m².
    • When eGFR falls below 45 ml/min/1.73 m2 while taking Metformin, the risks and benefits of continuing therapy should be considered.
    • Metformin should be discontinued if eGFR drops below 30 ml/min/1.73 m2 while taking it.

Those at risk for renal impairment (e.g., older people) should have their eGFR monitored annually or more often.

[Note: It’s crucial to follow prescribed dosages of Metformin and consult your healthcare provider for any adjustments. Dosage recommendations vary for adults and children].

How to Take It?

  • Swallow the tablet whole with a full glass of water. Do not crush, chew, or break the tablet, as it is designed for extended release.
  • Take Metformin XR 500mg with food once daily with the evening meal to reduce the risk of gastrointestinal side effects. 
  • Ensure you maintain a consistent schedule for taking Metformin XR to optimize its effectiveness in controlling blood sugar levels.

[Note: If you have difficulty swallowing tablets, talk to your healthcare provider about alternative formulations or administration methods].

How Does Metformin XR Work?

Metformin XR decreases glucose production in the liver and increases insulin sensitivity in peripheral tissues. It primarily targets the liver, inhibiting gluconeogenesis and producing glucose. By reducing glucose production, it helps lower blood sugar levels. Additionally, it enhances insulin sensitivity in muscles and fat tissues, allowing cells to take up glucose from the bloodstream more effectively. Overall, it helps improve glycemic control in individuals with type 2 diabetes by reducing both fasting and postprandial blood sugar levels.

Important Safety Information

Side Effects

Common Side Effects

  • Diarrhea
  • Nausea,
  • Vomiting
  • Abdominal discomfort
  • Bloating

These Metformin XR side effects usually occur at the start of treatment and may resolve over time.

Mild Side Effects

  • Extreme tiredness
  • Decreased appetite
  • Metallic taste in the mouth
  • Reduced appetite
  • Headache
  • Weakness or fatigue

Adverse/Serious Side Effects

  • Lactic acidosis (symptoms may include rapid breathing, dizziness, severe weakness, and abdominal pain)
  • Vitamin B12 deficiency (symptoms such as anemia, neuropathy, and cognitive impairment)
  • Hepatotoxicity or abnormal liver function 
  • Hypoglycemia (when Metformin XR is used in combination with other antidiabetic medications or insulin)

[Note: It’s important to discuss any concerns or Metformin side effects with your healthcare provider while taking Metformin XR 500mg].

Warnings

Renal Function Impairment: Metformin XR should be used cautiously in individuals with impaired renal function, as the kidneys primarily excrete it. Renal function should be assessed before initiating treatment and regularly after that. Avoid use in patients with significantly reduced renal function (eGFR <30 ml/min/1.73 m²) due to the increased risk of lactic acidosis.

Hepatic Impairment: Metformin XR should be used with caution in individuals with hepatic impairment, as it may accumulate in the body and increase the risk of lactic acidosis. Liver function tests should be monitored periodically, and the dosage may need to be adjusted accordingly.

Vitamin B12 Deficiency: Long-term use of Metformin XR may be associated with vitamin B12 deficiency, leading to megaloblastic anemia and neurological complications. Monitoring vitamin B12 levels and supplementation may be necessary, especially in individuals at risk of deficiency.

Hypoglycemia: Metformin XR may increase the risk of hypoglycemia (low blood sugar) when combined with insulin or other antidiabetic agents. Patients should be educated about the signs and symptoms of hypoglycemia and how to manage it appropriately.

Boxed Warning (Lactic Acidosis)

There is a risk of developing lactic acidosis, a dangerous buildup of lactic acid in the blood, with Metformin XR 500mg. Its accumulation can cause lactic acidosis, particularly in patients with kidney disease or hypoxemia. Rapid breathing, abdominal pain, muscle cramps, dizziness, and severe weakness characterize it. 

Several factors contribute to lactic acidosis, including advanced age, congestive heart failure, and the use of multiple medications. Lactic acidosis must be treated promptly with discontinuation of Metformin and supportive measures.

Precautions

Monitor Your Kidney Function: Regular monitoring of kidney function, including serum creatinine levels and estimated glomerular filtration rate (eGFR), is essential to detect any decline in kidney function. Metformin XR should not be used in individuals with significant renal impairment (eGFR <30 ml/min/1.73 m²) and should be used cautiously in those with mild to moderate renal impairment.

Monitor Your Liver Function: Periodic assessment of liver function tests is recommended to detect any signs of hepatotoxicity or liver dysfunction. Metformin XR should be used with caution in individuals with hepatic impairment.

Monitor Your Vitamin B12 Level: Long-term use of Metformin XR may lead to vitamin B12 deficiency due to decreased absorption. Monitoring vitamin B12 levels and supplementation may be necessary, especially in individuals with risk factors for deficiency, such as older age or a vegetarian diet.

Avoid Alcohol Consumption: Alcohol consumption may increase the risk of lactic acidosis when combined with Metformin XR. It’s advisable to limit or avoid alcohol intake while taking this medication.

Stay Hydrated: Maintaining adequate hydration is essential, especially during illness, fever, or situations that may lead to dehydration, as dehydration can increase the risk of lactic acidosis.

Inform healthcare providers: Inform your healthcare providers, including doctors, dentists, and pharmacists, about all the medications you are taking, as they may interact with Metformin XR 500mg.

Metformin XR Contraindications

Metformin is contraindicated in those with,

  • Abnormal creatinine clearance (CrCl).
  • Lactic acidosis
  • GFR <60 ml/min/1.73m²
  • Risk factors for lactic acidosis
  • Hepatic impairment
  • Unstable heart failure
  • 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

Missed Dose

The Metformin XR 500mg dose you missed should be taken as soon as you remember if you forgot. If your next dose is almost due, skip the one you missed and continue as usual. You should not take two doses together to compensate for a missed dose. Remember that missing doses may affect blood sugar control, so take your medication consistently. 

[Note: If you have any queries about missed doses, talk to your healthcare provider for guidance].

Overdose

Metformin XR may cause diarrhea, nausea, and stomach pain if you take too much. Metformin alone is less likely to cause hypoglycemia (low blood sugar). Check your blood glucose if you feel weak, shaky, or sweaty. Follow the instructions you’ve been given for bringing it back to normal if it’s less than 70 mg/dL. If you take too much metformin, you may develop lactic acidosis. People with kidney or liver problems, as well as older adults, are examples. 

[Note: You should seek immediate medical attention if any symptoms you are experiencing seem life-threatening or severe. You can also reach Poison Control at 1-800-222-1222].

Storage

Metformin XR should be stored at room temperature, away from moisture, heat, and direct light. It is essential to keep the medication in its original container with the lid tightly closed. Avoid storing the tablets in the bathroom or kitchen, where humidity and temperature fluctuations occur. Additionally, ensure it is kept out of reach of children and pets. 

[Note: If you have questions about storing Metformin XR, consult your healthcare provider or pharmacist for guidance].

Metformin XR Interactions

  • Glycopyrrolate
  • Alcohol
  • Estrogens, progestins, or birth control pills
  • Steroid medications like prednisone or cortisone
  • Stimulant medications for attention disorders, weight loss, or to stay awake
  • Topiramate
  • Dichlorphenamide
  • Ranolazine
  • Phenytoin
  • Specific antivirals for HIV or hepatitis
  • Metoclopramide
  • Memantine
  • Thyroid medications
  • Isoniazid
  • Methazolamide
  • Phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine
  • Trospium
  • Acetazolamide
  • Digoxin
  • Lamotrigine
  • Medicines for heart disease, blood pressure, irregular heartbeat
  • Niacin
  • Vandetanib
  • Cimetidine
  • Zonisamide
  • Midodrine

[Note: All possible interactions are not described in this list. Be sure to tell your healthcare provider about all the medicines you take].

Metformin XR Alternatives

  • Glucophage XR (metformin hydrochloride)
  • Fortamet (metformin hydrochloride)
  • Glumetza (metformin hydrochloride)
  • Riomet ER (metformin hydrochloride)
  • Metformin ER (metformin hydrochloride)
  • Metformin Hydrochloride ER (metformin hydrochloride)
  • Riomet (metformin hydrochloride)
  • Riomet PF (metformin hydrochloride)
  • Riomet 1000 (metformin hydrochloride)
  • Metformin Hydrochloride (metformin hydrochloride)
  • Riomet 500 (metformin hydrochloride)

[Note: Consult with your doctor before considering any alternative medications. They can provide personalized advice based on your medical history, current medications, and treatment goals].

Quick Tips

    1. Ozempic vs Metformin Comparison
    2. Causes and Treatment of Metformin-Induced Diarrhea
    3. Can Metformin Help with Gestational Diabetes in Pregnancy

Frequently Asked Questions

How long does Metformin XR last?

Metformin XR is an extended-release version of Metformin, a medication used to treat type 2 diabetes. One dose of Metformin XR can control your blood sugar for up to 12 hours. This means you can take it once in the morning and not worry about your blood sugar for the rest of the day. However, once you stop taking this medication, it takes about 4 days for most of the medication to leave your body.

Is Metformin XR better than regular Metformin?

Metformin is available as both a regular version and an extended-release version. The extended-release version, called Metformin XR, has a longer duration of action and is better tolerated by the body. This means that it has fewer side effects and is less likely to cause gastrointestinal issues. Both Metformin IR and Metformin XR effectively lower blood sugar levels, but Metformin XR may be a better choice for individuals who may have trouble tolerating the regular version.

What foods should I avoid while taking Metformin?

When taking Metformin, it is important to avoid certain foods. This includes refined carbohydrates like white bread, white rice, candy, soda, white pasta, and white rice. Saturated fats, such as red meat and butter, should also be avoided. Trans fats found in baked goods from stores and fast food should also be limited. 

Additionally, it is important to avoid consuming high levels of sodium found in prepackaged snacks, canned soups, and fast food. Sugar-sweetened soda, chips, crackers, ice cream, cakes, and chocolates should also be avoided.

Can I use Metformin 500 mg for weight loss?

Metformin XR 500mg may contribute to weight loss in some individuals, particularly those with obesity or overweight status. It can help improve insulin sensitivity and reduce appetite, leading to potential weight loss over time. However, individual responses vary, and weight loss is not guaranteed for everyone. It’s essential to follow a balanced diet and incorporate regular exercise for optimal results in managing weight while taking Metformin XR 500mg. Always consult your healthcare provider for personalized guidance on using Metformin 500 mg for weight loss.

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