Metformin

Metformin HCl is a prescription oral medication used to improve blood sugar control in adults and children 10 years and older with type 2 diabetes mellitus. It is used in combination with diet and exercise and may be prescribed alone or with other antidiabetic medications. It belongs to the biguanide class of medications and is commonly used as a first-line treatment for type 2 diabetes.

Below is a quick overview of important facts for patients and caregivers:

Metformin hydrochloride tablets are prescribed for use:

• In pediatric patients 10 years of age and older with type 2 diabetes mellitus
• As an adjunct to exercise and diet
• In adults with type 2 diabetes mellitus
• To improve glycemic control

This medication is not indicated for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis.

Metformin is an antihyperglycemic medication that lowers blood sugar levels in patients with type 2 diabetes mellitus by reducing both basal and postprandial plasma glucose levels. It helps lower blood sugar through several actions in the body:

• Enhancing the sensitivity of insulin by increasing the uptake and utilization of glucose in peripheral tissues
• Reducing the amount of glucose absorbed from the intestines
• Lowering the amount of glucose produced by the liver

Unlike some other diabetes medications, Metformin does not increase insulin production.

With Metformin therapy:

• Insulin secretion remains unchanged
• Fasting insulin levels may decrease
• A day-long plasma insulin response may decrease

Always follow your healthcare provider’s instructions. General guidelines include:

• Take Metformin exactly as prescribed.
• Take with meals to reduce stomach upset.
• Swallow tablets whole.
• Continue your prescribed diet and exercise program.
• Your healthcare provider will monitor kidney function before and during treatment.
• Blood sugar and HbA1C levels should be monitored regularly.
• Check your blood sugar as directed.

You may occasionally pass a soft mass in your stool that looks like a tablet. This is not harmful. If your body is under stress (fever, infection, injury, or surgery), your diabetes medication needs may change. Inform your healthcare provider immediately.

Metformin dosage should be individualized based on blood sugar control, tolerability, and kidney function. Always follow your healthcare provider’s instructions.

Adult dosage (immediate-release tablets):

Pediatric dosage (age 10 years and older):

Use in renal impairment:

Renal function should be assessed before starting therapy and periodically during treatment.

Important information:

Discontinue Metformin HCl at the time of or before an iodinated contrast imaging procedure in patients:

• With eGFR between 30-60 mL/min/1.73 m²
• Receiving intra-arterial iodinated contrast
• With a history of alcoholism, heart failure, or liver disease

Re-evaluate eGFR 48 hours after the procedure and resume this medication if renal function is stable.

Immediate-Release vs Extended-Release Metformin

Metformin tablets are available in both immediate-release (IR) and extended-release (XR or SR) formulations. This page refers to immediate-release metformin tablets, which are typically taken two or three times daily with meals. Extended-release formulations are designed for once-daily dosing and may be better tolerated in some patients. Your healthcare provider will determine which formulation is appropriate based on your treatment needs.

Metformin overdose has been reported in cases involving ingestion of more than 50 grams.

• Hypoglycemia has been reported in approximately 10% of cases, although a direct causal relationship has not been established.
• Lactic acidosis has been reported in approximately 32% of overdose cases.

Metformin can be removed by dialysis, with a clearance of up to 170 mL/min under good hemodynamic conditions. Hemodialysis may be useful for the removal of accumulated drugs in patients with suspected metformin overdose. If an overdose is suspected, seek immediate emergency medical help or contact a poison control center.

Metformin tablets are generally well tolerated, although serious side effects can occur in some cases.

Common Side Effects

Commonly reported Metformin side effects are listed below:

• Diarrhea
• Nausea
• Upset stomach
• Vomiting
• Metallic taste

These effects are usually temporary and often improve with continued use. Taking this medication with meals may help reduce gastrointestinal discomfort.

Serious Side Effects

Metformin tablets may cause lactic acidosis, a rare but potentially fatal condition requiring hospital treatment. Seek immediate medical attention if you experience any of the following:

• Severe weakness or fatigue
• Muscle pain
• Trouble breathing
• Feeling cold in the hands or feet
• Dizziness or lightheadedness
• Slow or irregular heartbeat
• Severe drowsiness
• Stomach pain with nausea or vomiting

The risk of lactic acidosis is higher in people with kidney or liver problems, heavy alcohol use, dehydration, recent surgery, severe infection, heart attack, stroke, or certain x-ray tests using injectable contrast dye. Metformin rarely causes low blood sugar when used alone, but may increase the risk when combined with other diabetes medications, alcohol, or not eating enough.

This is not a complete list of side effects. Contact your healthcare provider for medical advice about adverse reactions. You may report side effects to the FDA at 1-800-FDA-1088 or visit MedWatch.

While taking this medication, the following warnings and precautions should be considered:

• Excess alcohol use: Avoid excessive or binge drinking while taking Metformin.
• Hepatic impairment: Avoid use in patients with clinical or laboratory evidence of liver disease.
• Macrovascular outcomes: There is no definitive evidence that macrovascular risk reduction has been established.
• Vitamin B12 deficiency: Long-term use of Metformin tablets may be associated with decreased vitamin B12 levels; measurement of hematologic parameters annually is recommended.
• Surgery or restricted intake: Temporarily discontinue during surgical procedures or when food and fluid intake are limited.
• Renal impairment: Assess eGFR before starting therapy and periodically thereafter. Contraindicated if eGFR is below 30 mL/min/1.73 m².
• Iodinated contrast procedures: Temporarily discontinue at the time of or before certain contrast imaging procedures. Restart only after renal function is stable.
• Hypoxic conditions: Conditions such as heart failure, shock, myocardial infarction, or severe infection may increase risk. Discontinue if these occur.
• Combination therapy: Risk of hypoglycemia increases when used with insulin or sulfonylureas; dose adjustment of the concomitant agent may be necessary.
• Lactic acidosis: Rare but serious risk. Higher in patients with kidney impairment, liver disease, hypoxic states, advanced age, or excessive alcohol use. Discontinue immediately if suspected.

Pregnancy and Breastfeeding

Pregnancy: Available data have not identified a drug-associated risk of major congenital disabilities or miscarriage. However, poorly controlled diabetes during pregnancy increases risks such as preeclampsia, preterm delivery, stillbirth, and fetal complications. Animal studies did not demonstrate adverse developmental effects at clinically relevant exposures. It should be used during pregnancy only if clearly needed and under medical supervision.

Breastfeeding: Metformin is present in human breast milk in small amounts. Available data are limited and have not established a clear risk to the breastfed infant. The benefits of breastfeeding should be weighed against the mother’s clinical need for Metformin and any potential risks to the infant.

Metformin tablets may interact with certain medications that increase the risk of lactic acidosis, affect kidney function, or alter blood glucose control.

Drugs that may increase the risk of lactic acidosis:

• Carbonic anhydrase inhibitors (e.g., zonisamide, acetazolamide, topiramate) may increase the risk of metabolic acidosis. Consider more frequent monitoring.
• Alcohol can potentiate the impact of Metformin on lactate metabolism. Avoid excessive or binge drinking.

Drugs that may reduce Metformin clearance:

The following drugs may increase metformin accumulation and raise the risk of adverse effects:

• Ranolazine
• Vandetanib
• Dolutegravir
• Cimetidine

Carefully assess the benefits and risks of concomitant use and monitor appropriately.

Drugs affecting glycemic control:

• Insulin and insulin secretagogues (e.g., sulfonylureas) may increase the risk of hypoglycemia when used with Metformin.
• Certain medications (e.g., thiazide diuretics, corticosteroids, thyroid products, estrogens, oral contraceptives, sympathomimetics) may increase blood glucose levels and reduce glycemic control.

Patients should inform their healthcare provider about all substances, supplements, over-the-counter drugs, and medications they use before starting Metformin tablets.

Other prescription medications used to manage type 2 diabetes include:

These medications contain different active ingredients and should only be used based on medical advice. Brand availability may vary by location and supply. Your healthcare provider will choose the most appropriate treatment based on your overall health, blood sugar goals, and individual risk factors.

Prescription diabetes medications may be costly at many U.S. retail pharmacies. Ordering Metformin online from Polar Bear Meds may help reduce overall costs while maintaining safety, quality, and reliability.

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• Shipping timelines may vary depending on processing requirements and location.
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All Metformin orders require a valid prescription. Medications are dispensed by licensed pharmacies that comply with applicable pharmacy regulations and safety standards.

• https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1e8136e0-cc98-41e4-ad4b-a8fc27fb4daa&version=15#:~:text=DOSAGE%20AND%20ADMINISTRATION,a%20day%20with%20meals%20(%202.1)
• https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/metformin-information
• https://www.ncbi.nlm.nih.gov/books/NBK518983/
• https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-metformin