NCC Officers' Training Academy
GWALIOR (Est 1965)
Metformin
What is metformin?
Metformin is an FDA-approved antidiabetic agent that manages high blood sugar levels in type 2 diabetes patients. It reduces glucose absorption from the intestines, lowers liver glucose production, and improves insulin sensitivity. Metformin is recommended with dietary changes and exercise for better results.
Managing blood sugar levels with medications like metformin can prevent complications such as kidney damage, nerve issues, blindness, amputations, and sexual dysfunction. Effective diabetes control can also lower the risk of heart attacks or strokes.
Metformin side effects
Get emergency medical help if you have signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Some people using this medicine develop lactic acidosis, which can be fatal. Get emergency medical help if you have even mild symptoms such as:
unusual muscle pain;
feeling cold;
trouble breathing;
feeling dizzy, light-headed, tired, or very weak;
stomach pain, vomiting; or
slow or irregular heart rate.
Common metformin side effects may include:
low blood sugar;
nausea, upset stomach; or
Before taking this medicine
You should not use metformin if you are allergic to it, or if you have:
severe kidney disease; or
metabolic acidosis or diabetic ketoacidosis (call your doctor for treatment).
If you need to have surgery or any type of x-ray or CT scan using a dye that is injected into your veins, you may need to temporarily stop taking metformin. Be sure your caregivers know ahead of time that you are using this medication.
Tell your doctor if you have ever had:
kidney disease (your kidney function may need to be checked before you take this medicine);
high ketone levels in your blood or urine;
heart disease, congestive heart failure;
liver disease; or
if you also use insulin, or other oral diabetes medications.
You may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. This may be more likely if you have other medical conditions, a severe infection, chronic alcoholism, or if you are 65 or older. Ask your doctor about your risk.
Follow your doctor’s instructions about using metformin if you are pregnant or you become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications in both the mother and the baby. Tell your doctor if you become pregnant while taking metformin.
Metformin may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk.
You should not breastfeed while using this medicine.
Not treated with pioglitazone or metformin: Pioglitazone 15 mg/metformin 850 mg PO qDay
Metformin monotherapy: Pioglitazone 15 mg/metformin 850 mg PO qDay or BID; select dosage that is as close as possible to current dosage of metformin
Pioglitazone monotherapy: Pioglitazone 15 mg/metformin 850 mg PO qDay
Pioglitazone and metformin: Select a dosage as close as possible to current dosage of pioglitazone and metformin while not exceeding three tablets orally per day
Dosage Modifications
Hepatic impairment
- Baseline ALT <2.5 xULN: Use caution
- Baseline ALT ≥2.5 xULN: Do not administer
- ALT >3 xULN or jaundice after initiating therapy: Discontinue
Renal impairment
- Obtain eGFR before starting metformin
- eGFR <30 mL/min/1.73 m²: Contraindicated
- eGFR 30-45 mL/min/1.73 m²: Not recommended to initiate treatment
- Monitor eGFR at least annually or more often for those at risk for renal impairment (eg, elderly)
- If eGFR falls below 45mL/min/1.73 m² while taking metformin, risks and benefits of continuing therapy should be evaluated
- If eGFR falls below 30 mL/min/1.73 m²: while taking metformin, discontinue the drug
Congestive heart failure
- Preexisting NYHA Class I or II congestive heart failure: Pioglitazone 15 mg and metformin 850 mg
- After initiation or with dosage increase, monitor patients carefully for adverse reactions related to fluid retention as has been seen with pioglitazone (eg, weight gain, edema and signs and symptoms of congestive heart failure)
- If congestive heart failure develops while receiving therapy, consider discontinuation or dosage reduction of pioglitazone
Interaction
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