Metformin: functions, dosage, side effects, how to use

Uses of metformin

What drug metformin?

Metformin is a drug to control high blood sugar levels which is usually given to type 2 diabetes patients. The way metformin works is by helping to restore the body's response to insulin that is produced naturally.

Another function of metformin is to decrease the amount of sugar that your liver produces and that your stomach / intestines absorb.

Metformin is a drug that can be consumed and accompanied by a diet and exercise program, to prevent diabetes in people who are at high risk of developing diabetes.

How do you use metformin?

Metformin is a drug that is taken by mouth according to doctor's instructions, usually 1-3 times a day. Drink plenty of water while on treatment with this medicine, unless your doctor says otherwise.

The metformin dosage is based on your medical condition, kidney function, and response to treatment. Your doctor may ask you to take this drug in a low dose at first, and increase the dose gradually to reduce the risk of side effects such as stomach upset.

Your doctor will also adjust the dose according to your blood sugar level to find the most appropriate dose for you. Follow the doctor's instructions carefully.

Take this drug regularly for optimal benefits. Don't forget to eat it at the same time every day.

If you are already taking other antidiabetic drugs (such as chlorpropamide), follow your doctor's instructions carefully about whether you should stop or continue the old medication before starting metformin.

Check your blood sugar regularly as directed by your doctor. Record the results and tell the doctor. Also tell your doctor if the results show your blood sugar is too high or too low. Your dose / medication may need to be changed.

How to store this drug?

Metformin is a drug that is best stored at room temperature, away from direct light and damp places. Don't keep it in the bathroom. Don't freeze it. Other brands of this drug may have different storage rules.

Observe the storage instructions on the product package or ask your pharmacist. Keep all medicines away from children and pets.

Do not flush medicines down the toilet or down the drain unless instructed to do so. Discard this product when it has expired or when it is no longer needed.

Consult your pharmacist or local waste disposal company about how to safely dispose of your product.

Metformin dosage

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before starting treatment.

What is the dose of metformin for adults?

The following are the recommended metformin doses for adults:

Metformin dosage for adults with type 2 diabetes

Conventional preparations of metformin

• The starting dose of metformin is 500 mg orally twice a day or 850 mg orally once a day. The dose can be increased every 1 week according to tolerance.
• The maximum dose of metformin is 3,000 mg per day

Metformin modified-release

• The starting dose of metformin is 500-1,000 mg orally once a day. The dose can be increased per week according to tolerance.
• The maximum dose of metformin is 2,000 mg per day

What is the dose of metformin for children?

Metformin dosage for children with type 2 diabetes:

• The starting dose of metformin for children is 500 mg orally 1-2 times a day or 850 mg once a day. The dose can be increased every 1 week according to tolerance
• The maximum dose of metformin for children is 2,000 mg per day, divided into 2-3 doses (administration)

In what dosage is Metformin available?

Metformin is a drug extended release tablet which is available in sizes 500 mg and 1,000 mg.

Metformin Side Effects

What side effects may occur due to metformin?

The side effects of metformin that are classified as mild are:

• Headache or muscle aches
• Feeling weak
• Mild nausea, vomiting, diarrhea, gas, stomach pain.

Metformin is a drug that can cause lactic acidosis (buildup of lactic acid in the body, which can be fatal). Lactic acidosis can develop slowly and get worse over time. Seek immediate medical help if you experience symptoms of lactic acidosis, such as:

• Muscle pain or feeling weak
• Numbness or cold feeling in the hands and feet
• Difficulty breathing
• Feel dizzy, head spinning, tired, and very weak
• Stomach pain, nausea accompanied by vomiting
• Slow or irregular heartbeat

Call your doctor right away if you experience more severe symptoms:

• Shortness of breath, even after trying to take a deep breath
• Swelling or rapid weight gain
• Fever, chills, body aches, flu symptoms

Not everyone experiences the following side effects. There may be some side effects not listed above. If you have concerns about certain side effects, consult your doctor or pharmacist.

Metformin Drug Warnings and Cautions

What should be known before using this drug?

Before taking metformin, make sure you:

• Tell your doctor and pharmacist if you are allergic to metformin or any other substance contained in metformin liquid or tablets. Also inform all types of allergies you have. Ask the pharmacist or check the drug manufacturer's patient information for a list of its ingredients
• Tell your doctor and pharmacist what medications (both prescription and nonprescription) you are taking, including vitamins, nutritional supplements, and herbal products.
• Tell your doctor if you have or have had certain diseases
• Tell your doctor if you are pregnant, are trying to become pregnant, or are breastfeeding. If you take metformin and become pregnant, call your doctor.
• Tell your doctor if you eat less or exercise more often than usual. This can affect your blood sugar. The doctor will give further advice if this happens.

Is metformin safe for pregnant and lactating women?

There is no adequate research on the risks of using metformin for pregnant or breastfeeding women. Always consult your doctor to weigh the potential benefits and risks before using this medication. This drug is included in the risk of pregnancy category B (not risky according to several studies) according to the US Food and Drug Administration (FDA), or the equivalent of the POM in Indonesia.

The following references the pregnancy risk categories according to the FDA:

• A = Not at risk
• B = No risk in several studies
• C = May be risky
• D = There is positive evidence of risk
• X = Contraindicated
• N = Unknown

Drug Interactions

What drugs may interact with metformin?

Interactions with other drugs can affect how the drug works and increase the risk of dangerous side effects. Record all medicinal products you use (including prescription, non-prescription and herbal medicines) and share them with your doctor and pharmacist. Do not start, stop, or change the dose of any medication without your doctor's permission.

Tell your doctor about other medicines you are currently taking, especially:

• Furosemide (Lasix)
• Nifedipine (Adalat, Procardia)
• Cimetidine or ranitidine
• Amiloride (Midamor) or triamterene (Dyrenium)
• Digoxin (Lanoxin)
• Morphine (MS Contin, Kadian, Oramorph)
• Procainamide (Procan, Pronestyl, Procanbid)
• Quinidine (Quin-G) or quinine (Qualaquin)
• Trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra)
• Vancomycin (Vancocin, Lyphocin)

You will be at higher risk for hyperglycemia (high blood sugar) if you take metformin with other drugs that increase blood sugar, such as:

• Isoniazid
• Diuretics (medications that stimulate urination)
• Steroids (prednisone, etc.)
• Medicines for the heart and blood pressure (Cartia, Cardizem, Covera, Isoptin, Verelan, and others)
• Niacin (Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, etc.)
• Phenothiazines (Compazine, etc.)
• Thyroid medicine (Synthroid, etc.)
• Birth control pills and other hormone pills
• Medicines for seizures (Dilantin, etc.);
• Diet pills or medicines for asthma, flu, and allergies.

Can food or alcohol interact with this drug?

Certain drugs should not be used with meals or when eating certain foods because drug interactions can occur. Consuming alcohol or tobacco with certain drugs can also cause interactions to occur. Discuss your use of drugs with food, alcohol, or tobacco with your health care provider.

What health conditions can interact with metformin?

Other health conditions you have may affect the use of this drug. Always tell your doctor if you have other health problems, especially:

• Excessive alcohol consumption
• Underactive adrenal glands
• Underactive pituitary gland
• Nutritional deficiencies
• Weakened physical condition
• Other conditions that cause low blood sugar - Patients with this condition may experience low blood sugar when taking metformin
• Anemia (low levels of red blood cells)
• Vitamin B12 deficiency - Use with caution as it can worsen the condition.
• Congestive heart failure, acute or unstable
• Dehydration
• Acute heart attack
• Hypoxemia (reduced oxygen in the blood)
• Kidney illness
• Liver disease
• Sepsis (blood poisoning)
• Shock (low blood pressure, low blood circulation) —A rare condition, called lactic acidosis, can occur. Talk to your doctor if you have any concerns about this.
• Diabetic ketoacidosis (ketones in the blood)
• Severe kidney disease
• Metabolic acidosis (excess acid in the blood)
• Type 1 diabetes — Patients with this condition should not take this drug
• Fever
• Infection
• Operation
• Trauma — This condition can cause temporary problems with blood sugar control and your doctor may treat it with insulin.

Metformin overdose

What should I do in an emergency or overdose?

In case of an emergency or overdose, contact the local emergency services provider (119) or immediately to the nearest hospital emergency department.

Overdose symptoms can include signs of hypoglycemia and the following symptoms:

• Great fatigue
• Feeling weak
• Inconveniences
• Gag
• Nausea
• Stomach ache
• Decreased appetite
• Deep, gasping breath
• Shortness of breath
• Dizzy
• The head feels light
• Heart rate slower or faster than normal
• Skin flushed red
• Muscle ache
• Feeling cold

What should I do if I miss a dose?

If you forget a dose of this medicine, take it as soon as possible. However, when it is nearing the time of the next dose, skip the missed dose and return to the usual dosing schedule. Don't double the dose.