This article is not medical advice. Always seek the advice of your physician or use the medication guide.

Metformin Information

What is Metformin?

Metformin is used as the first-line medication in treating type 2 diabetes. It’s also prescribed for people who are at a higher risk of developing type 2 diabetes.

Metformin uses go beyond keeping type 2 diabetes under control. It is also commonly used as an off-label medication for gestational diabetes (diabetes during pregnancy), prediabetes (having higher-than-normal blood sugar levels), and polycystic ovary syndrome (PCOS) in women.

Metformin over the counter is not available as this is a prescription-only drug. Metformin classification is known as biguanides. This is a group of oral medications that treat diabetes type 2 by reducing the liver’s rate of glucose production. It also increases the body’s insulin sensitivity besides lowering the absorption of sugar through the intestines.

Metformin brand name

Metformin generic name is Metformin (met FOR min). You’ll also find it in other tradenames listed below;

• Glucophage
• Glucophage XR
• Glumetza
• Riomet
• Fortamet

Is Metformin insulin?

No. Although Metformin hcl and insulin manage blood sugar levels, they differ from how they are administered to how they work. For instance, Metformina is an oral drug used to treat and prevent type 2 diabetes (it’s not used for diabetes type 1). It’s also used to induce ovulation in women who aren’t responding to Clomiphene treatment. On the other hand, insulin is used in the management of diabetes type 1 and type 2.

Another difference between Metformin hydrochloride and insulin is that the latter is administered via an injection into the layer of fat beneath the skin.

Metformin and insulin are used together sometimes, though, in type 2 diabetic patients who are exclusively treated using insulin. One of Metformin benefits is to decrease the body’s resistance to insulin. This combination increases the effectiveness of insulin. Besides, research shows that it reduces mortality rate and heart problems significantly.

Metformin Forms and Strengths

Tablet (immediate release): 500mg, 850mg, and 1000mg Tablet (extended release): 500mg, 750mg, and 1000mg Oral solution (immediate release): 100 mg/mL (Riomet) Oral solution (extended release): 47.31mg/47.3ml (Riomet) Reconstituted suspension: 500mg/5mL (Riomet)

How to take Metformin

How and when to take Metformin highly depends on its form and strength. The most important thing, however, is to read, understand, and follow the instructions in the patient’s information insert. Ask your doctor or pharmacist for clarification, especially if this drug has been prescribed off-label.

You may cut Metformin 500, 850, and 1000 mg immediate-release tablets into 2 if you can’t swallow it full. Metformin hcl er 500 mg should be swallowed full without crushing in the mouth. Extended-release tablets are meant to dissolve gradually in the stomach. Crushing or splitting them may easily cause an overdose. Your stomach could also inhibit the drug’s effectiveness without the special coating.

If you’re using Metformin oral solution, use the dropper or measuring cap or spoon that is included in the package for dosing accuracy.

What is the benefit of taking Metformin at night?

The best time to take Metformin is with or just after a meal as this helps a lot in minimizing Metformin adverse side effects. However, studies show that taking this medicine at bedtime improves diabetes management as it reduces morning hyperglycemia (high levels of blood sugar between 2 AM and 8 AM).

Dosing

Metformin dosage for Type 2 diabetes- Adults

Immediate-release tablets

• Initial dose: 500 mg twice a day or 800 mg once. Increase dose by 500mg weekly or 850mg biweekly
• Maintenance dose: 2000 mg/day in evenly divided dose
• Do not exceed 2550 mg per day

Extended-release tablets

• Initial dose: 500-1000 mg once per day. Adjust dosage by 500 mg increments weekly
• Do not exceed 2000 mg

Metformin dosage for Type 2 diabetes- Pediatrics (10 years and above)

Immediate release

• Initial dose: 500 mg twice per day. Adjust dosage by 500 mg increments weekly divided. Max dose should be administered in 2-3 treatments.
• Do not exceed 2000 mg/day

Extended-release oral suspension

• Initial dose: 500 mg once per day (preferably with evening meals)
• Adjust dosage by 500mg increments weekly.

Metformin for PCOS

Your doctor will decide the ideal Metformin dosage for PCOS, depending on your condition. Here is a standard prescription;

• Week one: Take one Metformin 500 mg tablet orally daily

• Week two: Take Metformin hcl 500 mg tablet twice a day

• Week three: Take these tablets three times a day

How does Metformin help PCOS?

Metformin is used to deal with PCOS-linked infertility and pregnancy complications, common among women in the reproductive age bracket. This disorder is associated with low ovulation rates and irregular or prolonged menstruation cycles. Metformin er 500 mg medication can boost your odds of conceiving by regulating menstruation and stimulating ovulation.

Metformin dosage for weight loss

Can Metformin cause weight loss? Yes. This is one of its typical side effects, although your doctor may also prescribe it on an off-label status to boost your weight loss regimen. If your doctor prescribes Metformin (Glucophage generic) for this purpose, you’ll be directed on the right dosage.

How long does it take for Metformin to work?

Metformin acts fast, and you should start feeling its effects as soon as 48 hours after starting the therapy. Maximum effect occurs in 4 to 5 days, dependent on dosage.

What is the lowest dose of Metformin you can take?

500 mg is often the lowest initial dose when treating different conditions using Metformin (Glucophage generic).

Max dose of Metformin

Metformin max dose varies depending on the disease or condition being treated, age of the patient, and the form of Metformin (ER or IR). When treating type 2 diabetes mellitus, adults should not exceed 2550mg and 2000mg for immediate-release and extended-release tablets, respectively. For children 10 years of age and above, the maximum dose for either of these tablets is 2000 mg.

Missed dose

Take the dosage provided you’ve missed it by at most 2 hours. Otherwise, leave it and ensure that you take your next dose on time. Do not double dose on Metformin diabetes medication as this may lead to overdose.

Can you overdose on Metformin?

Yes, Metformin overdose is possible, and it increases your risk of developing lactic acidosis. This is a severe medical condition where the body produces high lactic acid levels that the liver cannot metabolize fast enough. This leads to an accumulation of lactic acid in the bloodstream, which can be fatal.

Signs of Metformin overdose

• Vomiting
• Diarrhea
• Severe nausea
• Loss of appetite
• Epigastric pain
• Lethargy
• Hyperpnoea

Uses- What is Metformin used for?

Metformin is an antidiabetic drug used alongside exercises and diet to treat type 2 diabetes. It may also be prescribed to people who are at a higher risk of developing type 2 diabetes. In addition, Metformin can be used as an off-label medication in treating gestation diabetes, prediabetes, and PCOS in women.

Before using Metformin

1. Tell your doctor if you’ve suffered any of the following diseases;

• Congestive heart failure (heart failure)
• Kidney disease
• Liver disease
• High blood or urine ketone level
• Vitamin B12 deficiency

2. Let your doctor or pharmacist know if you’re using other antidiabetic medications, such as insulin too.

3. If you’re scheduled for a surgery, CT scan, or X-ray, tell your caregivers beforehand that you’re using Metformin. You may be advised to stop the medication temporarily.

4. You should not take Metformin hcl er if you’ve ever had an allergic reaction to it before

Metformin and Allergies

Metformin rarely causes allergic reactions, mainly when used as a single antidiabetic medication. Nevertheless, some people develop a severe allergic response characterized by;

• Severe dizziness
• Trouble breathing
• Itchiness
• Swelling of the face, tongue, and throat

Call the Poison Control Center at +1 800-222-1222 if you experience any of the above symptoms. If the patient has fallen and isn’t responding, call 911 immediately.

Metformin Interactions

Metformin interacts with over 330 drugs. Around 20 of these drugs have severe interactions and should never be taken alongside Metformin. The list below does not include all the drugs that interact with Metformin. So, tell your doctor about other drugs that you’re taking or are planning to take for advice.

Drugs that interact with Metformin

• Lisinopril
• Phentermine
• Synthroid
• Lantu
• Lasix
• Ibuprofen

Foods/drinks that interact with Metformin

• Alcohol

Diseases that interact with Metformin

• Cardiovascular disease
• Vitamin B12 deficiency
• Lactic acidosis
• Hypoglycemia

Metformin and Pregnancy

Using Metformin in pregnancy is considered safe when treating diabetes type 2 or PCOS. Research studies show that Metformin crosses the placenta during pregnancy. For this reason, most people are concerned about the risk of congenital disabilities. However, in one of the recent Metformin reviews, the researchers didn’t find any evidence that Metformin use during pregnancy increases the risk of malformations.

Metformin and Breastfeeding

Like other medications, Metformin is detectable in breast milk. However, these levels are considerably low and have not been linked to any negative effects on the baby or breast milk supply even with long term use.

Metformin in Pediatrics

The US FDA has approved the use of Metformin (Glucophage generic) in children 10 years and above. Doctors may prescribe it to children younger than 10 years only when the potential benefits outweigh the risks.

Metformin warnings

1. Black box warning- Metformin has FDA’s black box warning about its risk of causing lactic acidosis.

2. Alcohol- mixing Metformin and alcohol may increase your risk of lactic acidosis and dangerously low blood sugar levels, as indicated in Metformin Davis pdf.

3. Kidney problems- You should not use Metformin if you have kidney problems.

4. Liver problems- don’t use Metformin if you have existing liver problems. Ask your doctor for possible Metformin alternatives.

5. Severe allergies- Although rare, Metformin may cause an allergic reaction with symptoms, including hives, breathing difficulties, itchiness, and swelling on the face, tongue, and throat.

Metformin contraindications

Metformin contraindications include;

• Chronic heart failure
• Hypersensitivity
• Severe renal disease
• Diabetic ketoacidosis
• Myocardial infarction
• Metabolic acidosis

Metformin side effects

Common side effects of Metformin include;

• Vomiting
• Nausea
• Diarrhea
• Gas (flatulence)
• A feeling of weakness
• Muscle pain
• Low levels of Vitamin B12
• Low blood sugar levels (hypoglycemia)
• Upper respiratory tract infection
• Constipation
• Dizziness
• Chest discomfort
• Bloating
• Heartburn

How long do Metformin side effects last?

Metformin side effects are common during the initial dose and when the dosage is increased. More often than not, these unpleasant feelings resolve within the first 2 weeks.

Proper storage

Store Metformin tablet dosage in its original container away from children and direct heat and sunlight. Do not put it in moist areas, such as in the bathroom or near the kitchen sink. If you’re using Metformin oral solution, you can put it in the refrigerator, but not in the freezer.

Metformin cost

Metformin (Glucophage generic) is the most inexpensive antidiabetic medication. The best price for Metformin 500 mg (60 tablets) without Metformin coupon is around $4 at Walmart. This cost does get as high as $46 in some stores, including Rite Aid. With the best coupon for Metformin, you can get the same dosage between $3.70 and $13.02. This is an excellent way of saving money, especially if you’re getting a 90-day supply.

Metformin moa- How Metformin works

The Metformin mechanism of action is different from other drugs in other antihyperglycemic classes. Metformin works in 3 ways;

• It suppresses the secretion of glucose in the liver although how exactly it does this remains controversial.
• It increases body cells sensitivity to insulin further decreasing the amount of sugar in the blood.
• It reduces intestinal glucose absorption from the food we eat

Metformin recall- does Metformin cause cancer?

1. Metformin recall 2019- around December 2019, the FDA started investigating and testing the levels of N-Nitrosodimethylamine (NDMA) - a potential carcinogen- in Metformin medication. This was after 3 versions of this drug were recalled in Singapore. However, the US FDA did not confirm whether the level of NDMA in Metformin pills exceeded the acceptable daily intake limit of 0.096 micrograms. Consequently, the FDA didn’t issue a recall around this time but urged patients to continue using it only when clinically prescribed.

2. Metformin recall 2020- on May 28th, the US FDA released a press statement that it had asked 5 drug companies to voluntarily recall their Metformin extended-release tablets. This was after the FDA lab results proved high levels of N-NDMA in these medications. The pharmaceutical companies contacted are;

• Lupin Pharma
• Actavis Pharma, Inc.
• Marksans Pharma Ltd.
• Amneal Pharmaceuticals, LLC
• Apotex Corp.

As of July, 12th, 2020, these drug companies have recalled some of their Metformin lots in the US;

• Lupin- Metformin 1000 mg and Metformin hcl 500 mg extended-release tablet
• Amneal Pharmaceuticals, LLC- Metformin 500mg and 750mg extended-release tablet
• Apotex- Metformin 500 mg

Is Metformin safe?

With the recent Metformin cancer scare, it’s understandable if you’re wondering, “is Metformin dangerous?” Well, this drug is generally safe, and it’s still used as the front line defense in treating diabetes type 2.

However, Metformin long term side effects, including lactic acidosis, may necessitate the need for Metformin alternatives in some people. Lactic acidosis Metformin occurs when your kidneys can’t clear the metabolites of this drug efficiently, leading to a dangerous buildup of lactic acid in your system. If your kidneys are not functioning properly or if you want to avoid the unpleasant Metformin er side effects, you may want to consider natural alternatives to Metformin, such as;

• Berberine
• Inositol
• Cinnamon
• N-Acetyl Cysteine acid

Berberine vs Metformin

Berberine and Metformin have a lot of similarities in the fight against type 2 diabetes, and they tend to offer almost similar results. Although Metformin generic is the most prescribed antidiabetic drug, multiple studies show that berberine side effects are much more tolerable and controllable than Metformin.

Metformin, Metformin ER, Metformin XR, and Metformin IR – What are the differences?

All of these refer to the same medication, and they are prescribed in treating diabetes type 2. Metformin is sometimes referred to as Metformin IR (immediate-release). Metformin ER and XR are pretty much the same drug; they are only developed from different brand names. These 2 are the extended-release versions of the regular Metformin. As such, you don’t need to take them regularly as you’d do with Metformin or Metformin IR.

Metformin alcohol combination- is it safe?

Metformin and alcohol don’t necessary pose serious complications when used together; so an occasional bottle of beer may not be life-threatening. However, binge drinking while on a Metformin therapy complicates things. High levels of alcohol in your system alters your liver’s glucose production as the liver concentrates more on removing toxins. This may easily cause dangerously low levels of blood sugar, which increases your risk of potentially fatal conditions, such as lactic acidosis.

Metformin weight loss- what does Metformin do?

Does Metformin cause weight gain? No. Unlike insulin and Glipizide, Metformine does not cause weight gain. If anything, Metformin reviews show that some people shed a few pounds gradually. However, experts say that a Metformin pill isn’t a magical weight loss remedy as the amount lost is far less than you’d expect.

The relationship between Metformin and weight loss isn’t clear yet, but one plausible theory is that it minimizes calorie intake by suppressing appetite.

Metformin and diarrhea

Does Metformin cause diarrhea? Yes. Diarrhea is one of the side effects of this drug. Metformin diarrhea is thought to be a result of the increase in intestinal chloride secretion via apical chloride channels located in the apical membrane. Diarrhea when taking Metformin tends to resolve itself with time for most people. However, it’s essential to consult your doctor if it does not stop.

Glipizide Metformin- are there any differences?

Glipizide and Metformin are used to treat type 2 diabetes, but there are significant differences between them.

First, while Metformin class is a biguanide, Glipizide is in a category of medications known as Sulfonylurea. Metformin works by decreasing glucose production in the liver, increasing the body’s response to insulin, and reducing the absorption of glucose from food. On the other hand, Glipizide works by boosting insulin production in the body. This causes the body to utilize excess sugar leading to a decline of blood sugar levels.

Second, Glipizide increases the patient’s risk of hypoglycemia- a dangerously low level of blood sugar. On the contrary, Metformina 500 mg has a much lower risk of causing hypoglycemia.

Lastly, and more importantly, research studies comparing Metformin and Sulfonylureas show that the former has a much higher survival rate. This supports the use of Metformin as a first-line medication against diabetes type 2.

Trulicity and Metformin

Like Metformin, Trulicity is an antidiabetic medication, and it’s prescribed for people with type 2 diabetes. Trulicity works by stimulating the body to secrete insulin naturally. It also slows digestion besides lowering glucagon (a peptide hormone that increases glucose concentration in the blood).

Trulicity may be prescribed in situations where Metformin er 500 isn’t suitable for the patient. The significant difference between the 2 is that while Metformin is an oral medication, Trulicity is subcutaneously injected. Secondly, Metformin is in pregnancy category B, which signifies that it has no proven risks to pregnant women. Trulicity, on the other hand, is in category C. This suggests that it may have potential risks, although not yet determined. Lastly, Metformin half life is 4.5 hours while that of Trulicity is 120 hours.

Sitagliptin Metformin

Sitagliptin is the generic name for Januvia. Januvia and Metformin are oral medications that are combined with diet and exercises to treat type 2 diabetes mellitus. One of the differences between them is that unlike Metformin hcl 500, Sitagliptin has no risk of causing lactic acidosis. However, Sitagliptin has the potential to cause pancreatitis and musculoskeletal issues. Notably, although some Metformin Sitagliptin side effects are similar, others are unique to each drug.

Metformin anti aging

Recent animal studies show that rodents and worms put on a Metformin therapy outlived their placebo labmates. The researchers suggest that besides managing blood sugar levels, Metformin also has anti-aging effects, including reduced inflammation.

Although Metformin longevity in human beings seem promising, there are a few caveats. First, one study in France showed that Metformin causes vitamin B12 deficiency. Another study found out that combining Metformin and exercise therapies tend to be counterproductive. On the one hand, exercises lower the glucose-lowering abilities of Metformin. On the other hand, since Metformin increases heart rate, most patients are advised to engage in lower exercise workloads.

Jardiance and Metformin

Jardiance is an oral drug used to manage blood sugar levels and minimize the risk of cardiovascular and heart-related diseases among type 2 diabetes patients. Unlike Metformin, Jardiance is associated with low blood pressure, low immunity, and diabetic ketoacidosis (a serious condition where the body secretes excess blood acids). Metformin price is over 20x lower than that of Jardiance too.

All in all, Jardiance and Metformin are safe to take together, especially if you’re at a higher risk of heart attack or kidney damage. If you’re considering adding Jardiance to your antidiabetic therapy, you may want to consider a way to bring the total cost down, for instance, through insurance or manufacturer coupons.