Metformin

Indications
Oral
Type 2 diabetes mellitus
Adult: Initiate therapy slowly in order to minimise adverse gastric events. Initially 500 mg bid-tid or 850 mg 1-2 times daily, may increase doses in steps of 500 mg at intervals of at least 1 wk. Max: 2.25 g daily.
Child: ≥10 yr: Initiate therapy slowly in order to minimise adverse gastric events. Initially 500 or 850 mg once daily, increase doses either wkly by 500 mg daily or every 2 wk by 850 mg daily to a maintenance dose of 1500 - 2000 mg daily in 2 or 3 divided doses. Max dose 2000 mg daily.
Elderly: Doses may need to be reduced by around a third in elderly patients.
Oral
Polycystic ovarian syndrome
Adult: Initially 500 mg daily in the morning for 1 wk, then 500 mg bid for 1 wk, then 1.5-1.7 g daily in 2-3 divided doses.
Contraindications
Acute or chronic metabolic acidosis with or without coma (including diabetic ketoacidosis). Renal failure, severe renal or hepatic impairment, acute conditions which may affect renal function e.g. dehydration, severe infection or shock. Cardiac failure, CHF, IDDM, severe impairment of thyroid function; acute or chronic alcoholism. Acute or chronic diseases which may cause tissue hypoxia e.g. cardiac or respiratory failure, recent MI or shock. Pregnancy, lactation.
Warnings / Precautions
Caution when used in patients with CHF especially in those with unstable or acute heart failure. Risk of lactic acid accumulation increases with the degree of renal impairment. May need to discontinue treatment in patients with stress-related states e.g. fever, trauma, infection or surgery. Metformin should be temporarily discontinued for 48 hr in patients undergoing radiologic studies involving intravascular admin of iodinated contrast materials. Elderly. Monitor renal function regularly. May impair ability to drive or operate machinery.
Adverse Reactions
Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of vit B12. Chest discomfort, flushing, palpitation, chills, headache, lightheadedness, indigestion, abdominal discomfort.
Potentially Fatal: Lactic acidosis in presence of renal failure and alcoholism.
Overdose Reactions
Lactic acidosis may occur. Accumulated drug may be removed by haemodialysis.
Drug Interactions
Additive effect with sulphonylureas. Glycaemic control may be affected by diuretics, corticosteroids, phenothiazines, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, chlorpromazine and isoniazid. Metformin effects may be increased by ACE inhibitors, disopyramide, MAOIs. Cimetidine may increase the serum levels of metformin. Concurrent use with contrast agents may increase the risk of metformin-induced lactic acidosis. May decrease the anticoagulant effect of phenprocoumon, therefore routine anticoagulant monitoring is recommended.
Potentially Fatal: Lactic acidosis with alcohol. Thrombocytopenia has been reported with ketotifen.
See Below for More metformin Drug Interactions
Mechanism of Actions
The exact mechanism of action of metformin is unclear but it appears to reduce glucose absorption from the GI tract, reduce gluconeogenesis and enhance insulin sensitivity by increasing peripheral glucose uptake and utilisation.
Absorption: Slow and incomplete from the GI tract (oral); reduced if taken with food.
Distribution: Protein-binding: Negligible.
Excretion: Urine (as unchanged drug).
Administration
Should be taken with food.
Storage Conditions
Oral: Store at 20-25°C.
ATC Classification
A10BA02 - metformin ; Belongs to the class of biguanides. Used in the treatment of diabetes.
Storage
Oral: Store at 20-25°C.
Available As
  • Metformin 100 mg
  • Metformin 1000 mg
  • Metformin 2 mg
  • Metformin 2000 mg
  • Metformin 250 mg
  • Metformin 400 mg
  • Metformin 500 mg
  • Metformin 7.5 mg
  • Metformin 800 mg
  • Metformin 850 mg
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