What is Metformin? Check side effects and uses

Today, there are many discussions about the increase in type 2 diabetes and its challenges for the public health of the society. Type 2 diabetes is known as one of the chronic and complex diseases worldwide, which is associated with impaired production and use of insulin in the body. The excessive increase in the number of this type of diabetes requires solutions for its better control and management. In the rest of the article, we will review the uses, amount and time of use, precautions and side effects of Metformin tablets.

Pharmaceutical forms of metformin

Pharmacists produce drugs in different pharmaceutical forms according to the needs of doctors and patients. Metformin drug in the form of regular tablets 500 mg (generic), 850 mg (generic) and 1000 mg (generic), sustained release tablets 500 mg (generic, Glometza), 750 mg (generic) and 1000 mg ( Generic, Glumeza), oral solution 100 mg/mL (Riomet), extended-release oral suspension 47.31 g/473 mL per bottle.

Uses of metformin tablets

Metformin is used with a proper diet and exercise program and possibly with other medications to control high blood sugar in people with type 2 diabetes. Controlling high blood sugar can help prevent kidney damage, blindness, neurological problems, loss of limbs, and problems with sexual function. Proper diabetes control may also reduce the risk of heart attack or stroke. Metformin works by helping to restore your body’s proper response to the insulin you naturally produce. It also reduces the amount of sugar your liver makes and your stomach or intestines absorb.

Glucophage consumption in adults

1. Type 2 diabetes
2. Prevention of type 2 diabetes (off label)
3. Polycystic ovary syndrome (orphan)
4. Myoclonus epilepsy (orphan)

Glucophage use in children

1. Type 2 diabetes

Glucophage consumption in the elderly

1. Elderly patients are more likely to have reduced kidney function. Contraindicated in patients with renal failure, carefully monitor kidney function in the elderly and use with caution as they age.
2. This drug is not used in patients over 80 years of age unless normal kidney function is determined. The initial and maintenance dose of metformin in elderly patients should be conservative, because there is a possibility of decreased renal function in these people.
3. Controlled clinical studies of metformin did not include sufficient numbers of elderly patients to determine whether they respond differently from younger patients.

Pharmacological effects and mechanism of action of Metformin

Mechanism of action of metformin Metformin reduces hepatic glucose production and reduces GI glucose absorption. It also increases the insulin sensitivity of the target cell. The release of this drug in 2-3 hours and its absorption with bioavailability is 50-60%. Limited protein distribution is minimal and excreted through urine (90% through tubular secretion). It can also be removed in renal clearance (renal excretion capacity) of 450-540 ml per minute (regular release).

Dosage of Metformin tablets

The dosage of metformin tablets is 500 mg every 12 hours or 850 mg per day with meals. Dose increases by 500 mg per week or 850 mg every two weeks based on blood sugar control and patient tolerance. The extended-release tablet of this product is also prescribed 500 mg per day with dinner or 500 mg per day, which should not exceed 2000 mg per day. For the prevention of type 2 diabetes, 850 mg PO per day or 850 mg every 12 hours is prescribed as prescribed by the doctor.

Dosage of glucophage tablets in children

This product is used as a dietary supplement along with exercise to improve blood sugar control in adults and children under 10 years old with type 2 diabetes. Metformin tablets are prescribed by doctors at the age of 10 to 17 years in the initial immediate release of 500 mg every 12 hours and in the extended release of 500 mg PO per day with dinner. Also, if necessary, increase the dose by increasing 500 mg (5 ml) per week, up to a maximum dose of 2000 mg (20 ml) once a day, together with the evening meal.

Time to take Metformin

Be sure to read the patient information file and instructions for use, if available, before starting to use metformin solution or serum, before using or refilling it. Take this product orally as directed by your doctor. It should be noted that the dosage is determined by your doctor based on your medical condition, response to treatment and medications used. To reduce the risk of side effects (such as stomach upset), your doctor may instruct you to start this medication at a low dose and gradually increase your dose.

Precautions

Metformin may contain inactive ingredients that can cause allergic reactions or other problems. If you already have specific medical history such as breathing problems (obstructive lung disease or asthma), blood problems (such as anemia, vitamin B12 deficiency), liver disease, etc., be sure to inform your doctor. Before having surgery or any x-ray (scan) procedure using iodinated contrast material, tell your doctor or dentist about all the products you use (including prescription drugs, over-the-counter drugs, and herbal products).

1. This product can increase the risk of severe hypoglycemia, especially in the elderly, weak or malnourished, adrenal or pituitary gland failure, dehydration, hypoxic conditions, liver and kidney failure, stress caused by infection, fever, trauma, etc.
2. Concomitant use of insulin and insulin-secreting agents (eg, sulfonylureas) may increase the risk of hypoglycemia. Therefore, to minimize the risk of hypoglycemia in combination with metformin, a lower dose of insulin or insulin secretagogue is required.
3. Withholding food and fluids during surgery or other procedures may increase the risk of volume depletion, hypotension, and kidney failure.
4. There is a possibility of rare lactic acidosis due to metformin accumulation, which can be fatal.
5. In some cases, it causes ovulation in PCOS patients before menopause and lack of ovulation.
6. In case of exposure to stress (fever, trauma, infection) or experiencing diabetic ketoacidosis, it may be necessary to discontinue metformin treatment and prescribe insulin.

Contraindications for metformin tablets

1. Lactic acidosis is a rare but potentially severe consequence of metformin therapy, characterized by increased blood lactate levels (>5 mmol/L), decreased blood pH, electrolyte disturbances with increased anion gap, and increased lactate ratio.
2. Risk factors for metformin-related lactic acidosis include renal failure, concomitant use of certain medications (eg, carbonic anhydrase inhibitors such as topiramate), age 65 years or older, hypoxic conditions eg, acute congestive heart failure, excessive alcohol consumption, and liver failure.
3. Patients with CHF (congestive heart failure) who require pharmacologic management, especially patients with unstable or acute CHF who are at risk for hypoperfusion and hypoxemia, should use this drug with caution and as directed by their physician.
4. Do not use in patients 80 years of age or older unless CrCl shows that renal function is not reduced, as these patients are more susceptible to lactic acidosis.
5. In general, it should be avoided in patients with clinical or laboratory evidence of liver disease.
6. Once the patient is stabilized at any dose level of metformin, if a specific gastrointestinal problem occurs it is not related to the pill.
7. Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis who does not have evidence of ketoacidosis (ketonuria and ketonemia). Lactic acidosis is a medical emergency that must be treated in a hospital.

Metformin side effects

Some side effects such as nausea, vomiting, stomach upset, diarrhea, gas, weakness or metallic taste in the mouth have been observed after taking metformin. Stomach symptoms that occur after the first few days of your treatment may be signs of lactic acidosis. Remember that this medication has been prescribed because your doctor has determined that the benefits to you are greater than the risk of side effects. Most people who use this drug do not experience serious side effects. Some of the most important side effects of this product include the following:

• Diarrhea, immediate release product
• Nausea and vomiting, immediate release product
• Diarrhea, prolonged release product
• Nausea and vomiting, prolonged release product
• Abdominal pain and constipation
• Abdominal distension
• Indigestion/heartburn
• Flatulence
• Dizziness and headache
• Upper respiratory tract infection
• taste disorder

Drug interaction of metformin

Drug interactions may change how your medications work or increase your risk of serious side effects. To avoid drug interactions, prepare a list of chemical and herbal medicines you use and show them to the doctor when you visit. Many medications can affect your blood sugar and make it harder to control. Before starting, stopping, or changing any medication, talk to your doctor or pharmacist about how it may affect your blood sugar. Beta-blockers (such as metoprolol, propranolol, glaucoma eye drops such as timolol) may prevent a fast heartbeat.

Taking Metformin tablets during pregnancy and breastfeeding

Limited data in pregnant women are insufficient to determine the drug’s associated risk of birth defects or miscarriage. Published studies on metformin use during pregnancy have not reported a clear association of this drug with birth defects or risk of miscarriage. Poorly controlled diabetes mellitus in pregnancy increases the risk of diabetic ketoacidosis, preeclampsia, spontaneous abortion, premature delivery, stillbirth, and birth complications. Also, poorly controlled diabetes mellitus increases the risk of major birth defects, stillbirths, and complications related to macrosomia.

Review of human studies of glucophage tablets in pregnancy

Published data from post-marketing studies of this product have not reported a clear association with metformin and major birth defects, miscarriage, or adverse maternal or fetal outcomes when used during pregnancy. However, these studies cannot definitively prove the absence of risk associated with metformin due to methodological limitations, including small sample sizes and inconsistent comparison groups.

Review of animal studies of glucophage tablets in pregnancy

Metformin hydrochloride did not adversely affect developmental outcomes when administered to pregnant rats and rabbits at doses up to 600 mg/kg/day. This represents an exposure of approximately 2 and 5 times the clinical dose of 2,550 mg based on body surface area comparisons for rats and rabbits. Also determination of fetal concentration showed a partial placental barrier for this drug.

The effect of Glucophage tablets during breastfeeding

Limited published studies report that metformin is present in human milk. However, there is not enough information to determine the effects of this drug on nursing infants.

Metformin storage conditions

Store in the original bottle at room temperature away from light and moisture. You can use Metformin tablets until the expiration date, but throw away the solution and other forms after 100 days of any unused portion. Keep metformin out of the reach of children and animals. Dispose of this product properly when it has expired or is no longer needed. Do not pour this medicine into the street, sewer or toilet.

The last words of metformin tablets

As we explained in this article from Positive Green Online Pharmacy magazine, metformin tablet as one of the key drugs in the management of type 2 diabetes plays a vital role in controlling blood glucose levels and improving insulin sensitivity. This drug helps to reduce blood sugar with its multiple effects, including reducing glucose production from the liver, increasing glucose absorption in muscles and reducing its absorption in the intestine. Also, metformin is known as an antidiabetic drug with additional positive effects on blood cholesterol levels and body weight. This product should be used by patients with the approval and order of the doctor.

Site source: Medscape

Frequently asked questions about metformin tablets