WARNING

Metformin is a commonly prescribed medication for managing type 2 diabetes. While it is generally considered safe and effective, there are some risks associated with its use:

• Gastrointestinal Upset: One of the most common side effects of metformin is gastrointestinal discomfort, including diarrhea, nausea, and stomach upset. These symptoms usually improve over time but can be bothersome for some individuals.
• Lactic Acidosis: In rare cases, metformin can cause a serious condition called lactic acidosis, which is characterized by a buildup of lactic acid in the bloodstream. This condition can be life-threatening and requires immediate medical attention. Lactic acidosis is more likely to occur in people with kidney or liver problems or those with conditions that can cause hypoxia (low oxygen levels).
• Vitamin B12 Deficiency: Long-term use of metformin has been associated with a decrease in vitamin B12 levels in some individuals. Vitamin B12 deficiency can lead to symptoms such as fatigue, weakness, and neurological problems.
• Potential for Hypoglycemia: While metformin itself does not usually cause hypoglycemia (low blood sugar), it can increase the risk of hypoglycemia when used in combination with other diabetes medications that lower blood sugar levels.
• Kidney Function: Metformin is primarily excreted through the kidneys, so it should be used with caution in individuals with impaired kidney function. In some cases, metformin may need to be dose-adjusted or avoided altogether in people with severe kidney impairment.
• Heart Health: There have been some concerns about the potential impact of metformin on heart health, particularly in individuals with pre-existing heart conditions. However, recent research suggests that metformin may actually have cardiovascular benefits for some people with diabetes.

It’s important for individuals taking metformin to be aware of these potential risks and to discuss any concerns with their healthcare provider. Additionally, regular monitoring of kidney function, vitamin B12 levels, and blood sugar levels is typically recommended for those taking metformin long-term.

Why is this medication prescribed?

Metformin is primarily prescribed to manage type 2 diabetes. It helps control blood sugar levels by reducing glucose production in the liver and increasing the body’s sensitivity to insulin. By improving insulin sensitivity and reducing insulin resistance, metformin helps lower blood sugar levels, which is essential for managing diabetes and reducing the risk of associated complications such as heart disease, kidney damage, nerve damage, and blindness. Additionally, metformin may also be prescribed for certain other conditions, such as polycystic ovary syndrome (PCOS), where it can help regulate menstrual cycles and improve fertility by addressing insulin resistance.

How should this medicine be used?

Here’s how metformin is typically used:

• Dosage: The dosage of metformin varies depending on individual factors such as age, kidney function, and response to the medication. It is usually started at a low dose and gradually increased over time to minimize gastrointestinal side effects.
• Administration: Metformin is usually taken orally in the form of tablets or extended-release tablets. It is typically taken with meals to reduce gastrointestinal side effects.
• Frequency: Metformin is usually taken once or twice daily, as prescribed by a healthcare provider. It’s important to follow the prescribed dosing schedule and not to skip doses.
• Monitoring: Regular monitoring of blood sugar levels is important while taking metformin to ensure that the medication is effectively controlling diabetes. Healthcare providers may also monitor kidney function and vitamin B12 levels periodically, especially in individuals at higher risk for complications.
• Lifestyle Changes: Metformin is most effective when combined with healthy lifestyle habits, including a balanced diet, regular exercise, weight management, and avoiding smoking and excessive alcohol consumption.
• Caution with Other Medications: It’s important to inform healthcare providers about all medications, supplements, and herbal products being taken, as they may interact with metformin. Certain medications, such as those affecting kidney function or blood sugar levels, may require dosage adjustments when taken with metformin.

It’s essential for individuals prescribed metformin to follow their healthcare provider’s instructions carefully and to communicate any concerns or side effects experienced while taking the medication. Additionally, regular follow-up appointments with healthcare providers are important to ensure the medication’s effectiveness and safety.

Other uses for this medicine

While Metformin is primarily used to treat type 2 diabetes, it may also have other off-label uses, including:

• Polycystic ovary syndrome (PCOS): Metformin may be prescribed off-label to help manage symptoms of PCOS, such as irregular menstrual cycles, infertility, and insulin resistance.
• Gestational diabetes: In some cases, Metformin may be used off-label to manage gestational diabetes, a type of diabetes that occurs during pregnancy.
• Weight management: Metformin may be prescribed off-label to aid in weight loss or weight management, particularly in individuals with insulin resistance or obesity.

What special precautions should I follow?

Regarding special precautions for metformin use, here are some important considerations:

• Kidney Function: Metformin is primarily excreted through the kidneys, so it should be used with caution in individuals with impaired kidney function. Dosage adjustments or alternative treatments may be necessary in people with reduced kidney function to avoid the risk of lactic acidosis.
• Liver Function: Metformin is generally considered safe for people with liver disease, but caution is advised, particularly in cases of severe liver impairment. Liver function may need to be monitored regularly in individuals with liver disease.
• Alcohol: Drinking alcohol while taking metformin can increase the risk of lactic acidosis. It’s important to limit alcohol consumption and to avoid excessive drinking while on metformin therapy.
• Vitamin B12 Levels: Long-term use of metformin has been associated with decreased vitamin B12 levels in some individuals. Healthcare providers may recommend monitoring vitamin B12 levels periodically and considering supplementation if deficiency occurs.
• Surgery and Imaging Procedures: Metformin may need to be temporarily discontinued before certain surgeries, medical procedures, or imaging tests involving the use of contrast dye. This is to reduce the risk of lactic acidosis.
• Hypoglycemia: While metformin itself does not usually cause hypoglycemia (low blood sugar), it can increase the risk of hypoglycemia when used in combination with other diabetes medications or insulin. Monitoring blood sugar levels regularly is important to prevent and manage hypoglycemia.
• Pregnancy and Breastfeeding: The safety of metformin during pregnancy and breastfeeding is still being studied. Pregnant or breastfeeding individuals should discuss the risks and benefits of metformin with their healthcare provider before using the medication.

It’s important to follow all prescribed instructions and to communicate any concerns or side effects with a healthcare provider while taking metformin.

What special dietary instructions should I follow?

Special dietary instructions for metformin:

• It’s generally recommended to take metformin with meals to help reduce gastrointestinal side effects such as nausea and diarrhea. Follow your healthcare provider’s instructions regarding the timing and frequency of metformin doses with meals.
• A balanced diet that includes a variety of nutrient-rich foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats, is important for overall health and can complement the effects of metformin in managing blood sugar levels.

What should I do if I forget a dose?

• If you miss a dose of metformin, take it as soon as you remember, unless it is almost time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule.
• Do not take a double dose to make up for a missed one, as this can increase the risk of side effects.
• If you’re unsure about what to do, or if you frequently forget doses, consult your healthcare provider for guidance on managing your medication schedule effectively.

What side effects can this medication cause?

Metformin, like any medication, can cause side effects in some individuals. Common side effects of metformin include:

• Gastrointestinal Upset: The most common side effects of metformin are gastrointestinal symptoms, such as diarrhea, nausea, vomiting, abdominal discomfort, and gas. These symptoms typically occur at the beginning of treatment and may improve over time.
• Taste Changes: Some people may experience a metallic taste in the mouth or changes in taste sensation while taking metformin.
• Loss of Appetite: Metformin can sometimes cause a decrease in appetite or feelings of fullness, which may lead to reduced food intake.
• Vitamin B12 Deficiency: Long-term use of metformin has been associated with decreased vitamin B12 levels in some individuals, which can lead to symptoms such as fatigue, weakness, and neurological problems.
• Lactic Acidosis: Although rare, metformin can potentially cause a serious condition called lactic acidosis, characterized by a buildup of lactic acid in the bloodstream. Symptoms of lactic acidosis include weakness, muscle pain, difficulty breathing, abdominal discomfort, and irregular heartbeat. Lactic acidosis requires immediate medical attention.
• Hypoglycemia: While metformin itself does not usually cause hypoglycemia (low blood sugar), it can increase the risk of hypoglycemia when used in combination with other diabetes medications or insulin.
• Skin Reactions: Some individuals may experience skin reactions such as rash, itching, or erythema (redness) while taking metformin.
• Changes in Liver Function: In rare cases, metformin may cause abnormalities in liver function tests, although these effects are usually reversible.

It’s important to note that not everyone will experience these side effects, and many people tolerate metformin well. If you experience any bothersome or persistent side effects while taking metformin, it’s essential to discuss them with your healthcare provider. They can provide guidance on managing side effects and may adjust your dosage or recommend alternative treatments if necessary. Additionally, if you experience any symptoms of lactic acidosis or severe side effects, seek immediate medical attention.

What should I know about storage and disposal of this medication?

Storage and disposal of metformin:

• Storage: Metformin should be stored at room temperature, away from moisture and heat. Avoid storing it in the bathroom. Keep the medication in its original packaging, tightly closed, and out of reach of children and pets.
• Disposal: Unused or expired metformin should be disposed of properly to prevent accidental ingestion. Do not flush medications down the toilet or pour them down the drain unless instructed to do so. Instead, check with your pharmacist or local waste disposal company for guidelines on how to safely dispose of medications.

In case of emergency/overdose

In case of emergency/overdose of metformin:

• If you suspect an overdose of metformin or experience symptoms such as severe dizziness, lightheadedness, weakness, confusion, difficulty breathing, abdominal pain, nausea, or vomiting, seek immediate medical attention or contact a poison control center right away.
• Emergency medical treatment may be necessary for severe cases of metformin overdose. Treatment may include supportive care to stabilize vital signs, intravenous fluids, and measures to enhance metformin elimination from the body, such as hemodialysis.

What other information should I know?

• Follow your healthcare provider’s instructions carefully regarding the use of metformin, including dosage, frequency, and timing of doses.
• Keep all appointments with your healthcare provider for monitoring of blood sugar levels, kidney function, and other relevant parameters.
• Inform your healthcare provider about all medications, supplements, and herbal products you are taking, as they may interact with metformin.
• Be aware of potential side effects of metformin and report any bothersome or persistent symptoms to your healthcare provider.
• Maintain a healthy lifestyle, including a balanced diet, regular exercise, weight management, and avoiding smoking and excessive alcohol consumption, to complement the effects of metformin in managing diabetes.
• Carry identification or wear a medical alert bracelet indicating that you are taking metformin in case of emergencies.
• Keep a source of fast-acting sugar (such as glucose tablets or gel) with you in case of hypoglycemia (low blood sugar) while taking metformin.
• If you have any questions or concerns about metformin, don’t hesitate to discuss them with your healthcare provider or pharmacist.