COMMON BRAND NAME(S):
Glucophage

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Uses: (1) Used in combination with diet restrictions to treat non-insulindependent diabetes (type 2); (2) can be combined with a sulfonylurea for patients who do not have an adequate response to diet restrictions. May also be combined with insulin.

Other (unlabeled) generally accepted uses: (1) May be used as single-agent therapy to overcome insulin resistance; (2) could help non-diabetic, obese women with high blood pressure in helping improve blood pressure and lipid profile; (3) may help insulin-dependent (type 1) diabetics decrease insulin requirements; (4) may have a role in treating polycystic ovary syndrome (PCOS); (5) combination use with rosiglitazone may slow the progression of diabetes; (6) use in patients at risk for diabetes may PREVENT diabetes from happening.

As a Combination Drug Product [CD]: Metformin is available combined with glyburide (Glucovance) as initial treatment of type 2 diabetes or when blood sugar (glucose) control goals are not met by either medicine alone. Also available combined with glipizide (Metaglip).

How This Drug Works: Decreases sugar (glucose) production in the liver. It also increases sensitivity of the body to insulin.

Available Dosage Forms and Strengths

Tablets - 500 mg, 850 mg, 1,000 mg
Tablets, combination (Glucovance) - 250 mg metformin and 1.25 mg glyburide, 500 mg metformin and 2.5 or 5.0 mg glyburide
Tablets, combination (Metaglip) - 250 mg metformin and 2.5 mg glipizide, 500 mg metformin and 5.0 mg glipizide
Tablets, combination (Avandamet) - 500 mg metformin and 2 mg rosiglitazone
Tablets, extended release - 500 mg

Recommended Dosage Ranges (Actual dose and schedule must be determined for each patient individually.)

Infants and Children: Immediate release metformin is NOT recommended for children under 10 years old. For ages 10 to 16 years, the starting dose is 500 mg twice daily with meals. Dosing can be increased as needed and tolerated by 500 mg every 7 days to a maximum of 2,000 mg a day. Doses of this size are separated into equal doses and given 2 or 3 times a day based on results and patient tolerance. The safety and effectiveness for the XR form have not been established in that population.

16 to 60 Years of Age: Dosing is started at 500 mg twice daily. It is best to take this medicine with the morning and evening meals. Doses can be increased as needed and tolerated by 500 mg increments every 7 days. Some clinicians use 850 mg once daily. If the 850 mg dose is used, dosing is increased as needed and tolerated at 14-day intervals. Maximum dose is 2,500 mg if the 500 mg tablets are used, and 2,550 mg if the 850 mg tablets are used. Doses up to 2,000 mg are separated into 2 doses, but doses higher than this are best divided into 3 daily doses.

Over 60 Years of Age: Some patients may have acceptable blood sugar control with as little as 500 mg daily. If this dose is used, take it with the morning meal. Dose may be slowly increased if needed.

Conditions Requiring Dosing Adjustments

Liver Function: This drug should not be used by patients with liver compromise. This is a risk factor for lactic acidosis.
Kidney Function: NOT to be used in kidney disease (renal dysfunction) defined as females with steady-state creatinine levels greater than 1.4 or males with levels greater than 1.5.

Dosing Instructions: This drug should be taken with the morning and evening meals if it has been prescribed on a twice-daily basis. One study found that use of metformin with insulin at bedtime not only lowered risk of excessively low blood sugar (hypoglycemia), but also prevented weight gain. If you forget a dose: take the missed dose as soon as you remember it, unless it's nearly time for your next dose-if that is the case, skip the missed dose and take the next dose right on schedule. Talk with your doctor if you find yourself missing doses. Follow-up of benefits of this medicine involve finger stick blood sugar testing. Talk to your doctor about how often to check your blood sugar and what to check it with. (See the new Table 18-Patient Power and Home Test Kits).

Usual Duration of Use: Continual use on a regular schedule for a week is usually necessary to determine this drug's effectiveness in establishing tight glucose control. A month or more of continuous use will be needed before an effect on glycosylated hemoglobin (a measure of past success of glucose control) is seen. Long-term use (months to years) requires periodic evaluation of response and dose adjustment. See your doctor on a regular basis.

Please Note: The information contained on this page is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs or following any treatment or regimen. Only your doctor, nurse or pharmacist can provide you with advice on what is safe and effective for you.

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