Glucophage (Metformin): Usage, Side Effects, Dosage


Glucophage is a brand name of metformin hydrochloride, a medicine that can be prescribed to control blood sugar if you have type 2 diabetes . Metformin is an antihyperglycemic agent, which means that it helps reduce glucose production and absorption, as well as decrease insulin resistance . It is commonly used as a supplement to diet and exercise to help control diabetes.

Glucophage belongs to a class of drugs called biguanides , which are obtained from the flower of the French lilac. It is available as an immediate or sustained release oral tablet (Glucophage XR); Other extended-release brands of metformin include Fortamet and Glumetza. Metformin is also available as a generic drug. Riomet, another form of metformin, gives the drug as an oral solution that you drink.

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According to the American Diabetes Association (ADA) Standards for Diabetes Care, metformin, when tolerated, is the oral drug of choice for type 2 diabetes because it is considered safe and effective and may reduce cardiovascular risks .

Metformin is approved for use in adults and children over 10 years of age. The extended-release formula is approved for use by individuals 18 years of age and older.

Unlike people with type 1 diabetes , people with type 2 diabetes still produce insulin (although production may decrease as the disease progresses). The problem is that they do not produce enough hormone or what they do produce is not used effectively.

This leads to insulin resistance , when the hormone cannot direct sugar from the bloodstream to the cells for energy, and the liver and pancreas produce more insulin, although this is not necessary. The body is in chaos with high blood sugar and high insulin levels.

Glucophage helps restore normalcy by regulating blood sugar levels in three ways:

  • Reduces glucose production by the liver.
  • Reduces the absorption of glucose from food in the intestines.
  • Increases your body's insulin sensitivity by increasing glucose absorption and utilization in peripheral tissues.

Research shows that, as a first-line therapy for type 2 diabetes, metformin has beneficial effects on A1C (mean blood glucose), weight, and cardiovascular mortality compared to sulfonylureas.

Glucophage can be used with insulin or other diabetes medications for people with type 2 diabetes.

Updated ADA clinical guidelines recommend that patients with certain risk factors, including cardiovascular or kidney problems, receive other treatment along with metformin to help delay treatment failure.

Combinations containing metformin that may be recommended in place of Glucophage if you need to take more than one drug include:

  • Actoplus Met and Actoplus Met XR (metformin + pioglitazone)
  • Avandamet (metformin + rosiglitazone)
  • Glucovance (metformin + glyburide)
  • Invocamet and Invocamet XR (metformin + canagliflozin)
  • Janumet and Janumet XR (metformin + sitagliptin)
  • Jentadueto and Jentadueto XR (metformin + linagliptin)
  • Casano (metformin + alogliptin)
  • Combigliz XR (metformin + saxagliptin)
  • Metaglip (metformin + glipizide)
  • PrandiMet (metformin + repaglinide)
  • Sinjards and Sinjards XR (metformin + empagliflozin)
  • Xigduo XR   ( metformin + dapagliflozin)

Use not indicated on the label

In addition to being used for diabetes, Glucophage is sometimes used off-label in polycystic ovary syndrome (PCOS) as an aid to fertility, as a weight loss aid, for the treatment of gestational diabetes, or for lipodystrophy syndrome. HIV

Research has also shown that metformin targets many of the growth pathways of cancer, and studies are evaluating the possible increased survival of people with various types of cancer, including lung cancer, breast cancer, and breast cancer. bladder , who have been treated with metformin .

Metformin is also being studied for its effect on the thyroid gland, reducing the risk of goiter , thyroid nodules , and thyroid cancer .

Before drinking

To assess whether you are eligible to take glycophage or another form of metformin, your healthcare provider will test your blood glucose and A1C levels to obtain your current blood sugar control range.

Since metformin is often part of the first line of defense in type 2 diabetes, you can start with low doses with regular monitoring to see if glucose control improves.

Precautions and contraindications.

Certain medical circumstances can make metformin dangerous or even prohibit its use, including:

  • Kidney disease or kidney failure: Do not take Glucophage if you have severe kidney failure, as the drug poses a risk of lactic acidosis (see below). This risk increases with the severity of kidney disease as metformin is eliminated from the body.
  • Liver disease: Glucophage can reduce the absorption of lactate by the liver, increasing lactate levels in the blood. Do not take Glucophage if you have liver dysfunction due to an increased risk of lactic acidosis.
  • A history of heart attack, severe infection, or stroke – all of which increase the risk of lactic acidosis.
  • Known allergies or hypersensitivity: Do not take Glucophage if you have a known sensitivity to metformin.
  • Acute or chronic metabolic acidosis: Do not take Glucophage if you have metabolic acidosis, including diabetic ketoacidosis .
  • Pregnancy: There are no adequate and well-controlled studies on the use of metformin in pregnant women. Due to the risk of high blood glucose levels during pregnancy, insulin may be recommended to keep glucose levels as normal as possible.
  • Lactation: Metformin can pass into breast milk and there is a potential risk of hypoglycemia in babies.

Talk to your doctor about all the medications, supplements, and vitamins that you are currently taking. While some medications carry little risk of interactions, others may directly contraindicate their use or cause careful consideration of whether the benefits of treatment outweigh the disadvantages in your case.

Glucophage does not directly lower blood sugar levels like insulin does. Therefore, it is generally not suitable for people with type 1 diabetes who require insulin .


Glucophage is available in 500, 850, and 1000 milligram (mg) tablets; Glucophage XR is available in 500 or 750 mg tablets.

This medication should be gradually increased or adjusted to relieve stomach upset and to determine the lowest possible effective dose when first taken. How long it takes will depend on what your healthcare provider prescribes and how you respond to the medicine.

For example, a person who has taken metformin for the first time and has been prescribed 2000 mg can take this medicine as follows:

  • First week: 500 mg with breakfast and 500 mg with dinner.
  • Second week: 1000 mg with breakfast and 500 mg with dinner.
  • Third week: 1000 mg with breakfast and 1000 mg with dinner, which is in line with its therapeutic objective.

Those prescribed extended-release metformin generally start with a starting daily dose of 500 mg and increase to 500 mg each week.

For example, a person prescribed 1500 mg of sustained-release metformin can take this drug as follows:

  • First week: 500 mg with dinner
  • Second week: 1000 mg with dinner
  • Week 3: 1500 mg with dinner

During the titration, your healthcare professional may ask you to check your blood sugar level . If you experience hypoglycemia (low blood sugar) or any other side effects, contact your doctor so that your medication can be adjusted accordingly.

Recommended Maximum Daily Intakes
Adults Children from 10 to 16 years old
Glycophagus 2,550 mg 2000 mg
Glucophage XR 2000 mg

n / A

If you miss a dose, try to take the missed pill as soon as possible, unless you are getting closer to your next regular dose.

Doubling the dose or an overdose can lead to hypoglycemia (low blood sugar). Symptoms of hypoglycemia include dizziness, tremors, sweating, or confusion and should be treated right away.


Your healthcare provider may change your dose if you already have liver or kidney problems. In these cases, you should closely monitor your symptoms and blood markers.

Elderly patients should be prescribed the lowest possible dose due to the possibility of decreased kidney, liver or heart function, which may increase the risk of lactic acidosis. Any dose adjustment for the elderly should include a careful assessment of renal function.

How to take and store

To remember to take metformin, you should try to take it at around the same time every day .

People are advised to take Glucophage with food, as this increases its absorption in the stomach and reduces side effects (such as stomach cramps, diarrhea, and nausea). The extended-release version is usually taken once a day at dinner time.

Store this medicine at controlled room temperature (ideally 68 to 77 degrees Fahrenheit). You can travel with it in temperatures between 59 and 86 degrees Fahrenheit.

In general, try not to skip meals or drink alcohol while taking this medicine.

Side effects

As with any medication, the potential side effects must be weighed against the potential benefit. In the case of metformin, most of the side effects are fairly harmless.


Common side effects of Glucophage include :

  • Gas
  • Diarrhea
  • Stomach ache
  • Metallic flavor in the mouth

The first two usually top the list of people's complaints about the drug. Gas and diarrhea can often be relieved by gradually increasing the dose. If you experience these side effects, consult your doctor to make sure you are taking your medication correctly .

If you experience persistent side effects and are not yet taking the extended version of this drug, consider asking your doctor about the switch. Delivering them on time can help prevent gastrointestinal side effects.

Unlike many diabetes medications, Glucophage does not usually cause hypoglycemia. Also, unlike many type 2 diabetes medications, Glucophage does not cause weight gain and may even help with weight loss.

Severe form

Here concerns about lactic acidosis have been repeatedly expressed. This side effect is rare but serious.

Lactic acidosis occurs when lactic acid builds up in the blood and is caused by the body being forced to metabolize sugar without oxygen, rather than under aerobic conditions .

Although recent research suggests that it may not be directly related to metformin, the risk of lactic acidosis is increased in people with chronic kidney, liver, or heart disease .

If you experience any of the following symptoms, including symptoms of lactic acidosis and other serious reactions to metformin, seek medical attention immediately.

  • Cold feeling in the hands or feet.
  • Dizziness
  • Daze
  • Chest pain
  • Extreme weakness or fatigue
  • Unusual muscle pain
  • Shortness of breath or shortness of breath
  • Drowsiness or drowsiness
  • Stomach ache
  • Nausea or vomiting
  • Rash or hives

If lactic acidosis is not treated, it can lead to serious complications or even death (cardiac arrest).

Warnings and interactions

While you are taking metformin, your healthcare provider will want to monitor your blood sugar level and whether you should have an A1C test regularly to assess whether you need to adjust your medication dose or regimen. You may also need blood tests to check electrolytes, liver and kidney function.

Metformin can also cause B12 deficiency , a complication known as pernicious anemia that can lead to irreversible neurological damage. B12 deficiency has also been linked to an increased risk of stroke . The first symptoms of B12 deficiency can include anemia, tinnitus, and depression. It is important to monitor your B12 levels as supplements may be necessary.

If metformin is not enough to control blood sugar levels, hyperglycaemia (high blood sugar) may occur. It is important to monitor your blood sugar levels at home and seek immediate medical attention if you experience any signs of dangerously high blood sugar levels that could lead to unconsciousness. This can include confusion, seizures, dry mouth, vomiting, or bad breath.

Metformin can interact with many medications, which can interfere with their action or cause serious complications. Certain medical tests or procedures also carry risks, so always tell your doctor and dentist that you are taking Glucophage.

Serious interactions that can occur with the use of metformin include:

  • Medications or supplements for diabetes: When Glucophage is taken with the drug Glynase (glyburide), it can lower the levels of glyburide in the blood. When Glucophage is combined with supplements that target blood sugar, such as glimnema, the blood sugar can drop too low.
  • Gatofloxin: The use of this antibiotic with glycophage can cause blood sugar levels that are too high or too low. You may need to check your blood sugar level more often.
  • Contrast radiology: Contrast agents that contain iodine, such as those used in computed tomography (CT), in combination with metformin, can cause decreased kidney function and lactic acidosis. You may be asked to stop taking Glucophage 48 hours before any test with a contrast medium that contains iodine.
  • Beta- blockers : If you take beta-blockers such as lopressor (metoprolol) together with metformin, beta-blockers can prevent the rapid heartbeat you often feel when your blood sugar gets too low, virtually eliminating it. warning sign.
  • Dental or surgical procedures: Avoiding food or liquids during or in preparation for dental or surgical procedures while taking metformin may increase the risk of complications such as low blood pressure or kidney failure. You may need to temporarily stop taking the medicine.
  • Congestive heart failure, heart attack, or sepsis : Metformin-associated lactic acidosis can occur with these and other conditions associated with hypoxemia (low oxygen levels in the blood). If any of these events occur, you should stop taking the medicine.
  • Excessive alcohol consumption: Frequent alcohol consumption or the occasional excessive consumption of alcohol can increase the risk of lactic acidosis while taking Glucophage.
  • Diuretics : When Lasix (furosemide), which is used to treat high blood pressure or edema, is taken with glycophage, an interaction occurs that can raise blood glycophage levels and lower Lasix levels.
  • Calcium channel blockers : Adalat CC (nifedipine), which is used to treat high blood pressure or angina (chest pain), can improve glycophage absorption.
  • Cardiac medications: Ranexa (ranolazine) can increase metformin and the risk of lactic acidosis.
  • Tagamet (cimetidine): This medicine used to treat ulcers and gastrointestinal reflux (GERD) is an H2 blocker that reduces the amount of acid produced in the stomach. This can significantly raise blood levels of metformin, increasing the risk of lactic acidosis. When these drugs are taken together, careful monitoring is necessary.
  • Caprelsa (vandetanib): This drug used to treat thyroid cancer can increase metformin and the risk of lactic acidosis.
  • Human Immunodeficiency Virus (HIV) Medications: Integrase inhibitors such as tivicay (dolutegravir) , which are used with other medications to treat HIV, can increase metformin levels and the risk of lactic acidosis.
  • Carbonic anhydrase inhibitors: Medications such as Topamax (topiramate) and Zonegran (zonisamide) used to treat seizures, Diamox (acetazolamide) to treat glaucoma, and Keveyis (dichlorphenamide) to treat primary periodic paralysis (PPP) can cause acidosis hyperchloremic metabolic rate. This can increase the risk of lactic acidosis while taking Glucophage.

Also, anyone taking medications or supplements that can cause high blood sugar or loss of blood sugar control should be closely monitored while taking Glucophage. The same is true for anyone who stops treatment while taking Glucophage.

Medications and supplements that can cause hyperglycemia or loss of blood sugar control include:

  • Thiazides and other diuretics
  • Corticosteroids
  • Antipsychotics such as phenothiazines.
  • Thyroid Products
  • Estrogens
  • Oral contraceptives
  • Anticonvulsants such as Dilantin (phenytoin)
  • Niacin (B3, nicotinic acid)
  • Sympathomimetics
  • Calcium channel blockers
  • Isoniazid, used to treat tuberculosis (TB)

It is also important not to take more than one metformin medication at the same time, unless recommended by your doctor.

May 28, 2020: The Food and Drug Administration (FDA) required manufacturers of certain batches of metformin to voluntarily recall a product from the market after the agency identified unacceptable levels of N-nitrosodimethylamine (NDMA). Patients should continue to take their medication as prescribed until their healthcare provider prescribes an alternative treatment, if applicable. Stopping metformin without a replacement can pose a serious health risk for patients with type 2 diabetes.

Get the word of drug information

While metformin is an excellent option for treating type 2 diabetes, lifestyle approaches such as eating healthy and losing weight (in overweight people) are the most important ways to combat insulin resistance and prevent insulin resistance. possible long-term effects of diabetes. If you are prescribed Glucophage, be sure to take it as directed and consult your healthcare professional as recommended.

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