Metformin Hydrochloride

A to Z Drug Facts

Metformin Hydrochloride

 Action
 Indications
 Contraindications
 Route/Dosage
 Interactions
 Lab Test Interferences
 Adverse Reactions
 Precautions
Patient Care Considerations
 Administration/Storage
 Assessment/Interventions
 Patient/Family Education


(met-FORE-min HIGH-droe-KLOR-ide)
Glucophage
Tablets: 500 mg, 850 mg
Glucophage XR
Tablets, extended-release: 500 mg
Apo-Metformin
Gen-Metformin
Class: Antidiabetic, Biguanide

 Action Decreases blood glucose by decreasing hepatic glucose production. May also decrease intestinal absorption of glucose and increase response to insulin.

 Indications Adjunct to diet to lower blood glucose in patients with type 2 diabetes mellitus whose hyperglycemia cannot be controlled by diet alone.

 Contraindications Renal disease or dysfunction as suggested by serum creatinine > 1.5 mg/dL in males or > 1.4 mg/dL in females or abnormal Ccr; conditions which predispose to renal dysfunction (eg, cardiovascular collapse, acute MI, septicemia); in patients undergoing radiologic studies involving parenteral administration of iodinated contrast material (potential to acutely alter renal function); acute or chronic metabolic acidosis, including diabetic ketoacidosis.

 Route/Dosage

ADULTS: Initial dose: PO 500 mg bid, increase by 500 mg q wk (max, 2500 mg/day in divided doses).

ADULTS: Initial dose: PO 850 mg qd, increase by 850 mg q 2 wk (max, 2550 mg/day in divided doses).

ADULTS: Glucophage XR Initial dose: PO 500 mg qd with evening meal, increase by 500 mg q wk (max, 2000 mg once daily). If higher doses of metformin are required, administer at total daily dose up to 2500 mg in divided daily doses as described above.

 Interactions

Alcohol

Potentiates effect of metformin on lactate metabolism.

Cationic Drugs (eg, Amiloride, Digoxin, Quinidine)

May increase metformin serum concentration by competing for tubular secretion.

Cimetidine

Increases metformin serum concentration.

Furosemide

May increase metformin serum concentration; metformin may reduce furosemide serum concentration.

Iodinated Contrast Material

May cause acute renal failure and has been associated with lactic acidosis in patients receiving metformin.

Nifedipine

Increases metformin serum concentration.

 Lab Test Interferences None well documented.

 Adverse Reactions

EENT: Unpleasant/metallic taste. GI: Diarrhea; nausea; vomiting; abdominal bloating; flatulence; anorexia. METABOLIC: Lactic acidosis. OTHER: Subnormal vitamin B12 levels.

 Precautions

Pregnancy: Category B. Insulin is recommended to maintain blood glucose levels during pregnancy. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: Use with caution. Maximum doses are generally not used because of age-related decreases in renal function. Lactic Acidosis: Can occur and be fatal in » 50% of cases, as a result of metformin accumulation (eg, renal impairment) or with pathophysiologic conditions associated with tissue hypoperfusion and hypoxia. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient’s age. Renal Impairment: Decreased renal function results in decreased renal clearance and prolongation of the metformin half-life. Concomitant medications that affect renal function, result in significant hemodynamic changes or interfere with disposition of metformin (eg, cationic drugs eliminated by renal tubular secretion) should be used with caution. Hepatic Disease: Avoid metformin in patients with clinical or laboratory evidence of hepatic disease. GI Symptoms: GI symptoms occurring after a patient is stabilized on metformin are unlikely to be drug related but could be because of lactic acidosis or other serious disease. Iodinated Contrast Material: Withhold metformin for ³ 48 hr before parenteral contrast studies with iodinated materials. Reinstitute therapy 48 hr after the study and after renal function has been determined to be normal.


PATIENT CARE CONSIDERATIONS


 Administration/Storage

 Assessment/Interventions

OVERDOSAGE: SIGNS & SYMPTOMS
 Lactic acidosis: Malaise, myalgia, respiratory distress, increased somnolence, abdominal distress

 Patient/Family Education

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Copyright
© 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts

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