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Metformin

Molecule Description

Metformin belongs to the Biguanide group of medicines used to treat diabetes mellitus and reduce blood sugar levels.

Uses of Metformin

It is used for Type 2 diabetes mellitus (‘non-insulin dependent diabetes’) when diet and exercise have not been able to control your blood glucose levels.

Contraindications of Metformin

When should one not use Metformin

  • Type 1 diabetes mellitus
  • Liver disease
  • Kidney disease (severe)
  • Heart failure
  • Severe respiratory disease
  • If you are a heavy drinker of alcohol
  • If you are allergic (hypersensitive) to Metformin
  • If you have a severe infection such as infections of lung or your kidney. Infections can increase the risk for lactic acidosis (see 'Warnings and precautions')

Side effects of Metformin

Common side effects of this drug are:

  • The most common side effects of Metformin are loss of appetite, nausea, vomiting, stomach ache and mild diarrhea. Do not stop taking medicine if you experience these as these are transient and shall go away after a few weeks
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  • Altered taste sensations
  • Decreased Vitamin B12 levels
  • Skin rashes, redness, itching and hives
  • Weight loss is also a known side effect which is desirable in young and middle-aged obese patients
  • A rare but severe side effect of Metformin is lactic acidosis (symptoms: nausea, vomiting, generalized muscle weakness and rapid breathing; see warnings section)
  • Metformin does not usually cause sudden low blood sugar (hypoglycemia)
  • If Metformin is prescribed with other anti-diabetic medications, there may be an occurrence of low blood sugar level
  • Metformin can cause abnormal liver function tests and hepatitis. If you notice yellowing of the eyes or skin, contact your doctor immediately

Precautions and Warnings of Metformin

Pregnancy

Q:
Can I take Metformin during pregnancy?
A:
In general, in pregnancy-related diabetes, insulin is preferred over any oral blood-glucose-lowering medicines as a thumb rule. Your doctor will mostly not prescribe this medicine to you in pregnancy. Do not use in pregnancy without a doctor’s advice.

Breast Feeding

Q:
Can I take Metformin while breastfeeding?
A:
It is known to pass into mother’s milk. So it should be not taken in breastfeeding.

Driving

Q:
Can I drive if I have consumed Metformin?
A:
If you are taking Metformin along with other antidiabetic medicines, there are chances your blood sugar can fall. You may experience faintness, confusion and increased sweating. So, in this case, you should take extra care while driving. Keep a juice or chocolate handy while driving in case you start experiencing any of these and immediately have it.

Alcohol

Q:
Can I consume alcohol with Metformin?
A:
Avoid excessive intake of alcohol while taking Metformin. Alcohol lowers blood sugar and also increases the risk of a serious condition called lactic acidosis.

Other General Warnings

Talk to your doctor if
  • You experience vomiting, stomach ache, muscle cramps, difficulty in breathing, reduced body temperature and heartbeat
  • Stop the medication of Metformin for a short time if you have a condition that may be associated with dehydration (significant loss of body fluids) such as severe vomiting, diarrhea
  • Metformin can cause a critical condition called lactic acidosis
  • The risk factors are uncontrolled diabetes, serious infections, prolonged fasting or alcohol intake, dehydration, liver problems and any severe heart conditions

Mode of Action of Metformin

How Does It Work?

  • Your pancreas produces a hormone called insulin. Insulin drives glucose (sugar) from the blood to enter inside the cell. Then this glucose is utilized as energy by the cell
  • If you have diabetes mellitus, your pancreas either does not make enough insulin or your body is unable to use the insulin it produces properly (insulin resistance). As a result, glucose is not able to enter into the cells and this leads to a high level of glucose in your blood
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  • Metformin works by decreasing the amount of glucose absorbed from the intestine, lowering the amount of sugar created by the liver and facilitating entry of sugar into the cells

Interactions of Metformin

Interactions with other medicines

  • Phenytoin
  • Birth control pills or hormone replacement therapy
  • Diet pills or medicines to treat asthma, colds, or allergies
  • Increase urine production (a diuretic)
  • Heart or blood pressure medications
  • Niacin
  • Phenothiazines
  • Steroids (Prednisone, Methylprednisolone, Dexamethasone and others)
  • Thyroid medicine
  • Medicines like Furosemide and Cimetidine can increase the side effects of Metformin
  • If you need to have an injection of iodine-containing contrast medium into your bloodstream, for an X-ray or scan, your doctor will ask you to stop taking Metformin before or at the time of injection
  • If you are on medicines that are used to treat pain and inflammation (NSAID and COX-2 inhibitors such as Ibuprofen and Celecoxib) for the long term, these can damage your kidneys. Use of such medicines in diabetes should be avoided
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Interactions with food items

Absorption of Vitamin B12 appears to be reduced during long-term Metformin therapy and annual screening of serum Vitamin B12 levels and red blood cell parameters has been recommended to determine the need for Vitamin B12 injections.
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Dietary Restrictions of Metformin

Advisable to have a diabetic diet as recommended by your doctor or dietician. This medicine works best along with a proper diet and exercise. Exercise is known to decrease insulin resistance.

Dosage of Metformin

Overdose

You must seek emergency medical care immediately if you suspect overdose. In the case of overdose, lactic acidosis may occur. Symptoms of lactic acidosis are vomiting, stomach ache, muscle cramps and difficulty in breathing.
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Missed a Dose

If you miss any dose, take it as soon as you remember with food. However, if it is time for the next dose then skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
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Content Details

WRITTEN BY
REVIEWED BY
doctor

Dr. Ritu Budania

MBBS, MD (Pharmacology)

Last Updated on: 05 Oct 2020 | 10:47 PM (IST)

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