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This medicine is indicated in maturity onset diabetes either alone or with sulphonylureas. It is also used as adjuvant therapy in insulin dependent diabetes, particularly in obese patients.

GI upset, taste disturbance, abnormal liver function tests, hepatitis (inflammatory condition of liver), skin reactions, reduced B12 absorption are some of its side effects. Rarely it may cause lactic acidosis (buildup of lactate causing acidic pH of blood stream).

This medicine is contraindicated in patients with diabetic ketoacidosis (life threatening condition in which liver breaks down fats into ketones for energy) or precoma (a state of near unconsciousness), renal (kidney) or hepatic (liver) impairment, acute conditions predisposing to renal impairment, cardiac or respiratory failure, recent myocardial infarction (heart attack), alcoholism and in patients with administration of iodinated contrast materials.

This medicine should be taken with food.

Avoid this medication if:

  • You are allergic to this medicine or its contents 

Consult your doctor if:

  • You are pregnant, planning to have a child, or breastfeeding.
  • If you are avoiding unwanted pregnancy, so that your doctor may suggest a suitable form of birth control. Due to Metformin's effects on ovulation and pregnancy.
  • You have any sort of digestive problems after taking this medicine: Nausea, vomiting, diarrhea, etc.
  • You have a medical history of: Liver diseases, kidney diseases, congestive heart failure, or lung disease.
  • If you are about to undergo any medical or surgical treatment. 
  • If you are about to undergo any CT scan, or X-ray, as it may interact with the dyes used in some pf these procedures.
  • If you have a B12 deficiency, are anemic, or are developing symptoms of anemia, Such as: lethargy, aches and pains,  or a pale appearance to the skin. 

Be careful about:

  • Having your meals on time to maintain blood sugar levels.
  • Taking the medicine timely, in the way that your physician has prescribed (with food), this will help avoid digestive disturbances.
  • Alcohol consumption.
  • Avoiding dehydration in any form.
Type II diabetes
Metformin belongs to a class of drugs known as biguanides. It is used to improve insulin activity, and control weight in diabetic patients. It is also known to regulate menstrual cycles (periods) and is used in the treatment of PCOs (Poly Cystic Ovarian Disease.)
No, this drug does not contain hormones, or insulin,. It enhances the effect of insulin, which helps patients with diabetes or PCOs, since their bodies tend to develop a resistance to the actions of insulin.
Though there is no dangerous drug interaction, an adjustment in doses of both anti thyroid drugs, and steroids (eg: prednisone) may be required. It should be noted that patients taking steroids sometimes develop diabetes as a side effect. Please consult your physician, and discuss all the medicines you are taking, including their doses.
Lactic acidosis is a very rare, and potentially fatal side effect of this medication. It occurs when there is an excessive buildup of lactic acid in the body. It may occur in patients who have overdosed. Symptoms include stomach problems, dizziness, breathing difficulty, muscle aches, irregular heartbeat, etc. Patients who experience these symptoms should go to a doctor immediately.
Please use this medicine for the time that has been prescribed, and in the dose prescribed by your physician. Using it for longer than prescribed can cause side effects such as Vitamin B12 deficiency.
Low blood sugar is rare with Metformin, but it is a possible side effect, especially if you are taking other anti-diabetic drugs. Please maintain regularity in meals, dosage, and exercise to maintain blood sugar levels, and continue monitoring sugar levels. Also carry sugar or a sugary drink in case you feel dizzy, or develop any other sign of low blood sugar.
You can take the missed dose as soon as you remember. If you remember when it is almost time for your next dose, then skip the missed dose entirely. Do not double your dose to catch up for missed doses.
It is important to maintain regularity in meals, and exercise. Low blood sugar is rare, but may occur if you are taking other anti-diabetic medication.
Weight gain is unlikely with this medicine, however, it does cause weight loss. This is because it improves the actions of insulin, and decreases hunger. Please take note that this drug is not a medicine which treats weight loss, and should only be used if prescribed by your physician. This medicine may, however, cause bloating. It is best taken after meals to avoid this side effect.
This medication can result in a vitamin B12 deficiency after being used for a long time, and this can cause anemia. Please discuss with your doctor if you are already anemic, or if you start experiencing symptoms such as paleness, weakness, lethargy, etc.
In patients who have fatty liver, and hepatitis C related liver disease, it is safe and is recommended. However, it is discouraged in patients who have liver cirrhosis, due to its association with lactic acidosis.
This medicine is safe to use in pregnant females. No evidence of risk found. 
This medicine is contraindicated in lactating females.
Please avoid consuming alcohol when taking this medicine.
Assess risk factors for lactic acidosis (buildup of lactate causing acidic pH of blood stream). Discontinue immediately if metabolic acidosis (overproduction of acid in the body) is suspected. Monitor renal (kidney) function at least annually. Discontinue the medicine for 48 hours before and after the elective surgery. 

Metformin C4H11N5

Molecular Weight: 129g/mol
Dissociation Constant: -0.5
Indication

It is primarily indicated for treating Diabetes Mellitus type 2 and for prevention of diabetes. Orphan: Poly cyctic Ovary Syndrome. The molecule has been known to regulate triglyceride and LDL chloestrol level and has been found to be useful as weight reducing agent.

Mechanism of Action

It is responsible for reducing glucose absorption and enhancing insulin cell sensitivity.

Dosage

Strength: 1gm

Form: tablet

Dosing interval: 8-24 Hr

Maximum Dose: 2550 mg/day is well tolerated.

Dialyzable:Yes

Maintainance dose

Type 2 Non Insulin Dependent Diabetes Mellitus: Immediate Release: 500mg twice daily or 850mg per day then, 500mg three times a day. Extended Release: Glucophage XR: 500mg daily; titrate 500mg daily every week. Poly Cystic Ovary syndrome: 1-2g every day orally

Hepatic Adjustment

Risk of Lactic acidosis; Avoid)

Renal Adjustment

In patients with eGFR (glomerular filteration rates less than30ml/min/1.73m2 it is contraindicated. However, in patients eGFR 30-45ml/min/1.73m2 the therapy is not recommended.

  • pregnant

    Pregnancy

    Research on animals showed no effect and no human research was conducted. Or research on animals have shown some degree of effect but human research did not show any effects.

  • mother

    Lactation

    The medicine has shown studies that it enters mothers milk and hence not recommended.

ContraIndication
Cautions

Lactic Acidosis (black Box Warning). May cause ovulation in premenopausal women. May impair B12 and Ca absorption (monitor closely).

Pharmacokinetics

Time of onset: It is known to produce the action within 1-3 hours of administration as per researches conducted.

Tmax: For immediate release tablets the volume of distribution is known to be 650 Liters

Bioavailability: 50-60% (fasting condition)

Protein Binding : It is least bound to protein after administration as per studies.

Elimination Half Life (t1/2): 6 Hr

Metabolism: Not by Liver

Volume of Distribution (Vd): For immediate release tablets the volume of distribution is known to be 650 Liters

Metabolites:

There has not been any metabolites identified as it is reported that metformin is not metabolized.

Disclaimer

Dawaai's intention is to make sure that it's consumers get information that is accurate, reviewed by an expert and error-free. However, the information mentioned here should not be used as a replacement for the advice of a qualified physician. The information given here is for informational purposes only, which may not cover all possible precautions, side effects, contraindications or drug interactions. Consult your doctor and discuss your queries related to any medicine or disease.

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