Metformin

imhjournal.com

18 March، 2024

Scientific name: metformin

Pharmacological family: biguanide

Drug classification: diabetes treatment drugs

Category: Endocrine diseases

What is metformin

Metformin is one of the medications used to treat type 2 diabetes.

Mechanism of action

The diabetes regulator Metformin belongs to the biguanide class, and it reduces blood glucose levels by:

Reducing glucose synthesis in the liver.
Reducing glucose absorption in the intestine.
Increased cell sensitivity to insulin.

The use of metformin in people with type 2 diabetes improves the results of blood sugar tests, as it leads to:

Reducing fasting blood sugar.
Reducing the level of cumulative blood sugar (HbA1c).

HbA1c is a test that gives an idea of the average blood glucose level during the last three months, and is used to determine the effectiveness of the medication used to treat diabetes or to determine the extent of the patient’s adherence to using the medication.

What are the uses of metformin?

Metformin is used in the following cases:

Treating type 2 diabetes , and it can be used alone or in combination with other medications.
In cases of prediabetes in order to prevent type 2 diabetes .
Control of gestational diabetes .
Treatment of polycystic ovary syndrome .
Treating weight gain problems resulting from the use of antipsychotic medications.

Side effects

The use of metformin may be associated with some side effects in some patients, including:

Stomach pain and indigestion.
Diarrhea or constipation.
Bloating and gas.
heartburn.
Feeling a metallic taste in the mouth.
Headache.
Muscle and chest pain.
Skin redness or rash.
Change in the shape of nails.

Contraindications

Contraindications for the use of metformin include the following conditions:

Hypersensitivity to metformin or any of the components of the drug.
Chronic heart failure.
Diabetic ketoacidosis.
Metabolic acidosis.
Severe kidney disease.
Abnormal creatinine clearance resulting from:

Blood poisoning.
Myocardial infarction.

Breastfeeding.
surgeries.

The doctor must be informed about the use of metformin when planning any surgical procedure, and doses of metformin must be stopped on the day of surgery.

Precautions

The following precautions should be taken when using this medicine:

Tell the doctor if the patient has a history of heart attack , stroke , or diabetic ketoacidosis.
Tell the doctor if the patient suffers from kidney problems and diseases:

The use of metformin in some rare cases can cause a serious condition called lactic acidosis, so the doctor must be informed about the presence of kidney disease, and caution must also be exercised when using the medicine by the elderly.

Tell the doctor if the patient is planning any
Tell the doctor if you have a serious infection, severe diarrhea, vomiting, or fever, as the patient may have to stop taking metformin until he recovers.

The patient should stop taking metformin immediately and contact the doctor if the following symptoms appear:

Feeling very tired or weak.
Severe nausea, or vomiting.
Loss of appetite, or shortness of breath.
Severe stomach pain.
Feeling cold in the hands or feet.
Redness of the skin.
Muscle pain.

Drug interactions

The patient must inform the doctor of all the medications he is taking, whether they are prescription medications, non-prescription medications, nutritional supplements, or herbal medications. There are also some medications that increase the risk of lactic acidosis when taken in conjunction with metformin, such as:

Diclorovena Med, which is a drug that lowers blood sugar levels.
Acetazolamide, which is a diuretic.
Methazolamide, a medication used to treat glaucoma.
Topiramate, used to treat epilepsy and migraine pain.
Zonisamide, a treatment used to treat epilepsy and Parkinson’s diseases.

You must stop using metformin for 48 hours before and after using the contrast material used in medical imaging, as this may cause kidney failure and lactic acidosis.

read more: Healthy diet for diabetics

How to use metformin

The medicine is used as follows:

Slow-release tablets: Take once a day with the evening meal.
Immediate-release tablets: Take with meals two or three times a day.
Oral solution: Usually taken with meals once or twice a day.

Metformin dosage

The doctor usually starts by giving the patient the lowest effective dose of metformin, and the patient needs to monitor his blood sugar continuously so that the doctor can evaluate the effectiveness of metformin in controlling blood sugar.

Dosage for adults:

Metformin is used in adults with type 2 diabetes as follows:

Slow release discs:

The initial dose is 500 to 1000 mg once a day in the evening, and the dose can be increased by 500 mg per day every week so that the daily total is 2000 mg.

Immediate-release tablets or oral solution:

Start with a dose of 500 mg every 12 hours, or 850 mg once a day with meals. The dose can be increased every two weeks to reach the appropriate maintenance dose, which ranges from 1500 to 2550 mg per day, divided throughout the day. It is possible to take the medicine every 12 hours or every 8 hours according to the doctor’s instructions. It is taken orally, and should not exceed The total dose per day is 2550 mg.

Dosage for diabetes prevention

Metformin can be given to prevent type 2 diabetes in people with prediabetes or who have a risk factor for diabetes at a dose of 850 mg per day orally, which can be increased to 850 mg every 12 hours.

Dosage for children 10 to 16 years old

Metformin is given to children with type 2 diabetes between the ages of 10 and 16 years as follows:

Immediate-release tablets or oral solution: Start with a dose of 500 mg every 12 hours, and the dose may be increased every week by 500 mg, provided that the total daily dose does not exceed 2000 mg per day divided throughout the day as directed by the doctor.
Slow-release tablets should not be used due to limited information about their safety and effectiveness in children under 17 years of age.

How to use metformin

The following instructions must be followed when using metformin :

You must follow the doctor’s instructions and not take a dose more or less than the prescribed dose.
The patient should take metformin at the same time daily.
Slow-release tablets should be swallowed whole and not split or chewed.
Metformin helps control diabetes, but does not cure it completely. Therefore, the patient must continue taking it and treatment should not be stopped without speaking to the doctor.

If you miss a dose of metformin, you should take it as soon as you remember it, but if it is almost time for the next dose, you should skip the missed dose and follow the dosing schedule. That is, the dose should not be doubled to make up for the missed dose.

What are the storage conditions for metformin?

Metformin medicine must be kept in the container and closed well, and stored at room temperature away from light, excessive heat, and moisture, and be sure to keep it out of the reach of children.