Metformin (brand names Glucophage, Glucophage XR, Fortamet, Riomet, Glumetza, and others) is a popular and highly effective oral diabetes drug used to help manage Type 2 diabetes. This drug works by lowering the amount of glucose made by the liver and by making the body’s cells more sensitive to insulin. Metformin also has some other beneficial effects in that it may help lower blood lipid, or fat, levels (cholesterol and triglycerides) and can, in some people, promote a small amount of weight loss. Metformin can be used with other diabetes pills and with insulin. Side effects of taking metformin are relatively rare, the most common being bloating, nausea, and diarrhea, all of which are temporary. Some people shouldn’t take metformin, including people with kidney disease, liver disease, or congestive heart failure, for example, because of an increased risk of a potentially fatal condition called lactic acidosis. In recent years, there’s been some concern over the risk of vitamin B12 deficiency in people who take metformin. It is of the gliflozin class or subtype 2 sodium-glucose transport (SGLT-2) inhibitors class. This mechanism is associated with a low risk of hypoglycaemia (too low blood glucose) compared to sulfonylurea derivatives and insulin. Canagliflozin is an inhibitor of subtype 2 sodium-glucose transport proteins (SGLT2), which is responsible for at least 90% of renal glucose reabsorption (SGLT1 being responsible for the remaining 10%). Blocking this transporter causes up to 119 grams of blood glucose per day to be eliminated through the urine. Canagliflozin is an anti-diabetic drug used to improve glycemic control in people with type 2 diabetes. In extensive clinical trials, canagliflozin produced a consistent dose-dependent decrease in Hb A levels of 0.77% to 1.16% when administered either as monotherapy, in combination with metformin, in combination with metformin and a sulfonylurea, in combination with metformin and pioglitazone, or in combination with insulin, from initial Hb A levels. Secondary efficacy endpoints of higher reductions in weight and blood pressure (versus sitagliptin and glimiperide) were also observed in studies.
Metformin is an oral diabetes medicine that helps control blood sugar levels. Metformin is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Metformin is sometimes used together with insulin or other medications, but it is not for treating type 1 diabetes. You should not use metformin if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis (call your doctor for treatment). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin. Though extremely rare, you may develop lactic acidosis, a dangerous build-up of lactic acid in your blood. Call your doctor or get emergency medical help if you have unusual muscle pain, trouble breathing, stomach pain, dizziness, feeling cold, or feeling very weak or tired. The UK Prospective Diabetes Study, a large clinical trial performed in 1980-90s, provided evidence that metformin reduced the rate of adverse cardiovascular outcomes in overweight patients with type 2 diabetes relative to other antihyperglycemic agents. Treatment guidelines for major professional associations including the European Association for the Study of Diabetes, the European Society for Cardiology and the American Diabetes Association, now describe evidence for the cardiovascular benefits of metformin as equivocal. In 2017, the American College of Physicians's guidelines were updated to recognize metformin as the first-line treatment for type-2 diabetes. For example, a 2014 review found tentative evidence that people treated with sulfonylureas had a higher risk of severe low blood sugar events (RR 5.64), though their risk of non-fatal cardiovascular events was lower than the risk of those treated with metformin (RR 0.67). There was not enough data available at that time to determine the relative risk of death or of death from heart disease. study known as the Diabetes Prevention Program, participants were divided into groups and given either placebo, metformin, or lifestyle intervention and followed for an average of three years. Metformin treatment of people at a prediabetes stage of risk for type 2 diabetes may decrease their chances of developing the disease, although intensive physical exercise and dieting work significantly better for this purpose. The intensive program of lifestyle modifications included a 16-lesson training on dieting and exercise followed by monthly individualized sessions with the goals of decreasing weight by 7% and engaging in physical activity for at least 150 minutes per week. The incidence of diabetes was 58% lower in the lifestyle group and 31% lower in individuals given metformin. Among younger people with a higher body mass index, lifestyle modification was no more effective than metformin, and for older individuals with a lower body mass index, metformin was no better than placebo in preventing diabetes.
Your doctor or pharmacist will explain what type of metformin tablets you are on and how to take them. Metformin is also available as a liquid for children and people who find it difficult to swallow tablets. Liquid metformin is called by the brand name Riomet. Your doctor will check your blood sugar levels regularly and may change your dose of metformin if necessary. When you first start taking metformin standard-release tablets you will be advised to increase the dose slowly. For example: If you find you can't tolerate the side effects of standard-release metformin, your doctor may suggest switching to slow-release tablets. If you miss a dose of metformin, take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose. Treatment of type 2 diabetes mellitus ,particularly in overweight patients, when dietary management and exercise alone does not result in adequate glycaemic control. • In adults,metformin 850mg tablets may be used as monotherapy or in combination with other oral anti-diabetic agents, or with insulin. • In children from 10 years of age and adolescents, Metformin tablets may be used as monotherapy or in combination with insulin. A reduction of diabetic complications has been shown in overweight type 2 diabetic patients treated with metformin as first-line therapy after diet failure (see 5.1 pharmacodynamic properties). Adults: Adults with normal renal function (GFR≥ 90 m L/min) Monotherapy and combination with other oral antidiabetic agents: • The usual starting dose is one tablet 2 or 3 times daily given during or after meals. After 10 to 15 days the dose should be adjusted on the basis of blood glucose measurements. A slow increase of dose may improve gastrointestinal tolerability.
Metformin is a commonly recommended initial medication for patients with type 2. To avoid stomach upset, patients usually start with a very low dose 500 mg. Metformin hydrochloride is a white to off-white crystalline compound with a molecular formula of C 4 H 11 N 5 • HCl and a molecular weight of 165.63. Metformin hydrochloride is freely soluble in water and is practically insoluble in acetone, ether, and chloroform.