Metformin 1000mg Tablets

Metformin is a biguanide that improves glycemic control by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilization. It does not stimulate insulin secretion and therefore does not cause hypoglycemia when used alone.

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Stomach problems that occur later during treatment, which may be a sign of lactic acidosis (an acid health problem in the blood)
Low blood sugar, which may be more likely when this medication is used with other diabetes medications. Symptoms of low blood sugar may include:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating

If you experience any of these symptoms, call your doctor right away. Follow your doctor's instructions for managing low blood sugar, which may include taking glucose tablets, liquid glucose, or some fruit juices.

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild side effects. However, if you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor or seek medical help:

Stomach pain or heartburn
Gas
Diarrhea, upset stomach, or vomiting
Feeling tired or weak
Headache

This is not a complete list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
Certain health conditions, including:
+ Acidic blood problems
+ Kidney disease
+ Liver disease
Recent medical events, such as a heart attack or stroke
Any difficulties with eating or drinking, including situations where you may be required to fast before a procedure or surgery
* Upcoming or recent exams or tests that involve contrast agents, particularly if you have had one within the past 48 hours

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Before consuming alcohol, discuss the potential risks with your doctor.

If you experience low blood sugar, avoid driving, as it increases the risk of accidents. Monitor your blood sugar levels as instructed by your doctor. Additionally, follow your doctor's recommendations for regular blood tests to ensure your health is not affected.

Be aware that stress, such as fever, infection, injury, or surgery, can impact your blood sugar control. Changes in physical activity, exercise, or diet can also affect your blood sugar levels. Adhere to the diet and exercise plan recommended by your doctor to maintain optimal blood sugar control.

If you experience diarrhea or vomiting, contact your doctor promptly, as you may need to increase fluid intake to prevent excessive fluid loss. In hot weather or during physical activity, drink plenty of fluids to avoid dehydration.

Long-term use of metformin may lead to low vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor. Individuals 65 years or older should use this medication with caution, as they may be more susceptible to side effects.

Women of childbearing age who have not been ovulating may be at risk of pregnancy while taking this medication. To avoid pregnancy, use birth control measures while taking this drug. If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks with your doctor to ensure the best possible outcome for you and your baby.

• Iodinated contrast agents (temporarily discontinue metformin at the time of or prior to the procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m2; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable.)
• Severe renal impairment (eGFR <30 mL/min/1.73m²)

• Alcohol (increases risk of lactic acidosis)
• Carbonic anhydrase inhibitors (e.g., topiramate, zonisamide, acetazolamide, dichlorphenamide - may increase risk of lactic acidosis)
• Cimetidine (increases metformin plasma concentration by decreasing renal clearance)
• Drugs that reduce metformin clearance (e.g., ranolazine, vandetanib, dolutegravir, cimetidine, isavuconazole, trimethoprim, or crizotinib - may increase metformin accumulation and risk of lactic acidosis)

• Diuretics (thiazide and loop diuretics - may increase blood glucose, requiring metformin dose adjustment)
• Corticosteroids (systemic and inhaled - may increase blood glucose, requiring metformin dose adjustment)
• Sympathomimetics (e.g., decongestants, bronchodilators - may increase blood glucose)
• Phenothiazines (may increase blood glucose)
• Niacin (may increase blood glucose)
• Calcium channel blockers (some may affect glucose control)
• Thyroid products (may affect glucose control)

• Not specifically categorized as minor, but general caution with drugs affecting glucose levels.

• Unusual muscle pain (myalgia)
• Somnolence (sleepiness)
• Respiratory distress (shortness of breath)
• Abdominal distress (abdominal pain, nausea, vomiting, diarrhea)
• Hypothermia
• Arrhythmias
• Malaise
• Weakness

Metformin is often continued during pregnancy for women with gestational diabetes or pre-existing type 2 diabetes, especially if diet and exercise are insufficient. It is considered a reasonable option due to its efficacy and relatively low risk profile. However, insulin is often preferred for strict glycemic control.

Metformin is excreted into breast milk in small amounts. The amount ingested by the infant is generally considered low and unlikely to cause adverse effects. It is generally considered compatible with breastfeeding.

Approved for use in children 10 years of age and older with type 2 diabetes. Dosing should be carefully titrated, and renal function monitored, similar to adults.

Use with caution in elderly patients due to the higher likelihood of decreased renal function. Renal function should be assessed more frequently, and the lowest effective dose should be used to minimize the risk of lactic acidosis.

• Metformin is considered first-line pharmacologic therapy for most patients with type 2 diabetes.
• It is weight-neutral or can cause modest weight loss, and does not typically cause hypoglycemia when used as monotherapy.
• Always take with food to minimize gastrointestinal side effects (nausea, diarrhea, abdominal discomfort), which are common, especially at initiation.
• Temporarily discontinue metformin before or at the time of iodinated contrast imaging procedures and certain surgical procedures (e.g., major surgery, procedures with restricted food/fluid intake) to reduce the risk of lactic acidosis.
• Educate patients on the symptoms of lactic acidosis and the importance of seeking immediate medical attention if they occur.
• Long-term use may be associated with vitamin B12 deficiency; consider periodic monitoring and supplementation if needed.

• Sulfonylureas (e.g., glipizide, glyburide, glimepiride)
• DPP-4 inhibitors (e.g., sitagliptin, saxagliptin, linagliptin)
• SGLT2 inhibitors (e.g., empagliflozin, canagliflozin, dapagliflozin)
• GLP-1 receptor agonists (e.g., liraglutide, semaglutide, dulaglutide)
• Thiazolidinediones (e.g., pioglitazone, rosiglitazone)
• Alpha-glucosidase inhibitors (e.g., acarbose, miglitol)
• Insulin

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.