Metformin 500mg Tablets

Metformin is a biguanide that decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. It does not stimulate insulin secretion and therefore does not cause hypoglycemia in monotherapy.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while 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. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. Contact your doctor or seek medical help if you experience any of the following side effects or if they bother you or do not go away:

Stomach pain or heartburn
Gas
Diarrhea
Upset stomach or vomiting
Feeling tired or weak
* Headache

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult 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 allergic reaction you experienced, including any symptoms that occurred.
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

Additionally, if you are scheduled to undergo an exam or test that involves contrast agents, or have had one within the past 48 hours, discuss this with your doctor.

To ensure safe treatment, it is crucial to provide your doctor and pharmacist with a comprehensive list of:

All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
* Your complete medical history, including any health problems you are experiencing

Do not start, stop, or modify the dosage of any medication without first consulting your doctor to confirm that it is safe to do so in conjunction with this medication.

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, do not operate a vehicle, as this increases the risk of accidents. Monitor your blood sugar levels as directed by your doctor. Additionally, follow your doctor's instructions for regular blood tests to ensure your health is not adversely affected.

During periods of stress, such as fever, infection, injury, or surgery, it may become more challenging to manage your blood sugar levels. Changes in physical activity, exercise, or diet can also impact your blood sugar control. Adhere to the diet and exercise plan recommended by your doctor to maintain optimal blood sugar levels.

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

Long-term use of metformin may lead to decreased vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor to discuss potential implications.

If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

For individuals of childbearing age who have not been ovulating, there is a possibility of pregnancy. To avoid unintended pregnancy, use birth control while taking this medication. If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.

• Iodinated contrast agents (temporarily discontinue before/at time of procedure and for 48 hours after)
• Drugs that increase risk of lactic acidosis (e.g., excessive alcohol intake, topiramate, zonisamide, carbonic anhydrase inhibitors in patients with renal impairment)

• Cimetidine (increases metformin exposure)
• Carbonic anhydrase inhibitors (e.g., acetazolamide, dichlorphenamide, topiramate, zonisamide) - may increase risk of lactic acidosis
• Drugs that affect renal function (e.g., NSAIDs, ACE inhibitors, ARBs, diuretics) - may increase risk of lactic acidosis by impairing renal clearance of metformin
• Alcohol (increases risk of lactic acidosis)

• Nifedipine (increases metformin absorption)
• Furosemide (increases metformin plasma concentration)
• Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin) - may compete for renal tubular transport, increasing metformin concentration
• Sulfonylureas, insulin (increased risk of hypoglycemia)

• Not available

• Symptoms of lactic acidosis: malaise, myalgia, respiratory distress, somnolence, abdominal distress, hypothermia, hypotension, resistant bradyarrhythmias.
• Symptoms of hypoglycemia (if used with insulin or sulfonylureas): sweating, tremor, hunger, confusion, dizziness.
• Symptoms of vitamin B12 deficiency: fatigue, weakness, numbness, tingling, memory problems.

Metformin is generally considered a preferred oral agent for managing gestational diabetes or type 2 diabetes in pregnancy, especially when insulin is not desired or effective. Data suggest it does not increase the risk of major birth defects. However, insulin remains the gold standard for glycemic control in pregnancy.

Metformin is excreted into breast milk in small amounts. It is generally considered compatible with breastfeeding due to low infant exposure and lack of reported adverse effects in breastfed infants. Monitor infants for signs of hypoglycemia or gastrointestinal upset.

Approved for use in children 10 years of age and older with type 2 diabetes. Dosing should be carefully titrated. Monitor renal function and vitamin B12 levels.

Use with caution due to increased likelihood of decreased renal function in elderly patients, which increases the risk of lactic acidosis. Assess renal function more frequently. The lowest effective dose should be used.

• Metformin is often the first-line pharmacologic agent for type 2 diabetes, especially in overweight or obese patients, due to its efficacy, low risk of hypoglycemia (as monotherapy), and potential for weight neutrality or modest weight loss.
• Gastrointestinal side effects (nausea, diarrhea, abdominal discomfort) are common, especially at initiation. These can be minimized by starting with a low dose, titrating slowly, and taking with meals.
• Extended-release (XR) formulations can help reduce GI side effects and allow for once-daily dosing.
• Patients must be instructed to temporarily discontinue metformin before or at the time of iodinated contrast imaging procedures and for 48 hours afterward, and to re-evaluate renal function before restarting.
• Regular monitoring of renal function is crucial due to the risk of lactic acidosis in patients with impaired kidney function.
• Consider periodic monitoring of vitamin B12 levels, especially in patients on long-term therapy or those with risk factors for B12 deficiency.

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

If your symptoms or health issues persist or worsen, it is 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 it's a good idea 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.