Metformin 625mg 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.

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 can be characterized by:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating

If you experience any of these symptoms, call your doctor right away. For low blood sugar, follow your doctor's instructions, 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 list is not exhaustive, and you may experience other 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 normally, which may be relevant before undergoing certain procedures or surgery
* Upcoming or recent exams or tests that involve contrast agents, particularly if they have taken place within the past 48 hours. Discuss this with your doctor to determine the best course of action.

This list is not exhaustive, and it is crucial to disclose all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues to your doctor and pharmacist. This will help ensure your safety while taking this medication. Always verify that it is safe to take this medication with your other drugs 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, have your blood work checked as directed by your doctor and discuss the results with them.

Be aware that stress, such as fever, infection, injury, or surgery, can affect blood sugar control. Changes in physical activity, exercise, or diet can also impact 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 treatment with metformin may lead to low vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor.

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 potential risk of pregnancy. To avoid pregnancy, use birth control while taking this medication.

If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You will need to discuss the benefits and risks of this medication to both you and your baby.

• Iodinated contrast media (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 procedure; restart metformin only if renal function is stable.)
• Severe renal impairment (eGFR <30 mL/min/1.73m²)

• Alcohol (potentiates the effect of metformin on lactate metabolism, increasing the risk of lactic acidosis)
• Carbonic anhydrase inhibitors (e.g., topiramate, zonisamide, acetazolamide, dichlorphenamide) - may increase the risk of lactic acidosis by increasing serum bicarbonate levels and inducing non-anion gap metabolic acidosis.
• Cimetidine (increases metformin plasma concentration by reducing renal tubular secretion, increasing risk of lactic acidosis)

• Drugs that reduce metformin clearance (e.g., ranolazine, vandetanib, dolutegravir, cimetidine, isavuconazonium) - may increase metformin levels and risk of lactic acidosis.
• Drugs that can cause hyperglycemia (e.g., thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid) - may require dose adjustment of metformin.
• Nifedipine (increases metformin absorption and excretion, but overall effect on glucose control is usually minor).

• Not available

• Symptoms of lactic acidosis: malaise, myalgia, somnolence, respiratory distress, abdominal distress, increased somnolence, hypothermia, hypotension, and resistant bradyarrhythmias.
• Symptoms of hypoglycemia (rare with monotherapy): sweating, tremor, dizziness, confusion, hunger.
• Gastrointestinal side effects: nausea, vomiting, diarrhea, abdominal discomfort, metallic taste.

Metformin is generally considered a reasonable option for managing gestational diabetes or type 2 diabetes in pregnancy, especially when insulin is not preferred or sufficient. However, insulin remains the preferred first-line agent for strict glycemic control during pregnancy.

Metformin is excreted into breast milk in low amounts. It is generally considered compatible with breastfeeding, and adverse effects in breastfed infants are not expected.

Approved for use in children 10 years of age and older for type 2 diabetes. Dosing for extended-release formulations like 625mg may need careful consideration and titration, as most pediatric data is with immediate-release.

Use with caution due to increased likelihood of decreased renal function in elderly patients. Renal function should be assessed more frequently. Start with lower doses and titrate slowly to minimize gastrointestinal side effects and lactic acidosis risk.

• Metformin is 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. Starting with a low dose and titrating slowly, and taking with food (especially ER formulations), can help mitigate these.
• Extended-release formulations (like 625mg) are designed to improve gastrointestinal tolerability and allow for once-daily dosing.
• Patients should be educated on the symptoms of lactic acidosis and advised to seek immediate medical attention if they occur.
• Regular monitoring of renal function is crucial due to the risk of lactic acidosis in patients with impaired kidney function.
• Long-term metformin use can be associated with vitamin B12 deficiency; periodic monitoring and supplementation may be necessary.

• Sulfonylureas (e.g., glipizide, glyburide, glimepiride)
• DPP-4 inhibitors (e.g., sitagliptin, saxagliptin, linagliptin)
• SGLT2 inhibitors (e.g., canagliflozin, dapagliflozin, empagliflozin)
• GLP-1 receptor agonists (e.g., liraglutide, semaglutide, dulaglutide)
• Thiazolidinediones (e.g., pioglitazone, rosiglitazone)
• Insulin therapy
• 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. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide information about the medication taken, the amount, and the time it happened.