Metformin 850mg Tablets

Metformin is a biguanide that decreases hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis. It also 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 low blood sugar, follow your doctor's instructions for managing the condition, 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 not mentioned here. 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, other medications, foods, or substances. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, such as:
+ Acidic blood problems
+ Kidney disease
+ Liver disease
Recent medical events, including:
+ A heart attack
+ A stroke
Any difficulties with eating or drinking, including situations where you may be required to fast before a procedure or surgery.
* Upcoming or recent medical 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 problems 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 change 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, do not operate a vehicle, as this can increase your risk of being involved in an accident. 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 make it more challenging to control your blood sugar levels. Changes in physical activity, exercise, or diet can also impact your blood sugar. 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 your fluid intake to prevent excessive fluid loss. In hot weather or during physical activity, be cautious and drink plenty of fluids to avoid dehydration.

Long-term treatment with metformin may lead to a decrease in vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult with 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 to discuss the benefits and risks to you and your baby.

• Iodinated contrast agents (temporarily discontinue metformin at the time of or prior to the procedure and for 48 hours after, and restart only after renal function has been re-evaluated and found to be normal).
• Alcohol (acute or chronic excessive intake due to increased risk of lactic acidosis).

• Carbonic anhydrase inhibitors (e.g., topiramate, zonisamide, acetazolamide, dichlorphenamide) - may increase risk of lactic acidosis.
• Drugs that reduce metformin clearance (e.g., cimetidine, ranolazine, dolutegravir, isavuconazole, trimethoprim, vandetanib) - may increase metformin levels and 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 function.

• Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, triamterene, trimethoprim, vancomycin) - may compete for renal tubular transport, potentially increasing metformin levels.
• Nifedipine - may increase metformin absorption and Cmax.
• Furosemide - may increase metformin plasma and blood Cmax without altering renal clearance.
• Glucocorticoids, sympathomimetics, diuretics, thyroid products, phenothiazines, oral contraceptives, phenytoin, nicotinic acid, calcium channel blockers, isoniazid - may cause hyperglycemia, requiring dose adjustment of metformin.

• Not available

• Symptoms of lactic acidosis (malaise, myalgia, respiratory distress, somnolence, abdominal distress, hypothermia, hypotension, resistant bradyarrhythmias)
• Symptoms of vitamin B12 deficiency (fatigue, weakness, numbness/tingling, memory problems, anemia)
• Gastrointestinal side effects (nausea, vomiting, diarrhea, abdominal discomfort, metallic taste)

Metformin crosses the placenta. While some studies suggest it may be used in gestational diabetes or type 2 diabetes during pregnancy, insulin is generally the preferred agent for glycemic control in pregnancy. Use should be based on a careful risk-benefit assessment by the healthcare provider.

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 in healthy, full-term infants. Monitor breastfed infants for signs of hypoglycemia or gastrointestinal upset. Considered L3 (moderately safe) by some sources.

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 increased likelihood of decreased renal function. Renal function should be assessed more frequently in this population. The risk of lactic acidosis increases with age and impaired renal function.

• Metformin is typically the first-line pharmacologic agent for type 2 diabetes, especially in overweight or obese patients, due to its efficacy, low risk of hypoglycemia, and potential for weight neutrality or modest weight loss.
• Gastrointestinal side effects (nausea, diarrhea, abdominal discomfort) are common, especially at initiation. These can often be minimized by starting with a low dose, titrating slowly, and taking the medication with meals.
• Extended-release (ER) formulations may improve GI tolerability.
• Patients should be educated on the symptoms of lactic acidosis and instructed to seek immediate medical attention if they occur.
• Temporarily discontinue metformin before or at the time of iodinated contrast imaging procedures and for 48 hours after, restarting only after renal function has been re-evaluated and found to be normal.
• Long-term metformin use can lead to vitamin B12 deficiency; consider periodic monitoring and supplementation if needed, especially in patients with neuropathy or anemia.

• Sulfonylureas (e.g., glipizide, glyburide, glimepiride)
• DPP-4 inhibitors (e.g., sitagliptin, saxagliptin)
• SGLT2 inhibitors (e.g., empagliflozin, canagliflozin, dapagliflozin)
• 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'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 medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to facilitate prompt and effective treatment.