Metformin ER 750mg 24hr Tabs

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

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 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 treatment, 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. Although many people may not experience any side effects or only have mild 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 persist or bother you:

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
* 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 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 adjust the dose 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 directed by your doctor, and undergo blood tests as scheduled to ensure your condition is being properly managed. Discuss any concerns or questions with your doctor.

During periods of stress, such as illness, infection, injury, or surgery, your blood sugar levels may be more challenging to control. Changes in physical activity, exercise, or diet can also impact 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 your fluid intake to prevent excessive fluid loss. In hot weather or during intense 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. You may notice the appearance of the tablet in your stool; however, this is a normal occurrence and not a cause for concern. If you have any questions or concerns, discuss them with your doctor.

If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects. Women of childbearing age who have not been ovulating may experience a renewed 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, inform your doctor, as they will need to discuss the potential benefits and risks of this medication to you and your baby.

• Iodinated contrast media (hold metformin at time of or prior to procedure, and for 48 hours after, re-evaluate renal function before restarting)
• Alcohol (excessive acute or chronic use)

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

• Corticosteroids, diuretics (thiazide and loop), phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, isoniazid - may cause hyperglycemia, requiring dose adjustment of metformin
• Sulfonylureas, insulin - increased risk of hypoglycemia (if used in combination)

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

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

Metformin is generally considered a first-line oral agent for gestational diabetes and may be continued in type 2 diabetes during pregnancy if benefits outweigh risks. Limited data suggest no increased risk of major birth defects. Consult with an endocrinologist or high-risk obstetrician.

Metformin is excreted into breast milk in small amounts. It is generally considered compatible with breastfeeding. Monitor breastfed infant for adverse effects (e.g., hypoglycemia, poor feeding).

Metformin ER is not approved for pediatric use. Metformin IR is approved for children ≥10 years with type 2 diabetes.

Use with caution due to increased likelihood of decreased renal function in elderly patients, which increases the risk of lactic acidosis. Renal function should be assessed more frequently. Avoid initiation in patients ≥80 years unless renal function is normal.

• Metformin ER should be taken with the evening meal to minimize gastrointestinal side effects and optimize absorption.
• Patients should be educated on the symptoms of lactic acidosis and instructed to seek immediate medical attention if they occur.
• Hold metformin prior to or at the time of iodinated contrast imaging procedures and for at least 48 hours afterward, and restart only after renal function has been re-evaluated and found to be normal.
• Hold metformin in patients undergoing surgical procedures requiring restricted food and fluid intake or other procedures that may cause hypoperfusion or hypoxia.
• Regular monitoring of renal function (eGFR) is crucial, especially in elderly patients or those with pre-existing renal impairment.
• Consider periodic vitamin B12 level monitoring, especially in patients with risk factors for deficiency or those on long-term therapy.

• 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'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 taken, the amount, and the time it happened.