Classes
DEA Class; Rx
Common Brand Names; Glucophage, Glucophage XR, Glumetza, Riomet, Riomet ER
- Antidiabetics, Biguanides
Description
Oral biguanide antidiabetic agent
Used for type 2 diabetes mellitus (T2DM) in adult and pediatric patients 10 years and older; first-line T2DM therapy generally includes metformin
Risk of lactic acidosis is low but requires care in prescribing and monitoring
Indications
Adjunctive therapy to diet and exercise to improve glycemic control in adults with type 2 diabetes
Monotherapy or with sulfonylurea
Contraindications
Hypersensitivity to metformin
CHF
Diabetic ketoacidosis with or without coma
Severe renal disease: eGFR <30 mL/min/1.73 m²
Abnormal creatinine clearance resulting from shock, septicemia, or myocardial infarction
Lactation
Adverse Effects
- Diarrhea, immediate-release product (53%)
- Nausea/vomiting, immediate-release product (25%)
- Diarrhea, extended-release product (10%)
- Nausea/vomiting, extended-release product (7%)
- Low serum vitamin B-12 (7%)
- Abdominal pain (1-5%)
- Constipation (1-5%)
- Abdomen distention (1-5%)
- Dyspepsia/heartburn (1-5%)
- Flatulence (1-5%)
- Dizziness (1-5%)
- Headache (1-5%)
- Upper respiratory infection (1-5%)
- Taste disturbance (1-5%)
- Postmarketing Reports H3
- Cholestatic, hepatocellular, and mixed hepatocellular liver injury
- Lactic acidosis
- Hypoglycemia
Warnings
Increased risk of severe hypoglycemia especially in elderly, debilitated or malnourished, adrenal or pituitary insufficiency, dehydration, heavy alcohol use, hypoxic states, hepatic/renal impairment, stress due to infection, fever, trauma, or surgery
Concomitant administration of insulin and insulin secretagogues (e.g., sulfonylurea) may increase risk of hypoglycemia; therefore, a lower dose of insulin or insulin secretagogue may be required to minimize risk of hypoglycemia when used in combination with metformin
Withholding of food and fluids during surgical or other procedures may increase risk for volume depletion, hypotension, and renal impairment; therapy should be temporarily discontinued while patients have restricted food and fluid intake
Rare lactic acidosis may occur due to metformin accumulation; fatal in approximately 50% of cases; risk increases with age, degree of renal dysfunction, and with unstable or acute CHF; if metformin-associated lactic acidosis suspected, general supportive measures should be instituted promptly in a hospital setting, along with immediate discontinuation of therapy; in patients with a diagnosis or strong suspicion of lactic acidosis, prompt hemodialysis is recommended to correct acidosis and remove accumulated metformin (metformin hydrochloride is dialyzable, with a clearance of up to170 mL/minute under good hemodynamic conditions); hemodialysis has often resulted in reversal of symptoms and recovery
Possible increased risk of CV mortality
May cause ovulation in anovulatory and premenopausal PCOS patients
May be necessary to discontinue therapy with metformin and administer insulin if patient is exposed to stress (fever, trauma, infection), or experiences diabetic ketoacidosis
Several of the postmarketing cases of metformin-associated lactic acidosis occurred in setting of acute congestive heart failure (particularly when accompanied by hypoperfusion and hypoxemia); cardiovascular collapse (shock) acute myocardial infarction, sepsis, and other conditions associated with hypoxemia have been associated with lactic acidosis and may also cause prerenal azotemia; discontinue therapy when such events occur
May impair vitamin B12 or calcium intake/absorption; monitor B12 serum concentrations periodically with long-term therapy
Not indicated for use in patients with type 1 diabetes mellitus that are insulin dependent due to lack of efficacy
Withhold in patients with dehydration and/or prerenal azotemia
Conclusive evidence of macrovascular risk reduction with metformin not established
Pregnancy and Lactation
Limited data with in pregnant women are not sufficient to determine drug-associated risk for major birth defects or miscarriage
Limited published studies report that metformin is present in human milk; however, there is insufficient information to determine effects of metformin on breastfed infant and no available information on effects of metformin on milk production
Maximum Dosage
2,550 mg/day PO for regular-release tablets and oral solution; 2,000 mg/day PO for extended-release tablets and suspension.
Use more than 1,000 mg/day PO with caution in older adults. Adult Max: 2,550 mg/day PO for regular-release tablets and oral solution; 2,000 mg/day PO for extended-release tablets and suspension.
2,000 mg/day PO for regular-release tablets, oral solution, and extended-release suspension; safe and effective use has not been established for extended-release tablets.
10 years and older: 2,000 mg/day PO for regular-release tablets, oral solution, and extended-release suspension; safe and effective use has not been established for extended-release tablets.
Less than 10 years: Safety and efficacy have not been established.
Safety and efficacy have not been established.
Safety and efficacy have not been established.
How supplied
Metformin hydrochloride
tablet, immediate-release
- 500mg (generic)
- 850mg (generic)
- 1000mg (generic)
tablet, extended-release
- 500mg (generic, Glumetza)
- 750mg (generic)
1000mg (generic, Glumetza)
oral solution
- 100mg/mL (Riomet)
oral suspension, extended-release
- 47.31g/473mL per bottle (Riomet ER)
- Reconstituted suspension is 500mg/5mL