Metformin: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Drugs" to "Category:Pharmacology") |
Elcatracho (talk | contribs) |
||
| (12 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
==Administration== | ==Administration== | ||
*Type: Diabetes medication | *Type: [[Diabetes medication]] | ||
*Dosage Forms: | *Dosage Forms: 500mg, 850mg, 1000mg; ER 500mg, 750mg, 1000mg | ||
*Routes of Administration: PO | *Routes of Administration: PO | ||
*Common Trade Names: Fortamet, Glucophage, Glumetza, Riomet | *Common Trade Names: Fortamet, Glucophage, Glumetza, Riomet | ||
| Line 11: | Line 11: | ||
*Hold 48 hours for iodinated contrast | *Hold 48 hours for iodinated contrast | ||
;'''Immediate Release''' | ;'''Immediate Release''' | ||
*850- | *850-1000mg PO bid | ||
*Start | *Start 500mg BID or 850mg QD | ||
*Increase | *Increase 500mg qwk or 850mg q2wk | ||
*Max | *Max 2550mg/day | ||
;'''Extended Release''' | ;'''Extended Release''' | ||
*1000- | *1000-2000mg PO QD | ||
*Start | *Start 500mg QD | ||
**Increase | **Increase 500mg qwk | ||
*Alt dosing; | *Alt dosing; 1000mg bid | ||
**Add | **Add 500mg immediate release for inadequate response | ||
*Do not crush or chew | *Do not crush or chew | ||
| Line 27: | Line 27: | ||
*Hold for iodinated contrast | *Hold for iodinated contrast | ||
;'''Immediate Release''' | ;'''Immediate Release''' | ||
* | *500mg tid | ||
*Alt dosing; 850- | *Alt dosing; 850-1000mg bid | ||
*Increase as needed | *Increase as needed | ||
*Max | *Max 2550mg/day | ||
;'''Extended Release''' | ;'''Extended Release''' | ||
*1500- | *1500-2000mg QD | ||
*Do not crush or chew | *Do not crush or chew | ||
*Max | *Max 2000mg/day | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
| Line 41: | Line 41: | ||
*Children aged 10-18 years of age | *Children aged 10-18 years of age | ||
===Diabetes Mellitus type 2=== | ===Diabetes Mellitus type 2=== | ||
*500- | *500-1000mg bid | ||
*Start | *Start 500mg QD | ||
*Increase | *Increase 500mg/day every 1-2 weeks | ||
*Max | *Max 2000mg/day | ||
==Special Populations== | ==Special Populations== | ||
| Line 58: | Line 58: | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
* | *Creatinine >1.4 female or >1.5 male | ||
*Metabolic acidosis | *Metabolic acidosis | ||
*DKA | *DKA | ||
| Line 70: | Line 70: | ||
;'''Caution''' | ;'''Caution''' | ||
*CHF | *[[CHF]] | ||
*Elderly | *Elderly | ||
*Alcohol abuse | *Alcohol abuse | ||
*Hypoglycemia risk | *[[Hypoglycemia]] risk | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
* | *[[Metformin-associated lactic acidosis]] | ||
*Megaloblastic anemia | *Megaloblastic anemia | ||
===Common=== | ===Common=== | ||
*Diarrhea | *[[Diarrhea]] | ||
* | *nausea and vomiting | ||
*Flatulence | *Flatulence | ||
*Indigestion | *Indigestion | ||
| Line 103: | Line 103: | ||
==See Also== | ==See Also== | ||
*[[Metformin-associated lactic acidosis]] | |||
*[[Diabetes medications]] | |||
==References== | ==References== | ||
| Line 108: | Line 110: | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Endocrinology]] | |||
Latest revision as of 23:20, 7 March 2021
Administration
- Type: Diabetes medication
- Dosage Forms: 500mg, 850mg, 1000mg; ER 500mg, 750mg, 1000mg
- Routes of Administration: PO
- Common Trade Names: Fortamet, Glucophage, Glumetza, Riomet
Adult Dosing
Diabetes Mellitus type 2
- Take with meals
- Hold 48 hours for iodinated contrast
- Immediate Release
- 850-1000mg PO bid
- Start 500mg BID or 850mg QD
- Increase 500mg qwk or 850mg q2wk
- Max 2550mg/day
- Extended Release
- 1000-2000mg PO QD
- Start 500mg QD
- Increase 500mg qwk
- Alt dosing; 1000mg bid
- Add 500mg immediate release for inadequate response
- Do not crush or chew
Polycystic Ovarian Syndrome
- Take with meals
- Hold for iodinated contrast
- Immediate Release
- 500mg tid
- Alt dosing; 850-1000mg bid
- Increase as needed
- Max 2550mg/day
- Extended Release
- 1500-2000mg QD
- Do not crush or chew
- Max 2000mg/day
Pediatric Dosing
- Take with meals
- Hold for iodinated contrast
- Children aged 10-18 years of age
Diabetes Mellitus type 2
- 500-1000mg bid
- Start 500mg QD
- Increase 500mg/day every 1-2 weeks
- Max 2000mg/day
Special Populations
- Pregnancy Rating: B
- Lactation risk: Probably safe
Renal Dosing
- Adult: Contraindicated Cr>1.4 in females and Cr>1.5 in med
- Pediatric: Contraindicated Cr>1.4 in females and Cr>1.5 in med
Hepatic Dosing
- Adult: Avoid with hepatic impairment
- Pediatric: Avoid with hepatic impairment
Contraindications
- Allergy to class/drug
- Creatinine >1.4 female or >1.5 male
- Metabolic acidosis
- DKA
- Lactic acidosis
- Iodinated contrast
- Hypoxemia
- Dehydration
- Sepsis
- Surgery
- Hepatic impairment
- Caution
- CHF
- Elderly
- Alcohol abuse
- Hypoglycemia risk
Adverse Reactions
Serious
- Metformin-associated lactic acidosis
- Megaloblastic anemia
Common
- Diarrhea
- nausea and vomiting
- Flatulence
- Indigestion
- Abdominal discomfort
- Anorexia
- Headache
- Rash
- Ovulation reduction
Pharmacology
- Half-life: 6 hours in plasma and 17 hours in blood
- Metabolism: CYP450
- Excretion: Urine
Mechanism of Action
- Decreases hepatic glucose production and intestinal absorption
- Increases insulin sensitivity
Comments
See Also
References
- Epocrates