Metformin: Difference between revisions

(Text replacement - "N/V" to "nausea and vomiting")
(Text replacement - "0 mg" to "0mg")
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*Hold 48 hours for iodinated contrast
*Hold 48 hours for iodinated contrast
;'''Immediate Release'''
;'''Immediate Release'''
*850-1000 mg PO bid
*850-1000mg PO bid
*Start 500 mg bid or 850 mg qd
*Start 500mg bid or 850mg qd
*Increase 500 mg qwk or 850 mg q2wk
*Increase 500mg qwk or 850mg q2wk
*Max 2550 mg/day
*Max 2550mg/day
;'''Extended Release'''
;'''Extended Release'''
*1000-2000 mg PO qd
*1000-2000mg PO qd
*Start 500 mg qd
*Start 500mg qd
**Increase 500 mg qwk
**Increase 500mg qwk
*Alt dosing; 1000 mg bid
*Alt dosing; 1000mg bid
**Add 500 mg immediate release for inadequate response
**Add 500mg immediate release for inadequate response
*Do not crush or chew
*Do not crush or chew


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*Hold for iodinated contrast
*Hold for iodinated contrast
;'''Immediate Release'''
;'''Immediate Release'''
*500 mg tid
*500mg tid
*Alt dosing; 850-1000 mg bid
*Alt dosing; 850-1000mg bid
*Increase as needed
*Increase as needed
*Max 2550 mg/day
*Max 2550mg/day
;'''Extended Release'''
;'''Extended Release'''
*1500-2000 mg qd
*1500-2000mg qd
*Do not crush or chew
*Do not crush or chew
*Max 2000 mg/day
*Max 2000mg/day


==Pediatric Dosing==
==Pediatric Dosing==
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*Children aged 10-18 years of age
*Children aged 10-18 years of age
===Diabetes Mellitus type 2===
===Diabetes Mellitus type 2===
*500-1000 mg bid
*500-1000mg bid
*Start 500 mg qd
*Start 500mg qd
*Increase 500 mg/day every 1-2 weeks
*Increase 500mg/day every 1-2 weeks
*Max 2000 mg/day
*Max 2000mg/day


==Special Populations==
==Special Populations==

Revision as of 16:32, 19 July 2016

Administration

  • Type: Diabetes medication
  • Dosage Forms: 500, 850, 1000; ER 500, 750, 1000
  • 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

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
  • Cr >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

  • 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
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