Metformin Extended Release Tablet

Generic name: Metformin hydrochloride extended-release

Drug class: Antihyperglycemic agent

Dosage form: Extended-release tablet

Route of administration: Oral

Dose:

• Adults: Initial dose of 500 mg to 1,000 mg once daily with the evening meal; may be increased weekly by 500 mg increments up to a maximum of 2,000 mg to 2,500 mg per day, depending on the specific formulation and patient response.
• Children: Use and dose must be determined by a healthcare provider.

Mechanism of action: Metformin inhibits mitochondrial respiratory chain complex I, leading to increased AMP levels and activation of AMP-activated protein kinase (AMPK). This activation reduces hepatic gluconeogenesis, decreases intestinal glucose absorption, enhances insulin sensitivity, and increases glucose uptake in peripheral tissues, thereby lowering blood glucose levels.

Drug usage cases:

• Type 2 diabetes mellitus
• Polycystic ovary syndrome (off-label)
• Gestational diabetes (off-label)
• Prediabetes (off-label)

Drug contraindications:

• Severe renal impairment (e.g., serum creatinine >1.5 mg/dL in males or >1.4 mg/dL in females)
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis
• Hypersensitivity to metformin hydrochloride
• Severe hepatic impairment
• Concurrent use of iodinated contrast agents (e.g., for CT scans) without appropriate precautions

Side effects:

• Gastrointestinal disturbances: nausea, vomiting, diarrhea, abdominal discomfort
• Metallic taste
• Vitamin B12 deficiency (long-term use)
• Lactic acidosis (rare but serious)
• Hypoglycemia (when used in combination with other antidiabetic agents)

Warnings:

• Monitor renal function regularly; discontinue if renal impairment develops.
• Use caution in patients with hepatic disease; avoid in severe hepatic impairment.
• Temporarily discontinue before procedures involving iodinated contrast agents; resume after 48 hours if renal function is stable.
• Alcohol may increase the risk of lactic acidosis; limit alcohol intake.
• Not recommended during pregnancy; use only if clearly needed and prescribed by a healthcare provider.
• Not recommended during breastfeeding; use only if clearly needed and prescribed by a healthcare provider.

Use during pregnancy or breastfeeding: Metformin is not recommended during pregnancy and should be used only if clearly needed and prescribed by a healthcare provider. It is also not recommended during breastfeeding; use only if clearly needed and prescribed by a healthcare provider.