Metform ER 500

Indications

Metform ER (Extended Release) tablets are prescribed for managing type 2 diabetes mellitus, especially in overweight patients where diet and exercise alone fail to maintain adequate blood sugar control.

• For Adults: Metform ER can be used either as a monotherapy or in combination with other oral diabetes medications or insulin.
• For Children and Adolescents (10 years and older): Metform ER may be used as a monotherapy or in combination with insulin.

Studies show that Metform ER effectively reduces the risk of complications in overweight adults with type 2 diabetes when used as a first-line treatment after diet-based interventions.

Always follow the advice of a registered healthcare professional.

Pharmacology

Metformin, a biguanide class medication, works by reducing both fasting and post-meal blood glucose levels in patients with type 2 diabetes. Unlike sulfonylureas, Metformin does not induce hypoglycemia. It works through three primary mechanisms:

1. Decreasing hepatic glucose production
2. Reducing intestinal glucose absorption
3. Enhancing insulin sensitivity, promoting glucose uptake and utilization in peripheral tissues.

Dosage & Administration

Metformin Immediate Release Tablets: Dosage must be personalized based on effectiveness and patient tolerance. Ensure the maximum recommended daily dosage is not exceeded.

• Adults: Typically, the starting dose is 500 mg twice daily or 850 mg once daily, taken with meals. Gradually increase the dose by 500 mg per week or 850 mg every two weeks, up to a maximum of 2000 mg per day. For additional glycemic control, doses can be increased to 2550 mg per day, split across three doses.
• Children: The starting dose is 500 mg twice daily, and increases should be in increments of 500 mg weekly, with a maximum of 2000 mg per day.

Metformin Extended Release Tablets: Swallow the tablets whole—do not crush, cut, or chew.

• Adults: The starting dose is typically 500 mg once daily with the evening meal. Gradually increase the dosage by 500 mg weekly, up to a maximum of 2000 mg once daily. Alternatively, it can be increased to 1000 mg twice daily with meals.
• Children: Metformin XR is not recommended for children due to limited data.
• Renal Impairment: Metformin is contraindicated for patients with eGFR <30 mL/min/1.73 m². Use cautiously in patients with eGFR below 45 mL/min/1.73 m².

Always follow the advice of a registered healthcare professional.

Drug Interactions

• Furosemide: No information is available about interactions with Metform ER when co-administered chronically.
• Nifedipine: May enhance Metform ER absorption, but Metform ER has minimal impact on Nifedipine.
• Other Drugs: Some drugs can induce hyperglycemia, leading to loss of glycemic control. These include thiazide diuretics, corticosteroids, oral contraceptives, and certain antihypertensive drugs.

Always consult your healthcare provider before combining Metform ER with other medications.

Contraindications

• Hypersensitivity: Avoid Metform ER if you have a known allergy to Metformin or any of the ingredients.
• Acute Metabolic Conditions: Do not use in cases of lactic acidosis or diabetic ketoacidosis.
• Severe Renal Failure: Avoid in patients with an eGFR below 30 mL/min.
• Conditions Affecting Kidney Function: Including dehydration, severe infection, or shock.
• Hypoxic States: Conditions such as cardiac or respiratory failure, or recent myocardial infarction.

Side Effects

Common Side Effects:

• Gastrointestinal symptoms like nausea, vomiting, diarrhea, and abdominal pain, especially during the initial stages of treatment. These generally resolve after some time.

Serious Side Effects:

• Lactic Acidosis: A rare but severe complication of Metformin therapy.
• Vitamin B12 Deficiency: Long-term use may impair B12 absorption, potentially leading to anemia or peripheral neuropathy.
• Liver Dysfunction: Rare cases of liver enzyme abnormalities have been reported.

Skin Reactions: Very rare cases of erythema, itching, or hives.

Pregnancy & Lactation

• Pregnancy: Metformin should not be used during pregnancy as it is not the preferred treatment for managing diabetes in pregnant women. Insulin is recommended to control blood glucose levels during pregnancy.
• Breastfeeding: Metformin is excreted in breast milk. While no adverse effects have been reported, the decision to breastfeed should be made with consideration of potential risks to the infant.

Warnings & Precautions

Metform ER is primarily excreted via the kidneys. Impaired renal function increases the risk of lactic acidosis and drug accumulation. Regular renal function monitoring is recommended.
Metformin may also lower Vitamin B12 levels, so periodic testing of B12 is advised during long-term use.

Avoid Metform ER in conditions like dehydration, severe infection, or trauma, which may compromise renal function. It is recommended to discontinue Metformin 2-3 days before surgery or any procedure that may affect renal function.

Special Populations

• Elderly: Renal function tends to decline with age, so dosage adjustments based on renal function are necessary. Regular monitoring is advised.
• Pediatric Patients (10–12 years): Caution is required when prescribing Metformin to children in this age group. Growth and puberty should be carefully monitored.

Overdose Effects

Though hypoglycemia is not common with Metformin overdose, lactic acidosis is a serious concern. Immediate medical attention is required for lactic acidosis, and hemodialysis may be necessary to remove Metformin from the body.

Therapeutic Class

Biguanides

Storage Conditions

Store at temperatures below 30°C, away from light and moisture. Keep out of reach of children.