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Metformin Hydro Chloride

Metformin hydrochloride is an oral antidiabetic drug used to treat type 2 diabetes. It works by decreasing glucose production in the liver and increasing insulin sensitivity. Common side effects include gastrointestinal issues like nausea and diarrhea. Rare but serious side effects include lactic acidosis and hypoglycemia. Metformin requires monitoring of renal function and is contraindicated in patients with kidney or liver disease.

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2K views3 pages

Metformin Hydro Chloride

Metformin hydrochloride is an oral antidiabetic drug used to treat type 2 diabetes. It works by decreasing glucose production in the liver and increasing insulin sensitivity. Common side effects include gastrointestinal issues like nausea and diarrhea. Rare but serious side effects include lactic acidosis and hypoglycemia. Metformin requires monitoring of renal function and is contraindicated in patients with kidney or liver disease.

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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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metformin hydrochloride

(met fore' min)


Glucophage, Glucophage XR, Riomet

Pregnancy Category B

Drug class
Antidiabetic

Therapeutic actions
Exact mechanism is not understood; possibly increases peripheral utilization of glucose,
increases production of insulin, decreases hepatic glucose production and alters intestinal
absorption of glucose.

Indications
• Adjunct to diet to lower blood glucose with type 2 (non–insulin-dependent)
diabetes mellitus in patients > 10 yr; extended release in patients > 17 yr
• As part of combination therapy with a sulfonylurea or insulin when either drug
alone cannot control glucose levels in patients with type 2 diabetes mellitus

Contraindications and cautions


• Contraindicated with allergy to metformin; CHF; diabetes complicated by fever,
severe infections, severe trauma, major surgery, ketosis, acidosis, coma (use
insulin); type 1 (insulin-dependent), serious hepatic impairment, serious renal
impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia
associated with primary renal disease; labor and delivery (if metformin is used
during pregnancy, discontinue drug at least 1 mo before delivery); lactation
(safety not established).

Available forms
Tablets—500, 850, 1,000 mg; extended-release tablets—500 mg; oral solution—
100 mg/mL

Dosages
ADULTS
500–850 mg/day PO in divided doses to a maximum of 2,550 mg/day. Dose should be
adjusted based on response and blood glucose level. ER tablet: Initially 500 mg/day PO
with the evening meal; may be increased by 500 mg each wk to a maximum of 2,550 mg
once daily.
PEDIATRIC PATIENTS 10–16 YR
500 mg/day PO in divided doses with meals; may be increased by 500 mg each wk to a
maximum of 2,000 mg/day. ER tablet is not recommended.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT
Smaller doses may be necessary; monitor closely and adjust slowly.

Pharmacokinetics
Route Peak Duration
Oral 2–2.5 hr 10–16 hr

Metabolism: Hepatic; T1/2: 6.2 and 17.6 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• Endocrine: Hypoglycemia, lactic acidosis
• GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea
• Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria

Interactions
Drug-drug
• Increased risk of hypoglycemia with cimetidine, furosemide, cationic drugs such
as digoxin, amiloride, vancomycin
• Increased risk of lactic acidosis with glucocorticoids or ethanol
• Increased risk of acute renal failure and lactic acidosis with iodinated contrast
material used in radiologic studies; stop metformin for 48 hr before and after such
studies
Drug-alternative therapy
• Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery

Nursing considerations
Assessment
• History: Allergy to metformin; diabetes complicated by fever, severe infections,
severe trauma, major surgery, ketosis, acidosis, coma; type 1 diabetes, serious
hepatic or renal impairment, uremia, thyroid or endocrine impairment, glycosuria,
hyperglycemia associated with primary renal disease, CHF, pregnancy, lactation
• Physical: Skin color, lesions; T, orientation, reflexes, peripheral sensation; R,
adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, serum
creatinine, liver function tests, blood glucose, CBC

Interventions
• Monitor urine or serum glucose levels frequently to determine effectiveness of
drug and dosage.
• Arrange for transfer to insulin therapy during periods of high stress (infections,
surgery, trauma).
• Use IV glucose if severe hypoglycemia occurs as a result of overdose.

Teaching points
• Do not discontinue this medication without consulting your health care provider.
• Monitor urine or blood for glucose and ketones as prescribed.
• Do not use this drug during pregnancy; if you become pregnant, consult with your
health care provider for appropriate therapy.
• Avoid using alcohol while taking this drug.
• Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-
colored stools, hypo- or hyperglycemic reactions.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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