Adult Dosing
Type II diabetes mellitus (NIDDM)
Fortamet
- Dose range: 1000-2500 mg PO qpm
- Initial: 500 mg PO qpm with meal
- Titration: May increase 500 mg/day qwk [Max: 2500 mg/day]
Glucophage, Riomet, Metformin TABS
- Usual start dose: 500 mg PO bid or 850 mg PO Daily with meal
- Titration: May increase by 500 mg PO qwk or 850 mg PO q2 wk; Max: 2,000 mg/day in divided doses; Alt: May also be titrated from 500 mg bid to 850 mg bid after 2 wks
- Max: 2,550 mg/day in patients requiring additional glycemic control
Note: Doses >2000 mg may be better tolerated given tid with meals
Glucophage XR, Metformin ETABS
- Dose range: 1,000-2,000 mg PO qpm
- Initial: 500 mg PO qpm with meal
- Titration: May increase 500 mg/day qwk [Max: 2,000 mg/day]
- Alt: 1,000 mg PO bid if adequate glycemic control is not achieved on 2,000 mg PO Daily
- Max: 2,550 mg of tabs in divided daily doses if higher doses of metformin are required
Glumetza
- Initial: 500 mg PO qpm with meal
- Titration: May increase 500 mg/day q1-2 wk [Max: 2,000 mg/day]
- Notes
- If this drug is considered appropriate for a patient already receiving immediate-release metformin, the patient may be switched to once daily at the same total daily dose, up to 2,000 mg Daily
- Individualize dosage based on both effectiveness and tolerability
Pediatric Dosing
Type II diabetes mellitus (NIDDM)
10-16 yrs
- TABS:
- Initial: 500 mg PO bid with meal
- Titration: May increase 500 mg/day qwk, [Max: 2,000 mg/day]
- Extended Release TAB:
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Lactic acidosis, a rare metabolic complication but fatal occurs with metformin accumulation during metformin therapy [US Black Box Warning]
- Impairment of renal function increases the risk of metformin accumulation and lactic acidosis. Monitor renal function prior to initiation of therapy and periodically thereafter, carefully titrated to establish the minimum dose for adequate glycemic effect. Discontinue the therapy on the evidence of renal dysfunction [US Black Box Warning]
- Metformin or any other anti-diabetic drug does not reduce macrovascular risk
- Be cautious while concomitant administration of drug that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin such as cationic drugs
- Temporarily discontinue the therapy in patients undergoing intravascular contrast studies with iodinated materials and withheld for 48 hours after procedure, as it is associated with increased risk of renal dysfunction and lactic acidosis. Reinstitute the therapy only after renal function has been re-evaluated and found to be normal
- Cardiovascular collapse, acute congestive heart failure, acute myocardial infarction and other conditions characterized by hypoxemia increases the risk of lactic acidosis and prerenal azotemia. Discontinue the drug immediately if such event occur
- Temporarily suspend metformin therapy for any surgical procedure and reinstitute only after patient’s oral intake has resumed and renal function has been evaluated as normal
- Impaired hepatic function is associated with lactic acidosis, avoid metformin therapy in patients with clinical or laboratory evidence of hepatic disease
- Warned the patients against the excessive alcohol intake as alcohol potentiates effect of metformin on lactate metabolism
- Metformin therapy can cause a decrease to subnormal levels of previously normal serum vitamin B12 levels; measure hematological parameters annually
- Evaluate serum electrolytes and ketones, blood glucose, pyruvate and metformin levels in type 2 diabetic patient, previously well controlled on metformin who developed laboratory abnormalities or clinical illness. If acidosis suspected, stop therapy and start alternative treatment
- Hypoglycemia can occur with metformin therapy when used concomitantly with other glucose-lowering agents (such as sulfonylureas and insulin) or ethanol or in condition when caloric intake is deficient. Elderly, debilitated, or malnourished patients, and those with adrenal or pituitary insufficiency or alcohol intoxication are at higher risk
- Temporary loss of glycemic control can occurs in stabilized diabetic patients, when exposed to stress such as fever, trauma, infection, or surgery, withhold metformin therapy and temporarily administer insulin
Cautions: Use cautiously in
- CHF
- Alcohol abuse
- Risk of hypoglycemia
- Elderly patients
- Concomitant use of cationic drugs
Supplemental Patient Information
- Advice patient to adhere to their diet, should do regular exercise, and do periodic testing of blood glucose and hemoglobin
- Patients should be instructed to avoid excessive use of alcohol while receiving treatment
- Patients should be instructed on the signs and symptoms of lactic acidosis
Pregnancy Category:B
Breastfeeding: Probably safe; metformin is detectable in low levels in the serum of breastfed infants. Milk metformin levels are relatively constant and infants receive <0.5% of the maternal weight-adjusted dosage. Use with caution while nursing newborn/premature infants and those with renal impairment. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 April 2011). As per manufacturer data, because of the potential for possible serious adverse reactions in nursing infants a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
- Fortamet
- Glucophage
- Glucophage XR
- Glumetza
- Riomet
US Availability
metformin (generic)
- TABS: 500, 625, 750, 850, 1000 mg
- ETABS: 500, 750, 1000 mg
Fortamet
Glucophage
Glucophage XR
Glumetza
Riomet
Canadian Trade Name(s)
Canadian Availability
metformin (generic)
Glucophage
Glumetza
Glycon
UK Trade Name(s)
UK Availability
metformin (generic)
- TABS: 500, 850 mg
- SOLN: 500mg/5mL
Glucophage
- TABS: 500, 850 mg
- PWDR for SOLN: 500, 1000 mg
Glucophage SR
Australian Trade Name(s)
- Diabex
- Diabex XR
- Diaformin
- Diaformin XR
- Formet
- Glucohexal
- Glucomet
- Glucophage
- Metex XR
Australian Availability
metformin (generic)
Diabex, Diaformin, Formet, Glucohexal
Diabex XR
Diaformin XR, Metex XR
Glucomet, Glucophage
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Glucophage 1000 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
60 mg = $141.08
180 mg = $383.29 - Fortamet 1000 MG TB24 [Bottle] (SHIONOGI PHARMA)
60 mg = $683.99
180 mg = $2027.97 - Glucophage 500 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
60 mg = $69.99
180 mg = $179.96 - Glumetza 500 MG TB24 [Bottle] (DEPOMED)
100 mg = $389
300 mg = $1131.93 - Glucophage XR 500 MG TB24 [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
60 mg = $69.99
180 mg = $180.97 - Glucophage XR 750 MG TB24 [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
30 mg = $53.99
90 mg = $139.96 - MetFORMIN HCl 500 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
60 mg = $12.99
120 mg = $19.98 - Glumetza 1000 MG TB24 [Bottle] (DEPOMED)
100 mg = $859.97
300 mg = $2480.03 - Fortamet 500 MG TB24 [Bottle] (SHIONOGI PHARMA)
60 mg = $338.55
180 mg = $980.02 - Glucophage 850 MG TABS [Bottle] (B-M SQUIBB U.S. (PRIMARY CARE))
60 mg = $113.29
180 mg = $315.48 - Riomet 500 MG/5ML SOLN [Bottle] (RANBAXY LABORATORIES)
473 5ml = $201.59
1419 5ml = $582.36
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
