Metformin : Uses, Dosage & Side effects

Metformin is one of the most widely prescribed medications for managing type 2 diabetes. Known for its efficacy, safety, and affordability, it has become a cornerstone in diabetes treatment worldwide.

But what exactly is Metformin, how does it work, and what should patients know about its dosage and potential side effects?

In this article, we’ll explore everything you need to know about Metformin, from its mechanism of action to its indications, dosage, and side effects.

What is Metformin?

Metformin is an oral antihyperglycemic medication belonging to the biguanide class. It is primarily used to manage blood sugar levels in individuals with type 2 diabetes.

Unlike other diabetes medications, Metformin does not cause weight gain and is often recommended as a first-line treatment for newly diagnosed patients.

Mode of Action: How Does Metformin Work?

Metformin works through several mechanisms to control blood glucose levels:

1. Reduces Glucose Production in the Liver: Metformin inhibits gluconeogenesis, the process by which the liver produces glucose. This helps lower fasting blood sugar levels.

2. Improves Insulin Sensitivity: It enhances the body’s response to insulin, allowing muscle cells to absorb glucose more effectively.

3. Slows Glucose Absorption: Metformin reduces the absorption of glucose from the intestines, preventing spikes in blood sugar after meals.

4. Increases Fatty Acid Oxidation: It promotes the breakdown of fats, which can help improve metabolic health.

By targeting these pathways, Metformin helps maintain stable blood sugar levels without causing hypoglycemia (low blood sugar) when used alone.

By understanding how Metformin works, its indications, dosage, and side effects, you can make informed decisions about your diabetes management. Always consult your healthcare provider for personalized advice and treatment options.

Indications of Metformin

Metformin is a versatile medication with a wide range of clinical applications. While it is primarily known for its role in managing type 2 diabetes, it is also used for other conditions due to its beneficial effects on insulin sensitivity and metabolic health.

Below is a detailed breakdown of the indications for Metformin:

1. Type 2 Diabetes Mellitus

Metformin is most commonly prescribed as a first-line treatment for type 2 diabetes. It is particularly effective in patients who are overweight or obese, as it does not cause weight gain and may even promote modest weight loss.

How it helps:

- Lowers fasting and post-meal blood glucose levels.

- Improves insulin sensitivity, allowing the body to use insulin more effectively.

- Reduces the risk of diabetes-related complications, such as cardiovascular disease.

When is it prescribed?

For newly diagnosed patients with type 2 diabetes.

As an add-on therapy for patients who do not achieve adequate blood sugar control with lifestyle modifications or other medications.

2. Prediabetes

Prediabetes is a condition where blood sugar levels are higher than normal but not high enough to be classified as diabetes. Metformin is often used to prevent or delay the progression to type 2 diabetes in high-risk individuals.

How it helps:

- Reduces insulin resistance, a key factor in the development of type 2 diabetes.

- Lowers blood sugar levels, helping to maintain them within a normal range

When is it prescribed?

For individuals with prediabetes who have additional risk factors, such as obesity, a family history of diabetes, or a history of gestational diabetes.

When lifestyle changes (diet and exercise) alone are insufficient to control blood sugar levels.

3. Polycystic Ovary Syndrome (PCOS)

Although not FDA-approved for this use, Metformin is widely prescribed off-label to manage symptoms of Polycystic Ovary Syndrome (PCOS), a common hormonal disorder in women of reproductive age.

How it helps:

Improves insulin sensitivity, which is often impaired in women with PCOS.

Regulates menstrual cycles and promotes ovulation, making it useful for women trying to conceive.

Reduces androgen levels, helping to alleviate symptoms like hirsutism (excessive hair growth) and acne.

May support weight loss, which is often challenging for women with PCOS.

When is it prescribed?

For women with PCOS who have insulin resistance or are at risk of developing type 2 diabetes.

As part of fertility treatment to induce ovulation.

4. Gestational Diabetes (Off-Label Use)

In some cases, Metformin is used during pregnancy to manage gestational diabetes, a condition where high blood sugar develops during pregnancy.

How it helps:

Controls blood sugar levels, reducing the risk of complications for both the mother and baby.

May be preferred over insulin in certain cases due to its ease of use and lower risk of hypoglycemia.

When is it prescribed?

When lifestyle changes and dietary modifications are insufficient to control blood sugar levels during pregnancy.

As an alternative to insulin for women who prefer oral medication.

5. Weight Management (Off-Label Use)

Metformin is sometimes used to support weight loss in individuals with obesity, particularly those with insulin resistance or metabolic syndrome.

How it helps:

Reduces appetite and food intake in some individuals.

Improves insulin sensitivity, which can help regulate metabolism and promote weight loss.

When is it prescribed?

For overweight or obese individuals with insulin resistance or metabolic syndrome.

As part of a comprehensive weight management plan that includes diet and exercise.

6. Prevention of Metabolic Syndrome

Metabolic syndrome is a cluster of conditions (high blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels) that increase the risk of heart disease, stroke, and diabetes. Metformin may be used to prevent or manage metabolic syndrome.

How it helps:

Improves insulin sensitivity and blood sugar control.

May help lower blood pressure and improve lipid profiles.

When is it prescribed?

For individuals at high risk of developing metabolic syndrome or type 2 diabetes.

7. Adjunct Therapy in Type 1 Diabetes (Off-Label Use)

In some cases, Metformin is used as an adjunct therapy in patients with type 1 diabetes to improve insulin sensitivity and reduce insulin requirements.

How it helps:

Enhances the effectiveness of insulin therapy.

May help reduce blood sugar fluctuations and improve overall glycemic control.

When is it prescribed?

For patients with type 1 diabetes who have insulin resistance or are overweight.

8. Cancer Prevention (Emerging Research)

Emerging research suggests that Metformin may have anti-cancer properties, particularly in reducing the risk of certain cancers (e.g., breast, colon, and pancreatic cancer) in individuals with type 2 diabetes.

How it helps:

May inhibit the growth of cancer cells by affecting cellular metabolism.

Reduces insulin levels, which can promote cancer cell growth.

When is it prescribed?

Currently, this use is investigational and not a standard indication.

Metformin is a highly versatile medication with a wide range of indications, from managing type 2 diabetes and prediabetes to treating PCOS and supporting weight loss.

Its ability to improve insulin sensitivity and regulate blood sugar levels makes it a valuable tool in modern medicine. However, its use should always be guided by a healthcare professional to ensure safety and efficacy.

If you believe Metformin could benefit you, consult your doctor to discuss your specific condition and treatment options. With proper use, Metformin can significantly improve your health and quality of life.

Metformin Tablet Dosage

Metformin is an oral medication commonly used to manage type 2 diabetes mellitus by improving blood sugar control. The dosage varies depending on the patient's condition, response to treatment, and other individual factors. Below is a detailed guide to metformin dosage:

1. Standard Metformin Dosage

a) Immediate-Release (IR) Tablets

• Starting Dose:

  • Adults: 500 mg twice daily or 850 mg once daily with meals

  • Children (10-16 years): 500 mg twice daily with meals

• Dose Adjustment: Increase by 500 mg every 1-2 weeks based on blood sugar levels and tolerability

• Maximum Dose: 2,550 mg per day (divided into 2-3 doses)

b) Extended-Release (ER) Tablets

• Starting Dose:

  • Adults: 500 mg to 1,000 mg once daily with the evening meal

• Dose Adjustment: Increase by 500 mg weekly based on response

• Maximum Dose: 2,000 mg per day

2. Special Populations

a) Elderly Patients

• Start at the lowest effective dose

• Monitor kidney function (eGFR) closely

• Avoid if eGFR <30 mL/min/1.73 m²

b) Patients with Renal Impairment

• eGFR 45-60 mL/min: Use caution, consider lower doses

• eGFR 30-45 mL/min: Reduce dose by 50% (Maximum: 1,000 mg/day)

• eGFR <30 mL/min: Contraindicated (Do NOT use)

c) Patients with Liver Disease

• Use with caution due to the risk of lactic acidosis

• Avoid in severe hepatic impairment

3. Dosage Adjustments for Special Conditions

a) Switching from Immediate-Release to Extended-Release

• Start with the same total daily dose

• Take once daily with the evening meal

b) Missed Dose

• Take the missed dose as soon as remembered

• Do NOT double dose to make up for a missed dose

c) Overdose Management

• Overdose may cause lactic acidosis (symptoms: nausea, vomiting, muscle pain, difficulty breathing)

• Seek emergency medical attention immediately

4. Important Administration Instructions

• Take with food to reduce stomach upset

• Do not crush, split, or chew extended-release tablets

• Regular blood sugar and kidney function monitoring is required

Side Effects of Metformin

Metformin, a widely used medication for managing type 2 diabetes, is generally well-tolerated. However, like all medications, it may cause side effects in some individuals.

These effects can range from mild discomfort to serious complications requiring medical attention. This chapter explores the potential side effects of metformin, their causes, and ways to manage them effectively.

1. Common Side Effects

Most people who experience side effects from metformin report mild symptoms, particularly during the initial weeks of treatment. These symptoms often subside as the body adjusts to the medication.

Gastrointestinal Discomfort

One of the most frequently reported side effects of metformin is digestive discomfort.

This includes nausea, vomiting, diarrhea, abdominal pain, bloating, and excessive gas.

These symptoms occur because metformin affects the way the intestines process glucose and may alter gut bacteria. To minimize discomfort, it is recommended to take metformin with meals and start with a lower dose, gradually increasing it as tolerated.

Metallic Taste in the Mouth

Some individuals experience a persistent metallic or bitter taste after taking metformin. Though not harmful, this can be unpleasant. Drinking plenty of water, maintaining good oral hygiene, or chewing sugar-free gum may help alleviate this sensation.

Mild Weight Loss

Due to its effects on glucose metabolism and appetite regulation, metformin may lead to a slight reduction in body weight. This is generally considered beneficial for overweight individuals with diabetes. However, sudden or excessive weight loss should be discussed with a healthcare provider.

2. Less Common Side Effects

While less frequent, some side effects of metformin require close monitoring.

Vitamin B12 Deficiency

Long-term use of metformin has been associated with reduced absorption of vitamin B12, leading to deficiency in some individuals. Symptoms may include fatigue, numbness or tingling in the hands and feet, difficulty concentrating, and anemia. Regular blood tests can help detect B12 deficiency early, and supplementation may be necessary in some cases.

Skin Reactions

Although rare, some people may experience rashes, itching, or redness of the skin after taking metformin. These reactions could indicate an allergic response. If skin irritation persists or worsens, medical advice should be sought.

3. Rare but Serious Side Effects

Though uncommon, some side effects of metformin can be severe and require immediate medical attention.

Lactic Acidosis (A Medical Emergency)

The most serious potential side effect of metformin is lactic acidosis, a rare but life-threatening condition caused by the accumulation of lactic acid in the blood. This condition is more likely to occur in individuals with kidney or liver impairment, severe dehydration, or excessive alcohol consumption. Symptoms include extreme weakness, muscle pain, difficulty breathing, dizziness, irregular heartbeat, and confusion.

If any of these symptoms occur, emergency medical care should be sought immediately.

Severe Hypoglycemia (When Combined with Other Medications)

Although metformin alone does not typically cause low blood sugar (hypoglycemia), when taken with insulin or certain other diabetes medications, it can contribute to dangerously low glucose levels. Symptoms include sweating, shakiness, dizziness, confusion, and blurred vision. It is essential for patients taking combination therapies to monitor their blood sugar levels and be aware of hypoglycemia warning signs.

4. Who Is at Higher Risk for Side Effects?

Certain groups of individuals may be more susceptible to experiencing side effects from metformin, including:

Elderly patients (especially those with kidney function decline)

Individuals with kidney or liver disease

Those who consume excessive alcohol

People with a history of gastrointestinal disorders

For these individuals, metformin should be used with caution and under close medical supervision.

5. Managing and Preventing Side Effects

To minimize the likelihood of experiencing side effects, the following strategies can be helpful:

• Take metformin with food to reduce stomach upset.

• Start with a low dose and increase gradually to allow the body to adjust.

• Drink plenty of fluids to stay hydrated, especially when experiencing diarrhea.

• Have regular check-ups to monitor kidney function and vitamin B12 levels.

• Avoid excessive alcohol consumption, as it increases the risk of lactic acidosis.

Most side effects of metformin are mild and temporary. However, understanding potential risks and how to manage them can ensure a safer and more effective treatment experience.

If side effects become severe or persistent, it is important to consult a healthcare professional for guidance.

Contraindications of metformin:

While metformin is a widely prescribed and effective medication for managing type 2 diabetes, it is not suitable for everyone. Certain medical conditions and situations increase the risk of serious complications, making metformin use unsafe.

1. Absolute Contraindications

Metformin is strictly contraindicated in the following conditions due to the high risk of severe complications:

Severe Kidney Disease (Chronic Kidney Disease, Stage 4 or 5)

Metformin is primarily excreted by the kidneys. When kidney function is significantly impaired, the drug can accumulate in the body, increasing the risk of lactic acidosis, a rare but potentially fatal condition.

Contraindicated if:

Estimated Glomerular Filtration Rate (eGFR) is less than 30 mL/min/1.73 m².

Patients have end-stage renal disease (ESRD) requiring dialysis.

Precaution for mild to moderate kidney impairment:

If eGFR is 30-45 mL/min/1.73 m², metformin should be used with caution, at a lower dose, and under strict medical supervision.

Severe Liver Disease

The liver plays a key role in lactate metabolism. In patients with liver failure or cirrhosis, the body’s ability to clear lactic acid is compromised, increasing the risk of lactic acidosis.

Contraindicated in:

Severe liver disease, including advanced cirrhosis or acute liver failure.

Elevated liver enzymes indicating significant hepatic dysfunction.

Lactic Acidosis or High Risk for Lactic Acidosis

Lactic acidosis is a life-threatening metabolic disorder associated with metformin accumulation. Patients with conditions that predispose them to lactic acidosis should not take metformin.

High-risk conditions include:

Severe infections (sepsis, pneumonia, urinary tract infections with sepsis risk)

Severe dehydration (prolonged vomiting, diarrhea, or inadequate fluid intake)

Severe heart failure (Class III-IV congestive heart failure)

Shock or conditions leading to tissue hypoxia (e.g., recent heart attack, severe respiratory failure)

Acute or Unstable Conditions Requiring Hospitalization

Metformin should be temporarily discontinued in situations that may alter kidney function, oxygen supply, or metabolic balance.

Examples:

Before major surgery (Metformin should be stopped at least 48 hours before surgery and restarted only after kidney function is confirmed to be normal.)

Severe acute illness requiring hospitalization (e.g., severe pneumonia, heart attack, stroke)

Severe dehydration due to prolonged vomiting or diarrhea

2. Relative Contraindications (Use with Caution)

In some cases, metformin may still be used under close medical supervision, but careful risk assessment is required.

Moderate Kidney Disease (eGFR 30-45 mL/min/1.73 m²)

Although metformin is absolutely contraindicated in severe kidney disease, it may still be prescribed in moderate impairment with dosage adjustments and regular kidney function monitoring.

Precautionary measures:

Use a lower dose (maximum 1,000 mg/day).

Monitor eGFR regularly (every 3-6 months).

Avoid using other nephrotoxic drugs (e.g., NSAIDs, contrast agents).

Chronic Alcohol Abuse or Heavy Alcohol Consumption

Alcohol significantly increases the risk of lactic acidosis when combined with metformin.

Patients who should avoid metformin:

Those with chronic alcohol use disorder

Those who frequently engage in binge drinking

Precautions for occasional drinkers:

Avoid heavy alcohol intake while taking metformin.

Drink alcohol only in moderation and with food.

Elderly Patients (≥80 Years Old)

Aging is associated with a natural decline in kidney function, which can increase the risk of metformin accumulation and lactic acidosis.

Recommendations for elderly patients:

Only prescribe metformin if kidney function (eGFR) is >45 mL/min/1.73 m².

Use the lowest effective dose and monitor renal function frequently.

Heart Failure (Mild to Moderate Cases)

While severe heart failure (NYHA Class III-IV) is a contraindication, metformin may be cautiously used in stable patients with mild to moderate heart failure. However, careful monitoring is essential, as heart failure can impair kidney function and increase the risk of lactic acidosis.

3. Drug-Related Contraindications

Use of Intravenous (IV) Contrast for Imaging Procedures

Metformin must be temporarily discontinued before receiving IV contrast dye for CT scans or angiography. The contrast dye can cause acute kidney injury, leading to metformin accumulation and lactic acidosis.

Guidelines for IV contrast use:

Stop metformin at least 24-48 hours before the procedure.

Restart only after kidney function (eGFR) is checked and normal.

Concurrent Use of Certain Medications

Some medications can increase metformin levels, worsen kidney function, or increase lactic acidosis risk.

Drugs that may interact with metformin:

Diuretics (e.g., furosemide, hydrochlorothiazide): Can cause dehydration and kidney dysfunction.

NSAIDs (e.g., ibuprofen, naproxen): Can reduce kidney function.

Corticosteroids (e.g., prednisone): May increase blood sugar levels, reducing metformin’s effectiveness.

4. Special Considerations for Pregnant and Breastfeeding Women

Pregnancy

Metformin is not strictly contraindicated in pregnancy, but insulin is generally preferred for managing diabetes in pregnant women. However, metformin may be used under medical supervision, especially in cases of gestational diabetes.

Breastfeeding

Metformin passes into breast milk in small amounts but is generally considered safe for breastfeeding mothers. However, infants should be monitored for signs of low blood sugar or digestive upset.

Metformin is an effective and widely used medication, but it is not suitable for all individuals. Understanding its contraindications helps ensure its safe use and prevents serious complications like lactic acidosis and kidney failure.

Before starting metformin, patients should undergo a thorough medical evaluation, including kidney and liver function tests, and should discuss any pre-existing conditions or medications with their healthcare provider.

Regular monitoring and appropriate dosage adjustments can help maximize the benefits of metformin while minimizing risks. If any concerning symptoms arise, such as extreme fatigue, muscle pain, breathing difficulties, or dizziness, medical attention should be sought immediately.

Pharmacokinetics of Metformin

Metformin, a widely prescribed first-line treatment for type 2 diabetes mellitus, is an oral biguanide that effectively lowers blood glucose levels without causing significant hypoglycemia.

Its pharmacokinetics play a crucial role in its efficacy and safety. This article explores the absorption, distribution, metabolism, and elimination of metformin, shedding light on how the drug functions within the human body.

1. Absorption and Bioavailability

Metformin is administered orally in both immediate-release (IR) and extended-release (ER) formulations. Upon ingestion, it is primarily absorbed in the small intestine, specifically in the jejunum.

The drug exhibits saturable, dose-dependent absorption, meaning that increasing doses do not proportionally increase plasma concentration.

• The absolute bioavailability of metformin is approximately 50-60% following oral administration.

• Peak plasma concentration (Cmax) is reached within 2-3 hours for IR formulations and 6-8 hours for ER formulations.

• Food intake delays absorption but does not significantly impact overall drug exposure.

2. Distribution

Once absorbed, metformin distributes primarily in body tissues, particularly in the liver, gastrointestinal tract, and skeletal muscle—key sites for its glucose-lowering effects.

• Plasma protein binding: Metformin is negligibly bound to plasma proteins, allowing for free drug circulation.

• Volume of distribution (Vd): Estimated to be 300-1000 L, indicating extensive tissue penetration.

• The drug accumulates in hepatocytes and muscle cells, where it exerts its primary action by reducing hepatic gluconeogenesis and increasing insulin sensitivity in peripheral tissues.

3. Metabolism

Unlike many other medications, metformin undergoes minimal hepatic metabolism. It does not undergo biotransformation via the cytochrome P450 enzyme system, which reduces the risk of drug-drug interactions involving hepatic metabolism. The lack of significant metabolism means that its pharmacological effects are primarily dependent on renal clearance rather than hepatic processing.

4. Elimination

Metformin is predominantly excreted unchanged in the urine via active tubular secretion. The kidneys play a crucial role in its elimination, and any impairment in renal function can lead to drug accumulation, increasing the risk of lactic acidosis—a rare but serious adverse effect.

• Renal clearance: Approximately 450-550 mL/min, indicating active secretion by organic cation transporters (OCT1 and OCT2) in the kidneys.

• Elimination half-life: Ranges between 4-8 hours for IR formulations and approximately 10-17 hours for ER formulations.

• Primary route of excretion: 90-100% excreted unchanged in the urine; fecal excretion accounts for a small percentage.

5. Factors Influencing Metformin Pharmacokinetics

Several physiological and pathological conditions can alter the pharmacokinetics of metformin, affecting its efficacy and safety:

Renal Impairment: Reduced kidney function significantly decreases metformin clearance, necessitating dose adjustments or discontinuation if the estimated glomerular filtration rate (eGFR <30 mL/min/1.73 m²).

Hepatic Impairment: Although metformin is not metabolized in the liver, severe liver disease increases the risk of lactic acidosis.

Drug Interactions: Medications that inhibit renal organic cation transporters (OCTs), such as cimetidine, ranolazine, and dolutegravir, can reduce metformin elimination and increase plasma concentrations.

Age and Pregnancy: In elderly patients, renal clearance naturally declines, requiring caution with dosing. In pregnancy, metformin crosses the placenta, but its pharmacokinetics remain largely unchanged.

Clinical Trails of Metformin

Metformin, primarily used for managing type 2 diabetes, has been investigated in various clinical trials for its potential benefits beyond glycemic control. Below is a summary of notable studies and their findings:

1. Targeting Aging with Metformin (TAME) Trial
The TAME trial is a nationwide, six-year study involving over 3,000 participants aged 65-79 across 14 research institutions. It aims to determine if metformin can delay the onset or progression of age-related diseases such as heart disease, cancer, and dementia. As of now, the trial is ongoing, and results are pending

2. Metformin for Alzheimer's Dementia Prevention
This study tests the effects of metformin on memory and Alzheimer's disease indicators in older adults who are overweight or obese and have mild cognitive impairment but do not have diabetes.

Participants are randomly assigned to take either a placebo or extended-release metformin daily for two years, with regular assessments of cognitive function. The trial is currently in progress, and no conclusive results are available yet.

3. Metformin in Li-Fraumeni Syndrome (MILI) Trial
This trial investigates whether metformin can reduce cancer risk in individuals with Li-Fraumeni Syndrome (LFS), a genetic condition that increases susceptibility to various cancers.

Preliminary studies have shown that metformin is well-tolerated and effective at reducing oxidative phosphorylation in LFS patients. However, the impact on cancer incidence has not been established due to the trial's size and short duration.

4. Metformin for Chemoprevention of Lung Cancer
A phase II trial examines the effect of extended-release metformin on lung cancer risk in overweight or obese individuals at high risk for the disease. Given metformin's established safety profile, the study explores its potential anti-cancer properties in this context. Results from this trial are awaited.

5. Metformin as a Myelin Repair Therapy in Multiple Sclerosis
Metformin is being tested in clinical trials for multiple sclerosis (MS). One trial is evaluating metformin as a myelin repair treatment in combination with clemastine, a hay fever medication.

This research aims to determine if metformin can promote remyelination in individuals with MS. The outcomes of this study are not yet available.

In summary, while metformin shows promise in various therapeutic areas beyond diabetes management, many clinical trials are still underway, and definitive results are pending.

Frequently asked questions (FAQs) about Metformin,

1. What is Metformin used for?

- Metformin is primarily used to manage type 2 diabetes. It helps control blood sugar levels by improving insulin sensitivity and reducing glucose production in the liver.

2. How does Metformin work?

- Metformin works by:

- Decreasing glucose production in the liver.

- Improving insulin sensitivity in muscle cells.

- Slowing glucose absorption in the intestines.

3. What are the side effects of Metformin?

- Common side effects include:

- Nausea, vomiting, or diarrhea.

- Stomach upset or abdominal pain.

- Loss of appetite.

- Rare but serious side effects include:

- Lactic acidosis (a medical emergency).

- Vitamin B12 deficiency with long-term use.

4. Can Metformin cause weight loss?

- Yes, Metformin may lead to modest weight loss in some individuals, as it can reduce appetite and improve insulin resistance. However, it is not a weight-loss drug.

5. Can I take Metformin if I’m pregnant?

- Metformin is sometimes used during pregnancy for women with gestational diabetes or polycystic ovary syndrome (PCOS), but you should only take it under the guidance of a healthcare provider.

6. Does Metformin cause kidney damage?

- Metformin itself does not cause kidney damage, but it is cleared by the kidneys. If kidney function is impaired, Metformin can accumulate and increase the risk of lactic acidosis. Regular kidney function tests are recommended.

7. Can I drink alcohol while taking Metformin?

- Alcohol should be consumed in moderation, as excessive alcohol intake can increase the risk of lactic acidosis and hypoglycemia (low blood sugar).

8. What should I do if I miss a dose of Metformin?

- Take the missed dose as soon as you remember, unless it’s almost time for your next dose. Do not double the dose to make up for a missed one.

9. Can Metformin be taken with other medications?

- Metformin can interact with certain medications, such as:

- Diuretics or corticosteroids (may increase blood sugar).

- Iodinated contrast dyes (temporarily stop Metformin before imaging tests).

- Always inform your doctor about all medications and supplements you are taking.

10. Does Metformin cause vitamin B12 deficiency?

- Long-term use of Metformin can lead to vitamin B12 deficiency. Regular monitoring and supplementation may be necessary.

11. Can Metformin be used for PCOS?

- Yes, Metformin is often prescribed for women with polycystic ovary syndrome (PCOS) to help regulate menstrual cycles, improve insulin resistance, and support fertility.

12. What is the difference between Metformin IR and XR?

- Immediate-Release (IR): Taken 2-3 times daily with meals.

- Extended-Release (XR/ER): Taken once daily, usually with the evening meal. XR has fewer gastrointestinal side effects.

13. Can Metformin cause low blood sugar (hypoglycemia)?

- Metformin alone is unlikely to cause hypoglycemia. However, the risk increases if taken with other diabetes medications like insulin or sulfonylureas.

14. How long does it take for Metformin to work?

- Metformin starts to lower blood sugar within a few days, but it may take up to 2-4 weeks to see the full effects.

15. Can I stop taking Metformin once my blood sugar is under control?

- No, you should not stop taking Metformin without consulting your doctor. Stopping abruptly can cause blood sugar levels to rise.

16. What foods should I avoid while taking Metformin?

- Avoid excessive sugary or high-carb foods. Focus on a balanced diet with whole grains, lean proteins, and vegetables to help manage blood sugar levels.

17. Can Metformin cause hair loss?

- Hair loss is not a common side effect of Metformin, but some individuals have reported it. If this occurs, consult your doctor.

18. Is Metformin safe for long-term use?

- Yes, Metformin is considered safe for long-term use when taken as prescribed and monitored by a healthcare provider.

19. Can I take Metformin if I have liver disease?

- Metformin is generally safe for people with liver disease, but your doctor will monitor liver function and adjust the dose if necessary.

20. Does Metformin cause lactic acidosis?

- Lactic acidosis is a rare but serious side effect of Metformin. It is more likely in individuals with kidney or liver impairment, dehydration, or those who consume excessive alcohol.

If you have specific questions about Metformin, always consult your healthcare provider for personalized advice.