Metformin Hydrochloride

Metformin is a popular oral diabetes medicine marketed as a generic or under the brand names of Glucophage, Fortamet, Glumetza, Riomet and D-Care DM2. Metformin is also combined with other oral diabetes medicines.

Metformin originates from the plant Galega officinalis that was used in medieval times to relieve individuals from frequent urination, a symptom associated with diabetes. Galegine was determined to be the active ingredient of this plant, and its first documented clinical use to lower blood sugar was in 1927. The concern for one severe side effect – lactic acidosis – in a number of similar medications kept Metformin off the market for a number of years even though Metformin only rarely causes lactic acidosis. The FDA approved Metformin for use in 1998 and declared this medication the first-line treatment for Type 2 Diabetes Mellitus in 2012.

Metformin

As a meal is digested in the body, sugar obtained from the food is converted to glucose.

Glucose is the form of sugar that appears in the blood.  Diabetes Mellitus is a condition in which a patient has a high amount of glucose in the blood. As blood glucose rises after a meal, insulin is normally released into the blood by the pancreas to move glucose from the blood into the cells of the body. Once glucose is inside the cells, it can be used in cellular metabolism or stored as energy. Physiologically, several things contribute to high blood glucose. Diabetic patients can be insensitive to insulin, leaving high amounts of glucose in the blood even when insulin production is normal.  Although there is already substantial glucose in the blood, the liver can continue to produce and release additional glucose into the bloodstream. Metformin decreases glucose production by the liver, decrease absorption of glucose in the intestines, and improves the body’s insulin sensitivity – all of which lower the level of glucose in the blood.

The FDA approves Metformin for the first-line treatment and management of Type 2 Diabetes Mellitus when diet and exercise are ineffective in managing blood glucose levels.

This medication is not effective for use in patients with Type 1 Diabetes Mellitus, who have high blood sugar because they do not produce insulin.  Metformin is also used to treat polycystic ovary syndrome in women.

A typical adult prescribed Metformin will initially take 500 mg by mouth twice a day, or 850 mg once a day. If the dose is well-tolerated, it may be increased after a week or two to 1000mg twice daily. The first effects of Metformin on blood sugar may be noticed within a few days, but the medication can take two weeks to reach maximum efficacy.

Metformin is best taken with meals and an ample amount of water. This medication is taken at regular intervals to ensure the constant regulation of a diabetic patient’s blood glucose levels. Patients should be cautious to not miss doses. However, if a dose is missed, the patient should skip the missed dose if it is close to the next scheduled dose. Patients should not take two doses at a time or take an extra dose.

Patients may not feel any better from this medication, but the regular use of Metformin helps decrease and manage blood sugar levels. The regular use of this medication will control symptoms associated with diabetes, as well as prolong the life of patients with Type 2 diabetes.

Common side effects of taking this medication occur in the gastrointestinal tract.

About half of patients taking Metformin immediate-release tablets will experience diarrhea, while about a quarter of patients will experience nausea and vomiting. If a patient suffers from these side effects, switching to an extended-release tablet may provide relief. Extended-release medications are formulated to release the medication slowly in the body over a longer period of time. This minimizes many side effects associated with digesting and absorbing Metformin.

The most serious adverse effect of metformin is lactic acidosis.  This is rare, but more likely to occur in patients with compromised kidney function or taking certain drugs.  Symptoms of lactic acidosis include muscle pain or weakness, difficulty breathing, lethargy, or abdominal pain. Discontinue the drug and contact your prescriber or pharmacist immediately if you believe you are developing lactic acidosis.

While Metformin can be effective in lowering blood sugar, this medication is not safe for use in some cases. Individuals overly sensitive or allergic to Metformin, have severely decreased kidney function, or severe or chronic metabolic acidosis can have severe complications with this medication. A physician may decide to not prescribe Metformin for a patient with these medical characteristics.

Lastly, patients taking Metformin should continue to check their blood sugar levels as instructed by their prescriber to ensure correct use and positive effect of the medication.

Resources:

PubMedHealth – Metformin

https://www.ncbi.nlm.nih.gov/books/NBK518983/

News Medical: Metformin History

https://www.news-medical.net/health/Metformin-History.aspx