METFORMIN
____________________
A Drug Study Presented to the
Faculty of the Nursing Department
San Pedro College, Davao City
Mr. Marc Jade Adlawan, RN
____________________
In Partial Fulfillment of
The Requirements NCM 216-RLE
GASTROINTESTINAL / METABOLISM NURSING ROTATION
By:
Khesler Bernie N. Bacalla, St.N.
BSN-3D Group 2
March 22, 2021
BRAND NAME Glucophage, Glucophage
XR, Fortamet, Glumetza,
and Riomet
GENERIC NAME Metformin
CLASSIFICATION Anti-diabetics, Biguanides
MODE OF ACTION Decreases hepatic production of glucose. Decreases
intestinal absorption of glucose, improves insulin
sensitivity. Therapeutic Effect: Improves glycemic
control, stabilizes/decreases body weight, improves
lipid profile.
ROUTE AND DOSE Diabetes Mellitus
PO (Immediate-Release Tablets, Solution):
ADULTS, ELDERLY: Initially, 500 mg twice daily or
850 mg once daily. Titrate in increments of 500 mg
wkly or 850 mg every other wk. May also titrate from
500 mg twice daily to 850 mg twice daily after 2 wks.
Maintenance: 1,000–2,550 mg/day in 2–3 divided
doses. Maximum: 2,550 mg/day.
CHILDREN 10–16 YRS: Initially, 500 mg twice daily.
Maintenance: Titrate in 500-mg increments wkly.
Maximum: 2,000 mg/day. PO (Extended-Release
Tablets [Glucophage XR]): ADULTS, ELDERLY:
Initially, 500 mg once daily. May increase by 500 mg at
1-wk intervals. Maintenance: 1,000–2,000 mg daily.
Maximum: 2,000 mg/day.
PO (Extended-Release Tablets [Glumetza]):
ADULTS, ELDERLY: Initially, 1,000 mg once daily.
May increase by 500 mg at 1-wk intervals. Maximum:
2,000 mg/day. [Fortamet]:Initially, 500–1,000 mg once
daily. May increase by 500 mg at 1-wk intervals.
Maximum: 2,500 mg/day.
Dosage in Renal Impairment
Contraindicated in pts with serum creatinine greater
than 1.5 mg/dL (males) or greater than 1.4 mg/dL
(females). Alternative Recommendation: CrCl 45–60
mL/min: Continue use; monitor renal function q3–6
mos. CrCl 30–44 mL/min: Use caution. Consider dose
reduction; monitor renal function q3mos. CrCL less
than 30 mL/min: Discontinue use.
Dosage in Hepatic Impairment
Avoid use (risk factor for lactic acidosis)
INDICATION Management of type 2 diabetes mellitus as
monotherapy or concomitantly with oral sulfonylurea or
insulin. OFF-LABEL: Polycystic ovarian syndrome,
gestational diabetes mellitus. Prevention of type 2
diabetes.
CONTRAINDICATION Hypersensitivity to metformin. Renal
disease/dysfunction; abnormal CrCl from any cause
including MI, septicemia, or shock; acute or chronic
metabolic acidosis (with or without coma).
SIDE EFFECTS Occasional (greater than 3%): GI disturbances
(diarrhea, nausea, vomiting, abdominal bloating,
flatulence, anorexia) that are transient and resolve
spontaneously during therapy. Rare (3%–1%):
Unpleasant/metallic taste that resolves spontaneously
during therapy
ADVERSE EFFECTS Lactic acidosis occurs rarely (0.03 cases/1,000 pts) but
is a serious and often fatal (50%) complication. Lactic
acidosis is characterized by increase in blood lactate
levels (greater than 5 mmol/L), decrease in blood pH,
electrolyte disturbances. Symptoms include
unexplained hyperventilation, myalgia, malaise,
drowsiness. May advance to cardiovascular collapse
(shock), acute HF, acute MI, prerenal azotemia.
DRUG INTERACTION Furosemide may increase concentration. Cationic
medications (e.g., digoxin, morphine, quiNINE,
raNITIdine, vancomycin) may increase
concentration/effects. IV contrast dye may increase
risk of metformin-induced lactic acidosis, acute renal
failure (discontinue metFORMIN 24–48 hrs prior to and
up to 72 hrs after contrast exposure). HERBAL: Garlic
may cause hypoglycemia. FOOD: None known. LAB
VALUES: May alter cholesterol, LDL, triglycerides,
HDL.
NURSING Assessment
RESPONSIBILITIES 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, LFTs, blood
glucose, CBC
Interventions
Monitor urine or serum glucose levels frequently
to determine effectiveness of drug and dosage.
WARNING: Arrange for transfer to insulin
therapy during periods of high stress (infections,
surgery, trauma).
WARNING: 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.
Swallow extended-release tablets whole; do not
cut, crush, or chew.
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.
REFERENCES:
RNpedia(n.d). metformin hydrochloride Nursing Considerations & Management.
Retireved March 21,2021 from rnpedia.com/nursing-notes/pharmacology-drug-
study-notes/metformin-hydrochloride/
Hodgson, K.J. and Kizior, R.J. (2014). Saunders Nursing Drug Handbook 2014.
St. Louis Missouri:Elsevier Inc.
