METFORMIN

Generic Name Metformin

Brand Name Glucophage, Glucophage XR, Fortamet, and Glumetza
Drug Classification Pharmacotherapeutic: Biguanide antihyperglycemic
Clinical: Antidiabetic agent
Pregnancy Category B
Mode of Action May promote storage of excess glucose as glycogen in
the liver, which reduces glucose production. Metformin
also may improve glucose use by skeletal muscle and
adipose tissue by increasing glucose transport across
cell membranes. This drug also may increase the
number of insulin receptors on cell membranes and
make them more sensitive to insulin. In addition,
metformin modestly decreases blood triglyceride and
total cholesterol levels.
Dose and Route Dosage for type 2 diabetes
Adult dosage (ages 18–79 years)
 Immediate-release tablets
o Typical starting dosage: 500 mg, twice
per day, or 850 mg, once per day.
o Maximum dosage: 2,550 mg per day.
 Extended-release tablets
o Typical starting dosage: 500 mg
o Maximum dosage: 2,000 mg per day.
(The maximum dose of Fortamet is 2,000
mg per day.)
 Child dosage (ages 10–17 years)
 Immediate-release tablets
o Typical starting dosage: 500 mg taken
twice per day.
o Maximum dosage: 2,000 mg per day.
Indication  Diabetes mellitus-Type 2
 Insulin resistance – as adjunct to insulin
 Metformin extended-release tablet (XR)
Contraindication  Hypersensitivity to drug
 Acute or chronic metabolic acidosis (including
diabetic ketoacidosis) with or without coma
 Underlying renal dysfunction
 Heart failure requiring drug therapy

Side Effects/ Adverse Occasional (greater than 3%): GI disturbances

Effects (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.

CNS: Headache
EENT: Metallic taste
ENDO: Hypoglycemia
GI: Abdominal distention, anorexia, constipation,
diarrhea, flatulence, indigestion, nausea, vomiting
HEME: Aplastic anemia, megaloblastic anemia,
thrombocytopenia
SKIN: Photosensitivity, rash
Other: Lactic acidosis, weight loss
Drug Interactions DRUG: Furosemide may increase concentration.
 Cationic medications may increase
concentration/effects.
IV contrast dye may increase risk of metformin-induced
lactic acidosis, acute renal failure
HERBAL: Garlic
LAB VALUES: May alter cholesterol, LDL, triglycerides,
HDL.

Nursing
Responsibilities 1. Teach patient to recognize and immediately report
signs and symptoms of acidosis, such as weakness,
fatigue, muscle pain, dyspnea, abdomi- nal pain,
dizziness, light-headedness, and slow or irregular
heartbeat.
2. Discontinue metFORMIN, report immediately if
evidence of lactic acidosis appears.
3. Inform patient that drug may cause diarrhea,
nausea, and upset stomach.
4. Teach patient about diabetes and importance of
proper diet, exercise, weight control, and blood
glucose monitoring.
5. Prescribed diet is principal part of treatment; do not
skip, delay meals.
6. Advise patient to report changes in health status
these may warrant dosage decrease or drug
withdrawal.
7. Periodically monitor glucose and gly- cosylated
hemoglobin levels to evaluate drug efficacy.
8. Diabetes requires lifelong control.
9. Report persistent headache, nausea, vomiting,
diarrhea or if skin rash, unusual bruising/bleeding,
 change in color of urine or stool occurs.
10. Do not take dose for at least 48 hrs after receiving
IV contrast dye with radiologic testing.
References:
Kizior, R.J., Hodgson, K.J., & EBSCO Publishing. (2019). Metformin.
Saunders nursing drug handbook 2019. St. Louis, Missouri: Elsevier

Sinha, S., (2020). Metformin. Retrieved on January 26, 2021 from

https://www.drugs.com/metformin.html

Mayo Clinic. (2020). Metformin (Oral Route). Retrieved on January 26, 2021
from https://www.mayoclinic.org/drugs-supplements/metformin-oral-route/
description/drg-20067074