metformin hydrochloride

(met fore' min)

Glucophage, Glucophage XR, Riomet

Pregnancy Category B

Drug class
Antidiabetic

Therapeutic actions
Exact mechanism is not understood; possibly increases peripheral utilization of glucose,
increases production of insulin, decreases hepatic glucose production and alters intestinal
absorption of glucose.

Indications
• Adjunct to diet to lower blood glucose with type 2 (non–insulin-dependent)
diabetes mellitus in patients > 10 yr; extended release in patients > 17 yr
• As part of combination therapy with a sulfonylurea or insulin when either drug
alone cannot control glucose levels in patients with type 2 diabetes mellitus

Contraindications and cautions

• Contraindicated with allergy to metformin; CHF; diabetes complicated by fever,
severe infections, severe trauma, major surgery, ketosis, acidosis, coma (use
insulin); type 1 (insulin-dependent), serious hepatic impairment, serious renal
impairment, uremia, thyroid or endocrine impairment, glycosuria, hyperglycemia
associated with primary renal disease; labor and delivery (if metformin is used
during pregnancy, discontinue drug at least 1 mo before delivery); lactation
(safety not established).

Available forms
Tablets—500, 850, 1,000 mg; extended-release tablets—500 mg; oral solution—
100 mg/mL

Dosages
ADULTS
500–850 mg/day PO in divided doses to a maximum of 2,550 mg/day. Dose should be
adjusted based on response and blood glucose level. ER tablet: Initially 500 mg/day PO
with the evening meal; may be increased by 500 mg each wk to a maximum of 2,550 mg
once daily.
PEDIATRIC PATIENTS 10–16 YR
500 mg/day PO in divided doses with meals; may be increased by 500 mg each wk to a
maximum of 2,000 mg/day. ER tablet is not recommended.
GERIATRIC PATIENTS AND PATIENTS WITH RENAL IMPAIRMENT
Smaller doses may be necessary; monitor closely and adjust slowly.

Pharmacokinetics
Route Peak Duration
Oral 2–2.5 hr 10–16 hr

Metabolism: Hepatic; T1/2: 6.2 and 17.6 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• Endocrine: Hypoglycemia, lactic acidosis
• GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea
• Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria

Interactions
Drug-drug
• Increased risk of hypoglycemia with cimetidine, furosemide, cationic drugs such
as digoxin, amiloride, vancomycin
• Increased risk of lactic acidosis with glucocorticoids or ethanol
• Increased risk of acute renal failure and lactic acidosis with iodinated contrast
material used in radiologic studies; stop metformin for 48 hr before and after such
studies
Drug-alternative therapy
• Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery

Nursing considerations
Assessment
• 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, liver function tests, blood glucose, CBC

Interventions
• Monitor urine or serum glucose levels frequently to determine effectiveness of
drug and dosage.
• Arrange for transfer to insulin therapy during periods of high stress (infections,
surgery, trauma).
• 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.
• 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.

Adverse effects in Italic are most common; those in Bold are life-threatening.