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Metformin

GlucophageBiguanideImmediate and extended release oral tablets and solution

Mechanism

Decreases hepatic glucose production, decreases intestinal glucose absorption, and improves insulin sensitivity.

Uses

  • Type 2 diabetes mellitus
  • Improving glycemic control with diet and exercise

Common effects

  • Diarrhea
  • Nausea
  • Abdominal discomfort
  • Reduced vitamin B12 over time

Serious risks

  • Metformin associated lactic acidosis
  • Risk accumulation with renal impairment
  • Contrast and procedure related risk

Monitoring

  • A1C and glucose
  • Estimated glomerular filtration rate
  • Vitamin B12 during long term treatment
  • Tolerance and adherence

Counseling

  • Take with food when directed
  • Extended release products should be swallowed intact
  • Limit excessive alcohol
  • Tell the care team before contrast studies or procedures
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