Metformin is the generic name for Glucophage. Both names will be used interchangeably on this page. This medication was approved by the FDA in 2000. Glucophage is oral diabetes medication that belongs to the group of medications called the biguanides.
It works by decreasing the amount of glucose the liver releases from the glycogen storage and also decreases the amount of sugar absorbed from meals and increases the sensitivity of the body to insulin.
Glucophage is different from other diabetes medications like sulfonylureas, because Glucophage does not cause hypoglycemia and does not cause the insulin secretion by the pancreas to increase.
Also, it has been found that Glucophage does not cause weight gain, unlike other oral diabetes medications. Some patients taking Glucophage have been found to lose weight. This does not mean that people should use this diabetes medication for weight loss alone. Metformin weight loss should be an added advantage for those with type 2 diabetes who are obese.
Glucophage is used to treat type 2 diabetes in adults and children over 10 years of age. It comes in different dosage strength tablets of 500mg, 850mg and 1000mg for the immediate release tablets. It is available in extended release form called Glucophage XR and comes in tablet strengths of 500mg and 750mg tablets. The diabetic person taking Glucophage is expected to adhere to diabetic diet and exercise regimen. Glucophage XR is for use in adults alone.
Glucophage does not cause hypoglycemia because it does not increase the insulin release. Hypoglycemia can occur when Glucophage is combined with other blood glucose lowering drugs, including insulin. Hypoglycemia can also occur with Glucophage and alcohol use.
Steroids like prednisone and other medications that raise blood sugar, will seem to reduce the effect of Glucophage because of the increase in blood sugar that occurs.
Furosemide increases the amount of Glucophage in the blood. The clearance of the drug by the kidney may not increase and this could lead to accumulation of the medication in the blood, which by itself could raise the risk for lactic acidosis.
Nifedipine increases the amount of Glucophage absorbed into the blood and also increases the amount of the Glucohage removed by the kidney.
Metformin is an acidic drug. As such, when taken with other acidic medications, the clearance of the drug by the kidney is reduced. This is because other acidic medications are also removed by the kidney and they compete with it for clearance. This could lead to the accumulation of the medicine in the blood which increases the risk for lactic acidosis. Examples of acidic medications are digoxin, aspirin, vancomycin, Penicillins, ranitidine, morphine, Dilantin, and others.
People taking Glucophage should avoid alcohol because alcohol increases the ability of this drug to form lactic acid. This increases the chance for lactic acidosis. Also, when alcohol damages the liver, the clearance of lactate is reduced and the chance of developing lactic acidosis also increases.
Lactic acidosis is a life-threatening condition that occurs due to accumulation of lactic acid in the body.
Metformin causes a rare adverse effect called lactic acidosis. Glucophage has a boxed warning for lactic acidosis. Lactic acidosis happens because Glucophage is a slightly acidic medicine that is removed by the kidney. Glucophage does not undergo change in the body, but gets removed the same way it enters the body. Glucophage is removed by the kidney and when there is problem with the kidney, liver or in heart failure, more of the medication remains in the body and cause lactic acid to accumulate. This is lactic acidosis. Lactic acid is made in the muscle when the muscle breaks down glucose without enough oxygen.
Signs and Symptoms of Lactic Acidosis are:
If you are taking Glucophage for sometime without problems and start to experience the above symptoms, without a known infection, you need to inform your doctor immediately. Lactic acidosis is emergency medical situation and needs to be presented to an emergency room and treated in the hospital. Most of the time hemodialysis is used to remove the excess of the drug from the blood in order to resolve lactic acidosis.
The following are people who should not take Glucophage:
Kidney function should be checked about twice a year. This is because it is the kidney that eliminates the drug from the body. Accumulation of this medication in the kidney can damage the kidney. Only patients with normal kidney function can be given Glucophage. If the patient is over 80years of age and receiving this medicine, the dose should be the lowest effective dose and kidney function should be checked more often. If patient develops problems with the kidney, metformin should be stopped.
HA1C tests should be done periodically to determine the continued effectiveness of metformin.
Patients should also have the level of vitamin B12 done periodically, to ensure that vitamin B12 is not being lowered by the medication
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