Glucophage: Advanced Glycemic Control for Type 2 Diabetes
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Glucophage, with its active ingredient metformin hydrochloride, represents a first-line pharmacological intervention in the management of type 2 diabetes mellitus. As a biguanide antihyperglycemic agent, it functions primarily by decreasing hepatic glucose production and improving insulin sensitivity in peripheral tissues. Its established efficacy, favorable safety profile, and extensive clinical history make it a cornerstone of modern diabetes therapy. This medication is indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and above.
Features
- Active Pharmaceutical Ingredient: Metformin hydrochloride.
- Available in immediate-release (IR) and extended-release (XR) tablet formulations.
- Standard immediate-release strengths: 500 mg, 850 mg, and 1000 mg.
- Standard extended-release strengths: 500 mg, 750 mg, and 1000 mg.
- White to off-white, film-coated, oblong-shaped tablets.
- Works primarily by suppressing hepatic gluconeogenesis.
- Increases peripheral glucose uptake and utilization.
- Delays intestinal glucose absorption.
- Does not stimulate insulin secretion, therefore not associated with hypoglycemia when used as a monotherapy.
Benefits
- Provides effective and consistent reduction of both fasting and postprandial plasma glucose levels.
- Demonstrated efficacy in lowering HbA1c, a key long-term marker of glycemic control.
- Associated with weight neutrality or modest weight loss, a significant advantage over many other antidiabetic agents.
- May improve lipid profiles by lowering triglycerides and LDL cholesterol.
- Has a long-standing safety record with a low risk of significant hypoglycemia.
- The extended-release formulation offers once-daily dosing, improving patient adherence and potentially reducing gastrointestinal side effects.
Common use
Glucophage (metformin) is primarily prescribed for the management of type 2 diabetes mellitus. It is used as monotherapy or in combination with other oral antidiabetic agents (such as sulfonylureas, DPP-4 inhibitors, or SGLT2 inhibitors) or with insulin to achieve optimal glycemic targets. Its use is also explored and approved in certain cases of prediabetes to delay or prevent the onset of overt type 2 diabetes. Furthermore, it is a primary treatment for polycystic ovary syndrome (PCOS) due to its ability to improve insulin resistance and regulate menstrual cycles in this population.
Dosage and direction
Dosage must be individualized based on efficacy and tolerability, under the direct supervision of a healthcare provider. The usual starting dose for adults is 500 mg twice daily or 850 mg once daily with meals. Dosage can be increased gradually, typically at weekly intervals, to minimize gastrointestinal adverse effects. The maximum recommended daily dose is 2550 mg administered in divided doses for the immediate-release formulation and 2000 mg once daily for the extended-release formulation. For pediatric patients (10-16 years old), the starting dose is 500 mg twice daily, with a maximum dose of 2000 mg per day. Tablets should be swallowed whole and never crushed or chewed. The extended-release tablets must be taken once daily with the evening meal.
Precautions
Prior to initiation, assess renal function (eGFR). Do not initiate if eGFR is below 30 mL/min/1.73m². Metformin use requires caution in patients at risk of impaired renal function, including the elderly, those taking antihypertensive drugs, or those with congestive heart failure. Temporarily discontinue Glucophage in patients undergoing radiologic studies involving intravascular iodinated contrast materials due to the risk of contrast-induced nephropathy. Withhold therapy in any condition associated with hypoxemia (e.g., acute congestive heart failure, sepsis), dehydration, or acute alcohol intoxication. Monitor vitamin B12 levels annually or biannually, as long-term use can be associated with deficiency. Inform patients of the risk of lactic acidosis and its symptoms.
Contraindications
Glucophage is strictly contraindicated in patients with severe renal impairment (eGFR < 30 mL/min) or renal disease. It is also contraindicated in patients with known hypersensitivity to metformin or any ingredient in the formulation. Use is prohibited in patients with acute or chronic metabolic acidosis, including diabetic ketoacidosis. It should not be used in patients undergoing medical procedures with a potential for hemodynamic instability or in a state of hepatic impairment, acute alcohol intoxication, or excessive alcohol intake.
Possible side effect
The most common adverse reactions are gastrointestinal in nature, including diarrhea, nausea, vomiting, flatulence, abdominal discomfort, and indigestion. These effects are often transient and dose-dependent. A metallic taste has also been reported. A rare but serious side effect is lactic acidosis, which is a medical emergency. Symptoms include malaise, myalgia, respiratory distress, somnolence, and abdominal pain. Long-term use has been associated with decreased vitamin B12 absorption, which can lead to megaloblastic anemia.
Drug interaction
Concomitant use with cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, trimethoprim, vancomycin) that are eliminated by renal tubular secretion may increase metformin plasma levels. Alcohol potentiates the effect of metformin on lactate metabolism and can increase the risk of lactic acidosis. Corticosteroids, diuretics, and sympathomimetics may produce hyperglycemia and may require dosage adjustment of Glucophage.
Missed dose
If a dose is missed, it should be taken as soon as the patient remembers. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Patients should never take a double dose to make up for a missed one, as this increases the risk of side effects.
Overdose
Hypoglycemia has not been seen with metformin overdose when used as a monotherapy; however, it can occur when overdosed in combination with other glucose-lowering agents (e.g., sulfonylureas or insulin). The primary risk of a significant metformin overdose is lactic acidosis. Overdose is a medical emergency requiring immediate hospitalization. Treatment is primarily supportive and includes hemodialysis, which clears metformin effectively from the blood.
Storage
Store Glucophage tablets at room temperature, between 20°C to 25°C (68°F to 77°F). Keep the medication in its original blister pack or bottle to protect it from light and moisture. Always keep all medications out of the reach of children and pets. Do not use tablets that are beyond their expiration date or show signs of physical degradation.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“Glucophage has been the foundation of my type 2 diabetes management for over a decade. After the initial adjustment period, it has provided stable glucose control with minimal side effects. Its effectiveness is well-documented in the literature, and my HbA1c has remained within target range consistently.” – Endocrinologist’s clinical observation.
“As a primary care physician, I find metformin to be an indispensable first-line agent. Its efficacy, cost-effectiveness, and cardiovascular safety profile make it the logical choice for most of my patients newly diagnosed with type 2 diabetes. The introduction of the XR formulation has significantly improved gastrointestinal tolerability.” – General Practitioner.
“Starting on the extended-release version made a world of difference. The once-daily dosing is easy to remember, and I experienced none of the digestive issues I had with the regular tablets. It has helped me manage my blood sugar levels effectively.” – Patient testimonial.