The Navigation Model of Therapy: Why Awareness Changes Everything
November 16, 2025
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Brand Name :
Glucophage
(France) [Available]Synonyms :
metformin
Class :
Antidiabetics, Biguanides
Brand Name :
Glucophage
(France) [Available]Synonyms :
metformin
Class :
Antidiabetics, Biguanides
Dosage forms & Strengths Â
Immediate Release Tablet Â
500mg Â
850mg Â
1000mg Â
Extended-Release Tablet Â
500mg Â
750mg Â
1000mg Â
Oral Solution Â
100mg/ml Â
Extended-Release Oral Suspension Â
47.31g/473mL per container Â
Immediate release
Initial dose: 500 mg orally twice or 850 mg orally once daily
Increase 500 mg weekly or 850 mg every 2 weeks as tolerated
Maintenance dose: 2000 mg/day in divided doses
Maximum dose: 2550 mg/day
Take the immediate release dose 2-3 times daily with meals
In general, a lesser dose below 1500 mg/day shows little efficacy. And a dose more than 2000 mg/day are least tolerable
Extended release
Initial dose: 500 to 1000 mg orally once daily
Increment in 500 mg every week as tolerated
Do not exceed 2000 mg/day
Take the medication with evening meal
If the glycemic level is not controlled with 2000 mg once daily, divide the dosing to 1000 mg twice daily
Switch to immediate release product, even if the suitable level is not achieved
Dosage forms & Strengths Â
Immediate Release Tablet Â
500mg Â
850mg Â
1000mg Â
Extended-Release Tablet Â
500mg Â
750mg Â
1000mg Â
Oral Solution Â
100mg/ml Â
Extended-Release Oral Suspension Â
47.31g/473mL per container Â
Indicated to improve glycemic control in pediatric patients ≥10 years with type 2 DM :
Age: 10 to <17 years
Immediate release
Initial dose- 500 mg orally twice daily
Increase the dose weekly as per tolerability
Divide the daily dose 2-3 times per day, with meals
Do not exceed the dose more than 2000 mg/day
Extended-release oral suspension
Initially 500 mg orally once daily with evening meal
Increase the dose weekly as per tolerability
Do not exceed the dose more than 2000 mg/day
To minimize gastrointestinal side effects, dose titration should be performed slowly
Elderly patients are more prone to decreased renal capability. Hence, the drug is contraindicated in geriatric with renal impairment. Â
Not indicated for patients >80 years Â
may decrease the diagnostic effect of each other when combined
they increase the toxicity of metformin
It may enhance the levels when combined with metformin by unspecified interactions mechanism
It may enhance the levels when combined with metformin by unspecified interactions mechanism
benzyl alcohol: they may increase the toxic effect of metformin
carbonic Anhydrase Inhibitors may increase the risk of adverse effects of metformin
carbonic Anhydrase Inhibitors may increase the risk of adverse effects of metformin
carbonic Anhydrase Inhibitors may increase the risk of adverse effects of metformin
carbonic Anhydrase Inhibitors may increase the risk of adverse effects of metformin
carbonic Anhydrase Inhibitors may increase the risk of adverse effects of metformin
may diminish the anticoagulant effect of Vitamin K Antagonists
may diminish the anticoagulant effect of Vitamin K Antagonists
may diminish the anticoagulant effect of Vitamin K Antagonists
may diminish the anticoagulant effect of Vitamin K Antagonists
may diminish the anticoagulant effect of Vitamin K Antagonists
NSAIDs may enhance the adverse/toxic effect of metformin
NSAIDs may enhance the adverse/toxic effect of metformin
NSAIDs may enhance the adverse/toxic effect of metformin
NSAIDs may enhance the adverse/toxic effect of metformin
NSAIDs may enhance the adverse/toxic effect of metformin
cephalexin increases the concentration of metformin in the serum
they increase the toxicity of metformin
they increase the toxicity of metformin
they increase the toxicity of metformin
they increase the toxicity of metformin
they increase the toxicity of metformin
metformin increases the concentration of dofetilide in the serum
they increase the toxicity of metformin
they increase the toxicity of metformin
they increase the toxicity of metformin
they increase the toxicity of metformin
they increase the toxicity of metformin
metformin reduces the effect of anticoagulation of vitamin K antagonists
metformin reduces the effect of anticoagulation of vitamin K antagonists
metformin reduces the effect of anticoagulation of vitamin K antagonists
metformin reduces the effect of anticoagulation of vitamin K antagonists
metformin reduces the effect of anticoagulation of vitamin K antagonists
When halometasone is used together with metformin, this leads to elevated risk or seriousness of hyperglycemia
metformin leads to a reduction in the rate of excretion of nitric oxide, which leads to an increased level of serum
methylprednisolone hemisuccinateÂ
When methylprednisolone hemisuccinate is aided with metformin, this leads to elevated hyperglycemia risk
vandetanib may enhance the serum concentration of metformin
ondansetron enhances the concentration of ondansetron in serum
ondansetron enhances the concentration of ondansetron in serum
may increase the hypoglycemic effect
may increase the hypoglycemic effect
may increase the hypoglycemic effect
may increase the hypoglycemic effect
may increase the hypoglycemic effect
it increases the toxicity of metformin in the serum
it increases the concentration of metformin in the serum
it increases the concentration of metformin in the serum
ombitasvir​/paritaprevir/​ritonavirÂ
the combination drug increases the toxicity of metformin
it increases the concentration of metformin in the serum
it increases the toxicity of metformin
it reduces the efficacy of metformin
It may enhance toxicity when combined with metformin by unspecified interactions mechanism
It may enhance toxicity when combined with metformin by unspecified interactions mechanism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
It may diminish the effects when combined with metformin by pharmacodynamic antagonism
abemaciclib: they may enhance the serum concentration of metformin
efficacy of metformin may be lowered when taken with norethisterone due to pharmacodynamic antagonism
metformin when taken with sibutramine should be monitored closely for alterations in blood sugar
the anti-diabetic efficacy of metformin can be reduced with mometasone furoate
Iodinated Contrast Agents may increase the adverse/toxic effect of Metformin
Iodinated Contrast Agents may increase the adverse/toxic effect of Metformin
Iodinated Contrast Agents may increase the adverse/toxic effect of Metformin
Iodinated Contrast Agents may increase the adverse/toxic effect of Metformin
it increases the concentration of metformin in the serum
it increases the concentration of metformin in the serum
it decreases the concentration of metformin in the serum
it increases the concentration of metformin in the serum
metformin is an oral antidiabetic drug that belongs to the biguanide class of drugs that is used for the management of type 2 diabetes. It is understood to function by decreasing the release of glucose in the liver and enhancing glucose utilization in muscles and by improving the utilization capacity for insulin. The effects of metformin are mainly based on activation of the AMP-activated protein kinase (AMPK) signal cascade, which results in suppression of the hepatic gluconeogenesis and enhancement of glucose utilization in peripheral tissues. metformin also has been reported to possess anti-inflammatory and anti-proliferative properties.Â
It is active against a wide variety of organisms and its effectiveness has been demonstrated in stabilizing the glycaemic control of people with type II diabetes. It is used alone or in conjunction with insulin; sulfonylureas and glucagon-like peptide-1 (GLP-1) receptor agonists.Â
Frequency defined Â
>10%Â Â
diarrhea (53%)Â Â
nausea (25%)Â Â
vomiting (25%)Â Â
1-10%Â Â
Low serum vitamin B-12 (7%)Â Â
Constipation (1-5%)Â Â
Abdominal pain (1-5%)Â Â
Dyspepsia/heartburn (1-5%)Â Â
Abdomen distention (1-5%)Â Â
Flatulence (1-5%)Â Â
Dyspepsia/heartburn (1-5%)Â Â
Dizziness (1-5%)Â Â
Flatulence (1-5%)Â Â
Upper respiratory infection (1-5%)Â Â
Headache (1-5%)Â Â
Taste disturbance (1-5%)Â
Metformin carries a black box warning for lactic acidosis which is a condition that is characterized by the accumulation of lactic acid in the body. It is recommended to use metformin with precautions in patient dealing with renal or hepatic disease and can be stopped before procedures involving intravascular iodinated contrast media.Â
Renal impairment Â
Liver impairment Â
Cardiovascular disease Â
Alcohol use Â
Surgery or radiologic procedures Â
Pregnancy consideration:Â Â Â
Pregnancy Category: The safety of metformin during pregnancy and breastfeeding is not well established.Â
Pregnancy Category: Category BÂ Â
Breastfeeding warnings:Â Â Â
metformin is excreted in breastmilk. Â
Pregnancy category:Â Â
Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. Â
Category B: No evidence of risk to the fetus is found in animal reproduction studies, and there are not enough studies on pregnant women. Â
Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a human product; Pregnant women must take care of the potential risks. Â
Category D: There is adequate data with sufficient evidence of human fetal risk from various platforms. However, despite potential dangers may be used only in emergencies for potential benefits. Â
Category X: Drugs listed in this category outweigh the risks over benefits. The drug is not for pregnant women. Â
Category N: No data is available for the drug under this category. Â
Metformin is an oral antidiabetic drug which is classified under biguanides category of drugs. It mainly helps in minimizing the capacity of the liver to produce glucose and enhancing the uptake of the insulin by the tissues of the body.Â
Metformin is also known to modulate a protein referred to as the AMPK that plays an essential role in the regulation of glucose concentration in the body. Activated AMPK leads to decreased glucose synthesis in the liver and increased glucose uptake in the body tissues. In addition, metformin can reduce the levels of glucose transported within the intestines which makes it more useful for regulating the amount of glucose present in the blood. For instance, it improves lipid level through a reduction in levels of triglycerides and LDL cholesterol in the blood. It can also increase endothelium’s blood vessel widening ability which reduces inflammation as well as have anti – cancerous impact to certain kinds of carcinoma.Â
PharmacodynamicsÂ
Metformin has several pharmacodynamic action, such as action on glucose and lipid metabolism and on some signal pathways. It mainly helps in limiting the amount of glucose synthesized in the liver and thus lowers the blood sugar level in case of Type 2 diabetic patients. This is done by inciting an enzyme known as AMP-activated protein kinase, which inhibits some enzymes that are involved in gluconeogenesis. It also enhances the ability of muscles and other tissues to use glucose more effectively and thus less glucose remains in the blood. It also beneficially impacts lipid profiles and directly decreases plasma triglycerides and LDL cholesterol.Â
PharmacokineticsÂ
AbsorptionÂ
It is taken orally and is quickly and well absorbed from the gastrointestinal tract. This should be taken with or without food to minimize the risk of gastrointestinal side effects. The maximum plasma levels are attained within 2 to 3 hours after the drug administration.Â
DistributionÂ
Metformin has fairly low plasma protein binding with only below 5% of the drug bound to plasma proteins. The apparent volume of distribution is approximately 654 L.Â
MetabolismÂ
It undergoes renal metabolism and excreted through kidneys through glomerular filtration and tubular secretion. 90% of the drug is eliminated in the urine within 24 hours of administrationÂ
Elimination/ExcretionÂ
The elimination half-life of metformin is approximately 6.2 hours in people with normal kidney function. In people with impaired kidney function, the elimination half-life may be prolonged. Â
Metformin is an oral antidiabetic drug that is used to control high blood sugar levels in patients with Type 2 diabetes and it should be taken with food. It is recommended that metformin should be administered with food to help reduce stomach upset that may result in nausea, vomiting and diarrhea.Â
Generic Name: metformin Â
Pronounced: met-for-min Â
Why do we use metformin? Â
Metformin is among the most common drugs that are usually used in the management of Type II Diabetes Mellitus. It is classified as a first-generation antidiabetic drug and is used in the management of patients with type 2 diabetes. It helps in lowering blood glucose levels by lowering the rate of glucose production in the liver and improving sensitivity to insulin. It can also be used for weight loss or to prevent weight gain and offer benefit to those with type 2 diabetes who are overweight or obese.Â
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