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Metformin is used with a proper diet and exercise program and possibly with other medications to control high blood sugar in people with type 2 diabetes.

Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood).

Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.

Usual Adult Dose for Diabetes Type 2
Immediate-release:
Initial dose: 500 mg orally twice a day or 850 mg orally once a day
-Dose titration: Increase in 500 mg increments weekly or 850 mg every 2 weeks as tolerated
Maintenance dose: 2000 mg/day in divided doses
Maximum dose: 2550 mg/day

Extended-release:
Initial dose: 500 to 1000 mg orally once a day
Dose titration: Increase in 500 mg increments weekly as tolerated
Maximum dose: 2000 mg/day

Switching to Extended-Release:
-Patients receiving immediate-release may switch to extended-release once a day at same total daily dose (up to 2000 mg/day)

Comments:
-Metformin, if not contraindicated, should be considered first line-therapy for the management of type 2 diabetes mellitus.
-Immediate-release: Take in divided doses 2 to 3 times a day with meals; titrate slowly to minimis gastrointestinal side effects. In general, significant responses are not observed with doses less than 1500 mg/day and doses above 2000 mg are generally associated with little additional efficacy and poorer tolerability.
-Extended-release (ER): Take with the evening meal; if glycemic control is not achieved with ER 2000 mg once a day, may consider splitting daily dose to ER 1000 mg twice a day; if glycemic control is still not achieve, consider switch to immediate-release product.

Use: To improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise.

Usual Pediatric Dose for Diabetes Type 2
10 years or older:
Immediate-release:
Initial dose: 500 mg orally twice a day
-Dose titration: Increase in 500 mg increments weekly as tolerated; daily dose should be taken in divided doses 2 to 3 times a day with meals
Maximum dose: 2000 mg/day

Extended-release oral suspension:
Initial dose: 500 mg orally once a day with evening meal
-Dose titration: Increase in 500 mg increments weekly based on glycemic control and tolerability
Maximum dose: 2000 mg/day

Comments:
-Titrate slowly to minimize gastrointestinal side effects.

Use: To improve glycemic control in children with type 2 diabetes mellitus as an adjunct to diet and exercise.

Get emergency medical help if you have signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Some people using this medicine develop lactic acidosis, which can be fatal. Get emergency medical help if you have even mild symptoms such as:

unusual muscle pain;

feeling cold;

trouble breathing;

feeling dizzy, light-headed, tired, or very weak;

stomach pain, vomiting; or

slow or irregular heart rate.

Common metformin side effects may include:

low blood sugar;

nausea, upset stomach; or

diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.