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Metformin (Metformin Hydrochloride) Buyer and Patient Handbook - South Africa

What is Metformin?

Metformin is an oral antidiabetic medication belonging to the biguanide class, primarily used to manage type 2 diabetes mellitus. It improves blood-sugar control by reducing hepatic glucose production and enhancing insulin-mediated glucose uptake. The product is authorised by the South African Health Products Regulatory Authority (SAHPRA) and carries FDA and EMA approval. It is available as immediate-release tablets.

Who Should Use Metformin?

• Adults diagnosed with type 2 diabetes who need better glycaemic control.
• Individuals with pre-diabetes who are advised to delay progression to diabetes.
• Patients whose lifestyle modifications alone are insufficient to achieve target HbA1c.

How Does It Work?

Metformin activates the enzyme AMP-activated protein kinase (AMPK), which signals the liver to produce less glucose and prompts muscle cells to absorb more glucose from the bloodstream. Think of it as a traffic controller that eases congestion on the road of blood sugar, allowing glucose to flow smoothly into cells for energy. The drug has a low risk of causing hypoglycaemia when used alone, but it is not a stimulant and has no abuse potential.

Why Choose Metformin?

• Proven efficacy: Long-standing clinical data demonstrate consistent HbA1c reductions.
• Weight-neutral or modest weight loss: Unlike some antidiabetic agents, it does not promote weight gain.
• Cost-effective: Generic versions are widely available at a fraction of brand-name prices.
• Renal safety when dosed correctly: Offers a favorable safety profile compared with many newer agents.

Off-label uses (e.g., Polycystic Ovary Syndrome) should only be considered after discussing potential benefits and risks with a qualified healthcare professional.

Dosage, Administration, Lifestyle and Dietary Recommendations

Recommended Dosage

• 500 mg tablet - once daily, titrating up as tolerated.
• 850 mg tablet - typically 850 mg twice daily.
• 100 mg tablet - commonly 500 mg with breakfast and 500 mg with dinner.

Dose adjustments are guided by renal function and glycaemic response.

How to Take

• Swallow the tablet whole with a full glass of water.
• Take with meals to minimise gastrointestinal upset.
• Do not crush or chew.

Missed Dose

• If you remember within 12 hours, take it with the next meal.
• If >12 hours have passed, skip the missed dose and resume the regular schedule.

Overdose

• Seek immediate medical attention.
• Symptoms may include nausea, vomiting, abdominal Pain and lactic acidosis (rare).

Special Populations

• Elderly: Start with the lowest dose (500 mg) and monitor renal function.
• Renal impairment: Contraindicated if eGFR < 30 mL/min/1.73 m²; dose reduction recommended for eGFR 30-45 mL/min/1.73 m².
• Pregnancy & breastfeeding: Generally considered safe but should be used under medical supervision.

Lifestyle & Diet

• Maintain a balanced diet low in simple sugars and refined carbohydrates.
• Regular physical activity (150 min moderate exercise per week) enhances Metformin’s effectiveness.
• Avoid excessive alcohol; it can increase the risk of lactic acidosis.

Precautions and Warnings

• Monitor renal function before initiation and periodically thereafter.
• Be alert for signs of lactic acidosis: unexplained muscle pain, rapid breathing, abdominal discomfort, feeling cold or dizzy.
• Use caution in patients with hepatic disease or congestive Heart Failure.
• Discontinue before any radiographic studies that use iodinated contrast agents; restart only after kidney function is reassessed.

Drug Interactions

Potential Side Effects

Common Side Effects

• Nausea, vomiting, diarrhoea
• Abdominal discomfort
• Metallic taste

Less Common Side Effects

• Decreased appetite
• Weight loss
• Skin rash

Serious Side Effects

• Lactic acidosis (rare but life-threatening) - seek emergency care if symptoms arise.
• Severe hypoglycaemia when combined with insulin or sulfonylureas - monitor blood sugar closely.

Who Should Avoid This Medication?

• Individuals with severe renal impairment (eGFR < 30 mL/min/1.73 m²).
• Patients with known hypersensitivity to Metformin or any excipients.
• Those with acute or chronic metabolic acidosis, including diabetic ketoacidosis.

Storage Instructions

• Keep tablets in the original container, tightly closed.
• Store at room temperature (15-30 °C); protect from moisture and light.
• Keep out of reach of children and pets.

Metformin Alternatives

Frequently Asked Questions

How long does it take for Metformin to start lowering blood sugar?

Metformin begins to reduce hepatic glucose output within a few days, but noticeable HbA1c improvement typically appears after 4-8 weeks of consistent therapy.

Can I take Metformin if I have a history of stomach ulcers?

Metformin is generally safe, but gastrointestinal irritation is common. If you have active ulcers, discuss alternative dosing (e.g., extended-release) with a healthcare professional.

Is it safe to drink coffee while on Metformin?

Moderate coffee consumption does not interfere with Metformin’s effectiveness. Excessive caffeine may aggravate stomach upset, so monitor your tolerance.

Do I need to take Metformin with food every time?

Taking Metformin with meals reduces the likelihood of nausea and diarrhoea. Consistency with meals also helps maintain stable blood glucose levels.

Can I exercise intensely while on Metformin?

Yes, regular exercise complements Metformin’s glucose-lowering action. However, stay hydrated and monitor blood glucose to avoid hypoglycaemia, especially if combined with other glucose-lowering agents.

What should I do if I experience persistent diarrhoea?

Contact a healthcare professional; they may recommend dose reduction, switching to an extended-release formulation, or providing symptomatic relief.

Is Metformin appropriate for type 1 diabetes?

Metformin is not a primary treatment for type 1 diabetes but may be added in select cases with insulin resistance under specialist guidance.

How often should my kidney function be checked?

At least annually, or more frequently if you have risk factors such as hypertension, heart failure, or are on medications affecting renal function.

Glossary

• HbA1c: A blood test that reflects average glucose levels over the past 2-3 months.
• AMPK (AMP-activated protein kinase): An enzyme that regulates cellular energy balance, pivotal in Metformin’s action.
• Lactic acidosis: A rare condition marked by buildup of lactic acid, potentially fatal if untreated.

Disclaimer

The information provided is for general educational purposes and does not replace professional medical advice. Off-label uses require a thorough risk-benefit discussion with a qualified healthcare provider. Our service offers medication information and online ordering assistance; it does not dispense prescriptions. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.