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PEBC: What You Need to Know: Metformin

Updated: Jul 25, 2020

Indication:

Type 2 diabetes. First line therapy as per Diabetes Canada guidelines. Cornerstone of treatment → combine with other diabetic medications for greater control

Dosing:

Start with low dose and slowly titrate over a few weeks. Divide into 2 to 3 doses per day for better GI tolerance.

Adverse Effects:

  • Gastrointestinal upset: diarrhea, gas, bloating, abdominal discomfort → reduce adverse effects by taking with food and slow dose titration. Symptoms disappear after a few weeks.

  • Weight neutral to weight loss for some patients

  • Low risk of hypoglycemia as monotherapy. Reduces weight gain of other medications (insulin, sulfonylureas)

  • May reduce vitamin B12 levels

  • Lactic acidosis is rare

  • Do not use for creatinine clearance under 30 mL/min

  • Hold for 48 hours after contrast dye studies to avoid renal dysfunction

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