Metformin is indicated in the management of type-2 Diabetes Mellitus.

Diabetes

Adults:

Metformin Tablets are often started at a dose of 850 mg once daily or 500 mg twice daily, administered with meals. At doses below 1500 mg per day, clinically significant responses are typically not observed. Increases in dosage should be taken in divided doses of 500 mg every week or 850 mg every two weeks, up to a maximum of 2000 mg per day. The effectiveness and tolerability of Metformin must be taken into account while determining the appropriate dosage. After two weeks, patients can also be titrated from 500 mg twice daily to 850 mg twice daily. Metformin may be administered to patients who need more glycemic control at a daily dose cap of 2550 mg. Doses above 2000 mg may be better tolerated given 3 times a day with meals.

Pediatrics:

The usual starting dose of Metformin is 500 mg twice a day, given with meals. Dosage increases should be made in increments of 500 mg weekly up to a maximum of 2000 mg per day, given in divided doses. 

Side effects reported with the use of the drug include-

• Diarrhea
• Flatulence
• Nausea/ Vomiting
• Asthenia
• Indigestion
• Abdominal pain
• Headache

Diarrhea	Flatulence	Nausea
Asthenia	Indigestion	Abdominal Pain

• Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain.
• The postmarketing metformin-associated lactic acidosis cases primarily occurred in patients with significant renal impairment.
• The risk of metformin accumulation and metformin-associated lactic acidosis increases with the severity of renal impairment because metformin is substantially excreted by the kidney. 
• Before initiating Metformin obtain an estimated glomerular filtration rate (eGFR)
• Initiation of Metformin is not recommended in patients with eGFR between 30-45 mL/min/1.73 m² . 
• The risk of metformin-associated lactic acidosis increases with the patient’s age because elderly patients have a greater likelihood of having hepatic, renal, or cardiac impairment than younger patients. Assess renal function more frequently in elderly patients. 
• Alcohol is known to potentiate the effect of metformin on lactate metabolism.