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Metformin Er Vs Metformin Hcl

Metformin Er Vs Metformin Hcl

Introduction

In the absence of contraindications, metformin is the first choice drug for the treatment of diabetes. Metformin reduces plasma glucose levels by acting at several levels; metformin reduces hepatic glucose production in the liver by inhibiting gluconeogenesis and glycogenolysis; metformin increases muscular insulin sensitivity by improving the uptake and utilization of peripheral glucose; moreover, metformin slows intestinal absorption of glucose.Until now, metformin was available as an immediate release (IR) formulation to be taken thrice a day, at dosages of 500, 850, and 1,000 mg, in tablet or powder. 

Dosing

The usual starting dose of metformin hydrochloride tablets is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in divided doses. Patients can also be titrated from 500 mg twice a day to 850 mg twice a day after 2 weeks. For those patients requiring additional glycemic control, metformin hydrochloride tablets may be given to a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given three times a day with meals.

The usual starting dose of metformin hydrochloride extended-release tablets is 500 mg once daily with the evening meal. Dosage increases should be made in increments of 500 mg weekly, up to a maximum of 2000 mg once daily with the evening meal.

Metformin hcl vs metformin

What I want to know from those taking both drugs is how they work best for you. I quit taking my met because it was doing nothing, but, I just noticed that it is the HCL and not the ER and I am pretty sure you are supposed to take HCL with meals and ER as directed like in the morning and at night. My doc dosed me like I was taking ER, so, if that is the case is it possible that it would not work as well? I have been experimenting, I have been taking that drug, 500mg before meals with my insulin and I am crashing almost every time.

Warnings

Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with metformin hydrochloride or metformin hydrochloride extended-release tablets; when it occurs, it is fatal in approximately 50% of cases. Lactic acidosis may also occur in association with a number of pathophysiologic conditions, including diabetes mellitus, and whenever there is significant tissue hypoperfusion and hypoxemia. Lactic acidosis is characterized by elevated blood lactate levels (>5mmol/L), decreased blood pH, electrolyte disturbances with an increased anion gap, and an increased lactate/pyruvate ratio. When metformin is implicated as the cause of lactic acidosis, metformin plasma levels >5mcg/mL are generally found.

The reported incidence of lactic acidosis in patients receiving metformin hydrochloride is very low (approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient years). In more than 20,000 patient-years exposure to metformin in clinical trials, there were no reports of lactic acidosis. Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications. Patients with congestive heart failure requiring pharmacologic management, in particular those with unstable or acute congestive heart failure who are at risk of hypoperfusion and hypoxemia, are at increased risk of lactic acidosis. The risk of lactic acidosis increases with the degree of renal dysfunction and the patient’s age.

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