Are you on Metformin and you are struggling with its side effects?
Tips and advice on how to avoid those side effects Coming up.
WHAT IS METFORMIN ? Metformin is a prescription drug to treat
diabetes.
Metformin is available under different brand names.
You might see yours listed right here!
Fortamet, Glucophage, Glucophage XR , Glumetza, Riomet
A common brand name here in the US is Glucophage.
Metformin also plays a role in the treatment of Polycystic Ovarian Syndrome.
The main stay of treatment and management of DM is diet and exercise coupled with lifestyle
changes such as weight loss.
There are many anti-diabetic drugs on the market, but Metformin continues to remain
a first line treatment to manage your diabetes.
Yes, it does have some side effects and I’ll touch upon them shortly.
If you want to go in to some detail about how metformin works click right here there
is a playlist looking at Metformin.
Dosages of Metformin: Mainly they are 2 forms of Metformin an extended release form and an immediate release form.
The doses for the IR form are: 500mg, 850mg & 1000mg.The doses for the ER tab are 500mg,
750mg and 1000mg.There is also a form that comes in a solution: 500mg per 5mL.Metformin
should be taken with your meals to reduce bowel and stomach side effects
The main difference between the 2 forms is that the ER form will not have to be taken
that often as it lasts longer.
Because it is given usually given once daily patients usually patients have a better compliance
with the ER release form.
The added advantage would be it has fewer side effects that the IR form.
What are the most common side effects?
There are several, the most common ones are GI side effects such as nausea and vomiting,
stomach pain, diarrhea, heart burn, forming gas.GI are side effects can be as high or
higher than 10%.
Like I mentioned earlier in this video it is more commonly seen with the IR form of
Metformin rather than the ER form.
Another common side effect which you can see up to 10% of cases is low blood sugar.
Also referred to as hypoglycemia.
As a diabetic you might be aware of some symptoms of low blood sugar such as palpitations, feeling
faint and lighted headed, sweats, shakiness, confusion, anxious or nervousness.
Some patients report chest pain.
Yes, chest pain or a constellation of symptoms which are related to your upper body such
as palpitations or flushing.
Now the difficulty when reporting this symptom is whether this is related to the medication
itself or indeed a cardiac symptom.
Diabetes is a risk factor for cardiovascular disease and you physician or provider might
want to rule out a cardiac cause for your reported symptoms.
They might want to work it up with testing such as blood work, an EKG or even if need
be a stress test.
Headache and dizziness are other symptoms reported.
This can be seen as high as 6% Now there is a side effect you might have
read about or your Doctor mentioned called lactic acidosis.
This was seen especially post marketing.
The risk of lactic acidosis is rare however you should be aware of the term.
What does it mean?
It just means your body is increasing with acidity, which obviously is not good for your
circulation and organs.
Who is at an increased risk for lactic acidosis?
If you have kidney problems especially if your GFR is less than 30, if your heart failure
in not well controlled, if you are undergoing a study which requires IV contrast, before or after surgical procedures, older patients above
the age of 65 especially with compromised kidney function.
Does that mean you can’t take the drug?
No, your health care provider is familiar with these situations and will consider changing
you to another anti-diabetic drug if the situation calls for a change.
If you are interested in when the drug Metformin should be stopped click on this video here.
Another side effect with long term use of Metformin is Vitamin B12 deficiency.
Low levels of B12 have been seen as early as 3-4 months after starting Metformin and
in other cases they after been seen after 5-10 years of treatment.
In a cross-sectional study looking at this up to 1/3 of patients on Metformin were B12
deficient.
B12 deficiency is associated with anemia and neuropathy.
Symptoms of anemia are shortness of breath and fatigue.
Symptoms of neuropathy are numbness and tingling of your feet and hands.
You might even have trouble walking; your mood can be affected presenting as irritability
or depression.
Another side effect associated with this drug is fatigue and has been reported up to 9%
of patients.
Now this is quite difficult to associate with the drug as being tired or fatigued is a vague
symptom.
If there is a correlation between starting the drug and having symptoms causality can
be perhaps established.
The only way one would know is by stopping the drug in consultation with your health care provider
and seeing if these symptoms go away However, this can be hard to do as feeling tired is
also a symptom of so many diseases including diabetes.
When do I have to call my doctor right away?
If you are having an allergic reaction to the medication.
You will have feeling of difficulty breathing, SOB, wheezing, a rash or possibly hives
You have very bad stomach pain with repeated episodes of vomiting or diarrhea OR even having
unusual muscle pain.
This could be a sign of a bad side effect known as Lactic acidosis, when there is too
much acid in your blood.
You might have signs of low blood sugar.
You will feel weak, shaky and dizzy.
You might start sweating, feel confused with a rapid heartbeat.
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How can you avoid side effects?
1) Start at the lowest dose and titrate up.
You will be advice to take the dose of 500mg with your dinner.
This is done not only to minimize side effects but to also help reduce your higher blood
sugar readings in the morning.
2) Your doctor will advise you to take this for 1-2 weeks.
If you are tolerating this then another dose of Metformin can be added in the morning with
your breakfast.
This can be taken for another 1-2 weeks.
3) A third dose can be added at Lunch time, But I usually recommend against that.
The reason is easy to understand..
You want to keep it simple and manageable.
I have seen if there are too many medication changes or the frequency of the medication
is changed too often that reduces the compliance of patients.
Please have a discussion regarding this with your health care provider
4) Your health care provider might want to switch to an extended release medication if
you are experiencing side effects.
This also simplifies how many pills you need to take.
Metformin is not the only anti-diabetic drug and in a future video I will look at Metformin
alternatives.
I’ll leave the link up here.
This video here looks at Metformin and B12 deficiency and the other video at Metformin
and dementia.
Think your health and have a good day.