Glucophage: Uses, Side Effects, Dosage & Interactions

Diabetes management and control are highly essential to reduce the risks of diabetes-related health complications. Poor diabetes management and control can increase the risk of heart-related issues, kidney damage, nerve damage, loss of vision, leg amputations, and sexual problems. Therefore diabetologists prescribe medicines, diet control, and lifestyle changes to ensure that your diabetes is under control. A widely used medicine for diabetes management is Glucophage tablets.

Know more about Glucophage working, uses, side effects, and other related information in this article.

About Glucophage

Glucophage tablets are used to control blood sugar levels in patients above 10 years. It helps in improving the glycemic control of the patients. It is a widely used medicine to be used along with exercise and diet control for effective type 2 diabetes management.

Glucophage is a medicine with its chemical composition as Metformin hydrochloride. These are oral tablets that come under the category of oral anti-hyperglycaemic drugs [5].

  • Chemical formula: Metformin hydrochloride is N, N-dimethylimidodicarbonimidic diamide hydrochloride [5].
  • Colour: White to off-white crystalline compound
  • Molecular formula  C4H11N5 • HCl [5]
  • Molecular weight:  165.63 [5]
  • Solubility: Soluble freely in the water. Insoluble in acetone, ether, and chloroform.

Glucophage Tablet

Uses of Glucophage Tablet

Glucophage tablet’s main composition is Metformin. Metformin is the best option that helps in restoring the body cells’ response to insulin. In this way, it helps in decreasing the amount of glucose made by the liver and the sugar absorbed by the stomach and intestines. Thus, the key uses of the Glucophage tablets are as follows:

  1. .Controlling sugar levels and thus helps in managing type 2 diabetes.
  2. Regulating body weight. It helps in weight management and thus helps in reducing weight or maintaining a stable body weight [1].
  3. The medicine has a good impact on body lipid metabolism. It thus helps in reducing body total cholesterol, LDL cholesterol levels, and triglyceride cholesterol levels [1].
  4.  Reduces the risks of diabetes-related complications. Studies have found that patients consuming this medicine for diabetes management had reduced risks of any diabetes-related complications like nerve damage, heart stroke, kidney damage, or eye damage when compare to diet-along patients or sulfonylurea and insulin monotherapy patients [5].
  5. It is also found in scientific research that medicine consumption by diabetic patients reduces the risks of myocardial infractions [5].

Summary

Glucophage Tablets help in managing blood sugar levels, reduces risks of diabetes-related complications, and is good for weight management and cholesterol management.

Drug variants

Glucophage is the brand name of the chemical metformin hydrochloride. The tablet of Glucophage comes in various dose formats.

Glucophage 500 mg

Active ingredient & strength Metformin Hydrochloride 500mg
Inactive ingredient & strength POVIDONE, UNSPECIFIED

Magnesium stearate

Hypromellose

Colour WHITE (white to off-white)
Shape Round
Size 11mm

Glucophage 850 mg

Active ingredient & strength Metformin Hydrochloride 850 mg
Inactive ingredient & strength POVIDONE, UNSPECIFIED

Magnesium stearate

Hypromellose

Colour WHITE (white to off-white)
Shape Round
Size 13mm

Glucophage 1000 mg

Active ingredient & strength Metformin Hydrochloride 1000 mg
Inactive ingredient & strength POVIDONE, UNSPECIFIED

Magnesium stearate

Hypromellose

polyethylene glycol 400

polyethylene glycol 8000

Colour WHITE
Shape Oval
Size 19 mm

Each Glucophage tablet also contains povidone and magnesium stearate.

Working action

Glucophage’s main ingredient metformin lowers the basal glucose levels and postprandial plasma glucose levels. This reduction helps in improving glucose tolerance in patients, especially with type 2 diabetes.

The Glucophage 3 main working action that regulates blood sugar levels is:

  • Glucophage reduces hepatic glucose production that in turn regulates high blood sugar levels. Thus, it inhibits gluconeogenesis and glycogenolysis and the glucose production by the liver reduces. It thereby makes the glucose enter into the body tissues.
  • Moreover, Metformin present in Glucophage reduces intestinal absorption of glucose.
  • It enhances insulin sensitivity by increasing peripheral blood glucose usage by the body.

The medicine has no impact on body insulin secretion levels. It changes the insulin response of the cells.

The medicine does not cause hypoglycemia in patients with type-1 diabetes and type-2 diabetes.

Dosage Instruction

Dosage of Glucophage is prescribed by the doctor as per the patient’s condition, age and weight. The maximum daily amount of this tablet is 2550 mg. It is therefore essential to avoid taking any higher amounts than 2550 mg [5].

The tablets should be consumed with food to avoid problems like nausea and vomiting. Below are the general dosage instructions for diabetic adults and children above 10 years.

  • Adult dosage

Instructions:

  • Age should be greater than or equal to 17 years.
  • Take with food.
  • Initially, 500 mg tablets twice daily are prescribed. Gradually the amount is increased to 500 mg at a 1-week interval.
  • Another option is to take 850 mg tablet once daily. Slowly the divided doses of 850 mg are increased at 2-weeks intervals.
  • The adult maximum dose amount is 2.55 grams/day [5].
  • Children Dosage

Instructions:

  • This medicine is not to be given to children below 10 years. Thus, it can be used for kids above 10 years.
  • For diabetic children, the initial dose is 500 mg twice daily. The dose is increased to 500 mg at 1-week intervals.
  • Maximum dose: 2 grams/ day [2].

When to Stop or Avoid Glucophage

Glucophage contradictions with other diseases and health conditions are as follows:

  1. Renal impairment: Glucophage can be harmful to patients having kidney-related issues. Metformin reduces the kidney functioning. As a result of which the renal clearance decreases. Therefore, it is essential to have estimated glomerular filtration rate (eGFR) test done before taking medicine. Patients with eGFR values less than 30 mL/min/1.73 m should not take Glucophage tablets [1, 5].
  2. Diabetic ketoacidosis: Glucophage can cause problems like dehydration, severe infection, and building up of lactic acidosis in patients with Diabetic Ketoacidosis. It can further result in kidney-related serious issues.
  3. Liver disease: These patients are at higher risk of lactic acidosis due to metformin consumption. This happens due to decreased lactate clearances. It can thus further harm the liver and other body functions. Thus avoid Glucophage tablets in patients with liver diseases [3].
  4. Alcohol consumption: Alcohol and Metformin present in Glucophage helps in increasing lactate metabolism. This can lead to higher levels of lactic acidosis which may be fatal. Thus, avoid alcohol while consuming medicine [3].
  5. Age > 65: Research has found that the total plasma clearance of medicine in elderly people decreases when compared to healthy young people. With increased age, Metformin can cause changes in renal functioning. It also increases the risk of liver, kidney, and heart impairment. Thus, it is necessary to take into consideration the health factors of elderly people before prescribing Glucophage. Avoid the medicine usage for patients above the age of 65 [1].

Summary

Avoid using Glucophage in patients with liver disease, diabetic ketoacidosis, kidney diseases, >65 years, and those who are on high alcohol consumption.

Side effects of Glucophage

Common side effects

  1. Diarrhea
  2. Vomiting and Nausea
  3. Excessive Flatulence
  4. Indigestion issues
  5. Abdominal discomfort and pain
  6. Asthenia
  7. Headache

Adverse Side Effects:

  1. Lactic Acidosis: It is a condition when lactic acids build up in the bloodstream. When the body cells have less oxygen to break down glucose, anaerobic respiration takes place in the body cells. This results in lactic acid production. This causes lactic acid accumulation and results in a burning sensation in muscles. It causes fatigue, weakness, and nausea. Some of its symptoms are fruity-smelling breathing, malaise, abdominal pain, respiratory distress, trouble while swallowing. Due to Glucophage the lactic acidosis levels in blood increase more than 5 mmol/L and decrease in the liver consumption of lactate [2]. This condition can be fatal if other ailments like kidney or heart disease are present. It thus requires immediate medical attention [3]. Discontinue Glucophage if you notice any symptoms of lactic acidosis.
  2. Vitamin B12 deficiency: Glucophage leads to decreased levels of Vitamin B12. If left untreated it can have negative effects on optimal hemopoietic, neuro-cognitive and cardiovascular functions. Thus, take Vitamin B12 supplements along with medicine [4].
  3. Hypoglycemia: Patients who are consuming insulin and insulin secretion drugs such as sulfonylureas, Glucophage can increase the risk of hypoglycemia. It is, therefore, necessary to consult the doctor before taking Glucophage if you are on insulin or insulin secretion drugs.

Summary

Adverse side effects of Glucophage are lactic acidosis, vitamin B12 deficiency, and dehydration.

Guidelines Before Using Glucophage

Before taking Glucophage tablets follow these instructions:

  1. Patients must be informed about the risks of lactic acidosis. Therefore health officials must provide information like symptoms and conditions leading to the development of lactic acidosis. Discontinue Glucophage if you notice such symptoms [3].
  2. Patients should regularly test for renal functioning while consuming Glucophage tablets.
  3. Glucophage can cause hypoglycemia if it is taken along with insulin therapy. Therefore inform the patients about this risk.
  4. Female diabetic patients consuming medicine may experience ovulation during the premenopausal stage and can lead to unintended pregnancy.
  5. Regular hematological parameters testing should be done if  you are consuming medicine. In this way you can avoid Vitamin B12 deficiency [4].
  6. Swallow the Glucophage tablets as a whole.  Do not crush or chew it.
  7. Discontinue the medicine if you notice any of the above-listed side effects.

Pregnancy & Nursing mothers

Pregnancy

The research data related to medicine and its impact on pregnant mothers is limited. Thus, it is not clear how the drug can lead to any sort of pregnancy complications. But most of the experts prefer to use Insulin during gestational pregnancy and in pregnant diabetic women for maintaining blood glucose levels. Thus, Glucophage usage should be avoided unless necessary during pregnancy [1].

Nursing Mothers

Researches on animals have displayed that Glucophage metformin passes through the milk and reaches plasma. Moreover, there exists a potential for hypoglycemia in infants. Thus, the decision to avoid this medicine during lactation should be made based on the mother’s health condition and needs [1].

Drug interaction

Glucophage has significant interactions with other drugs. These drugs may inhibit Glucophage action. It is, therefore, necessary to avoid these drugs along with this medicine.

Drug Impact  Recommendation
Carbonic Anhydrase Inhibitors 

Example: Topiramate, zonisamide, acetazolamide, or dichlorphenamide.

These drugs cause a decrease in the serum bicarbonate and result in metabolic acidosis.

Thus the risk of lactic acidosis increases when medicine is used with these drugs.

Regular monitoring of the patients is necessary [1].
Ranolazine, vandetanib, dolutegravir, and cimetidine. These drugs reduce the clearance of Glucophage and increase the risk of lactic acidosis [1, 3]. Avoid these drugs along with Glucophage tablets.
Insulin Secretagogues or Insulin Increases the risk of Hypoglycaemia [1]. Decrease the dosage of insulin while taking tablets.
Thiazides, diuretics, corticosteroids, thyroid products, estrogens, oral contraceptives Increases risks of hyperglycemia [5] Monitor you blood glucose levels while using Glucophage medicines along with these medicines.

Overdose

When the Glucophage medicine is consumed more than 50 grams it results in overdose of the medicine [1]. It can cause hypoglycemia, lactic acidosis and can lead to renal issues. Thus, such patients may require to undergo hemodialysis to remove accumulated overdose of the drug. Consult immediately the doctors in case of overdose.

Storage and handling

The medicine leaflet has storage instructions written on it. The medicine should be stored at 20°–25°C. Use light-resistant containers for dispensing it [1].

Bottom Line

Managing diabetes is highly essential to remain healthy and fit. Glucophage is still a highly used medicine for controlling glucose levels, especially during type-2 diabetes. But it is highly essential to have diet control and lifestyle changes along with medicine consumption to avoid any further health complications.

FAQs:

Can Glucophage cause hair loss?

No, Glucophage does not cause hair loss.

Is there any food to avoid while taking Glucophage medicines?

Yes, avoid eating high-fiber-based foods after taking Glucophage. Fiber tends to bind with the medicine and thus lowers the dose concentration in the body. So limit your fiber amount to less than 30 grams per day while you are taking Glucophage medicines.

Is it safe to take Glucophage tablets before meals?

Glucophage can cause diarrhea, stomach ache, and indigestion issues. Thus it is better to take the medicine after meals to avoid such problems. Avoid taking it before meals.

References:

  1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4a0166c7-7097-4e4a-9036-6c9a60d08fc6
  2. Misbin, R. I. (2004). The phantom of lactic acidosis due to metformin in patients with diabetes. Diabetes care, 27(7), 1791-1793.
  3. Salpeter, S. R., Greyber, E., Pasternak, G. A., & Salpeter, E. E. (2003). Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus: systematic review and meta-analysis. Archives of internal medicine, 163(21), 2594-2602.
  4. Andrès, E., Noel, E., & Goichot, B. (2002). Metformin-associated vitamin B12 deficiency. Archives of internal medicine, 162(19), 2251-2252.
  5. US Food and Drug Administration. (2008). Glucophage (metformin hydrochloride tablets)/Glucophage XR (metformin hydrochloride extended-release tablets)(NDA 20-357/S-031 and NDA 21-202/S-016). Princeton (NJ): Bristol-Myers Squibb, 3-32.

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