Metformin is the basic drug for the treatment of diabetes and should be used by every diabetic as long as there are no contraindications. It can not only be used alone for diabetic patients with ineffective dietary control and physical exercise alone; it can also be used in combination with other drugs, with insulin to increase the glucose-lowering effect of insulin and reduce the dosage of insulin, and with sulfonylureas for synergistic lowering of blood glucose. At present, there are three main dosage forms of metformin: ordinary tablets, extended-release dosage form, and enteric solvent form. In order to minimize the occurrence of adverse reactions, the dosage time of metformin is different for different dosage forms.

Metformin Tablets

Since ordinary tablets dissolve in the stomach, it is recommended that thetake (medicine) with meals, which reduces the incidence of gastrointestinal adverse reactions. The starting dose is 0.5g twice daily, gradually increasing as needed to a maximum daily dose of 2550mg (three times a day).

Metformin extended-release tablets

Extended-release tablets work by releasing the drug slowly and need to be taken only once a day. However, when the extended-release tablets enter the stomach, they start to release the drug, so in order to minimize the occurrence of gastrointestinal adverse reactions, it is recommended toTake it with dinner... The starting dose of the extended-release tablets is 500 mg, which is slowly increased as needed to a maximum daily dose of 2,000 mg.

Metformin enteric-coated tablets

Enteric-coated tablets begin to dissolve only after entering the intestine, which significantly reduces irritation of the stomach lining, but requireTaking medication before meals.It reduces the corrosion of the enteric tablet shell by gastric acid and avoids dissolution in the stomach, further reducing the incidence of adverse reactions. The starting dose of enteric-coated tablets is 0.25g twice daily, slowly increasing as needed to a maximum daily dose of 1800mg.

Major adverse effects of metformin

The most common adverse reactions to metformin are gastrointestinal reactions, such as nausea and vomiting, diarrhea and abdominal pain, but most of them can be relieved on their own, and the occurrence of these symptoms can be reduced by splitting the dose of metformin.

A relatively rare adverse reaction to metformin: lactic acidosis. Although the incidence of lactic acidosis is extremely low, when it does occur, the mortality rate is high and is characterized by dyspnea, abdominal pain, hypothermia, and coma. It is most often seen in patients with renal failure and can also occur in diabetic patients with acute renal deterioration.

Precautions for taking metformin

Patients who are allergic to Metformin should not take Metformin. Any patient who is allergic to a drug should not use the drug, and metformin is no exception, although the incidence is low.

Metformin is mainly excreted by the kidneys, so patients with renal insufficiency, mainly those with CKD stage 3b and above (patients with glomerular filtration rate less than 45) should not take metformin, as it increases the risk of lactic acidosis.

Diabetic patients with comorbidities such as decompensated heart failure, respiratory failure, shock, myocardial infarction, etc., taking metformin may cause tissue hypoxia and induce lactic acidosis, so metformin should not be used.

Serious infections and trauma can easily lead to temporary poor glycemic control, so when serious trauma or infection occurs, metformin needs to be discontinued and can be replaced with insulin for glycemic control.

Patients who develop metabolic acidosis, such as diabetic ketoacidosis, should not take metformin.

Patients with alcoholism, which may induce lactic acidosis, should not take metformin and are advised to abstain from alcohol.

In patients undergoing imaging, canonical contrast agents can cause renal failure and increase the risk of lactic acidosis. Patients taking metformin should discontinue the drug 48 hours before imaging and continue to take it for at least 48 hours after the test if renal function is not abnormal.

It should not be used in patients with vitamin B12 and folate deficiencies because metformin inhibits their absorption and can cause anemia.

In summary, metformin regular tablets should be taken with meals, extended-release tablets with dinner, and enteric-coated tablets should be taken before meals. Different dosage forms, taken at different times, can reduce the incidence of adverse effects. During the use of metformin, care should be taken to avoid lactic acidosis. Patients with allergy to metformin, severe renal insufficiency, cardiac failure, exhalation failure, cardiac infarction, shock, severe trauma, infections, metabolic acidosis, alcoholism, imaging tests, and vitamin B12 deficiency should not be given metformin, which should be kept in mind.

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(November 2, 2018 Dr. Tsang has questions and answers)

Metformin is known to the vast majority of diabetic patients as a first-line hypoglycemic agent. It has defended its position in clinical use by being effective and inexpensive.

Many people are familiar with metformin, but very few know how to take this drug? Should it be taken before or after meals? Should it be taken once a day or three times a day? Dr. Zeng will talk to you in detail about these questions.

We all know that metformin has different degrees of irritation to the gastrointestinal tract, and metformin can be divided into three types according to its structure: normal dosage form, enteric solvent type, and extended-release dosage form, and different dosage forms have different absorption and site of action. In order to reduce the stimulation of the gastrointestinal tract, its oral intake time can be adjusted. And the condition is different, so the dosage and the number of times each person takes it are also different.

1、Ordinary dosage form

The regular dosage form refers to metformin hydrochloride tablets or metformin hydrochloride capsules. It is dissolved and absorbed in the stomach as soon as it is taken, and it is also absorbed in the small intestine. Its pharmacological action determines that while the absorption rate of the drug is high, the stimulation of the stomach is also relatively large. Therefore, Metformin Hydrochloride Tablets can reduce the stimulation to the stomach when taken immediately after or after a meal. In addition, the absorption time of the common dosage form is relatively fast, and those with high blood sugar who need to take a larger dose of the drug, it is best not to finish the day's dose at one time, but should be evenly distributed to three meals to take, in order to reduce the adverse reactions of the drug.

2、Enterosol type

Enteric soluble refers to metformin hydrochloride enteric tablets or metformin hydrochloride enteric capsules. It is the drug wrapped in enterosoluble material that reaches the small intestine directly and works. As the enteric material is not dissolved in the acidic gastric environment, it is dissolved and released in the alkaline intestine. This dosage form overcomes the irritating effect of the normal dosage form on the upper gastrointestinal tract and also increases its bioavailability. Therefore, metformin enterosolvents should be given half an hour before meal, the advantage of this method of taking is that when the postprandial blood glucose reaches the peak, the concentration of the drug is correspondingly higher, the effect is stronger, and it covers the postprandial blood glucose peak period better, so as to achieve effective hypoglycemic effect. The enteric and regular dosage forms are only different in the time of administration, and there is no difference in the number of times of administration under the premise of the same dosage form.

3、Extended release dosage form

Extended-release dosage forms refer to metformin hydrochloride extended-release tablets or metformin hydrochloride extended-release capsules. Extended release dosage form is a breakthrough in drug formulation, in which the drug is wrapped in a gel and released slowly, delaying the release and absorption of the drug in the body, thus prolonging its duration of action. Due to the use of slow-release technology, the amount of drug dissolved in the stomach is greatly reduced, thus also avoiding adverse reactions in the upper gastrointestinal tract. As its concentration in the blood can last up to 24 hours, it only needs to be taken once a day and can be taken at any time of the day. The ease of administration makes it particularly suitable for office workers and elderly patients with memory loss.

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Metformin, which is more than 50 years old, is still the first-line drug used to treat type 2 diabetes. For one thing, the drug is safe, generally does not cause hypoglycemia when used alone, and studies have shown that it has a protective effect on the kidneys. Secondly, the drug can help with weight control, making it an excellent choice for obese diabetics.

However, clinically we see many people who cannot adhere to the medication. The reasons include abnormal liver and kidney function, gastrointestinal adverse reactions and so on. For gastrointestinal adverse reactions that lead to discontinuation of the drug, it is still unfortunate.

Metformin is available in a variety of dosage forms, including regular, enteric-coated tablets and extended-release formulations.

1. For the regular dosage form, which needs to be taken three times a day, the gastrointestinal reaction will be greater, and it is generally recommended that it be taken at the same time as a meal, or immediately after eating, to minimize the adverse gastrointestinal reaction.
2. The extended-release formulation improves compliance and can be effective when taken once a day, and is recommended to be taken with dinner or immediately after a meal.
   

At the same time, Metformin can inhibit the intestinal absorption of sugar, so Metformin is not recommended to be taken on an empty stomach, it should be taken with meals or immediately after meals to reduce adverse reactions and effectively exert its hypoglycemic effect.

Whether it's metformin or any other drug, the reason why you choose to take it before or after a meal is based on 3 main considerations:

1. Whether or not eating affects the absorption of the drug;

2. Side effects of the drug on the gastrointestinal tract or irritation of the gastric mucosa;

3. Dosage forms of drugs.

Metformin is the drug of choice for type 2 diabetics, and is also the drug of choice for the whole course of medication in the absence of contraindications, and has a role in improving fasting blood glucose and postprandial blood glucose, as well as reducing the risk of cardiovascular disease and other aspects of the role of Metformin, in addition to the application of metformin in type 2 diabetics, in type 1 diabetes mellitus, polycystic ovary syndrome blood glucose control, but also has a certain degree of application. Metformin is non-toxic to the liver and kidneys, has few side effects in long-term application, has good compatibility with other hypoglycemic drugs, and is one of the most widely used blood glucose control drugs in clinical application.

Although metformin is good, but it has a higher incidence of side effects, that is, side effects on the digestive tract, taking metformin will have a certain degree of stimulation of the digestive tract, some patients may cause nausea, vomiting, abdominal distension, abdominal pain and even diarrhea and other side effects, but through the low-dose starting dose of the drug, and gradually increase the dosage of the approach, the majority of patients can be the body can be gradually tolerated, but in order to reduce the irritation of the digestive tract of the In order to minimize its irritation to the digestive tract, forFor metformin regular tablets, capsules and extended-release tablets, it is generally recommended to take them with a meal.First of all, meals do not affect the absorption of metformin in the body to take effect, taking after meals can also reduce the direct stimulation of metformin on the gastric mucosa, is a better way to take the drug.

However, metformin also has another dosage form, that is, enteric-coated tablets, as the name suggests, enteric-coated tablets are covered with a layer of enteric coating, which will enable the drug to enter the intestinal tract before it begins to disintegrate and be absorbed, thus reducing irritation for the stomach, so it is generally recommended toMetformin enteric-coated tablets on an empty stomachThe drug can be taken on an empty stomach to enable the drug to enter the intestinal tract through the stomach as soon as possible, reduce the residence time of the drug in the stomach, and quickly enter the intestinal tract to dissolve and absorb the effect.

Therefore, for different dosage forms of metformin, the timing of taking after meals or fasting is also different, if you are taking metformin ordinary dosage form, gastrointestinal reaction is larger friends, may want to try to choose a slow-release tablets or enteric-coated tablets, these two drug formulations, one is to slow down the release of the drug, and the other is to reduce the irritation of the drug on the stomach, for the reduction of gastrointestinal side-effects, there are certain advantages However, it should be noted that, whether it is a slow-release tablet or enteric-coated tablets, can not be broken to take or chewed to take, must be swallowed whole.

Diabetes is now a rising trend year by year and tends to be younger, China's diabetes prevention and treatment guidelines preferred recommended metformin as an oral hypoglycemic agent, some patients take metformin don't know what time to take it is good, that metformin is a good meal before serving, or after serving good?

First of all, metformin is a biguanide hypoglycemic drug, which can promote the full utilization of insulin, increase the uptake and utilization of glucose in tissues, inhibit the absorption of glucose, increase and improve the sensitivity to insulin, and it has the effect of lowering the fasting and postprandial hyperglycemia of patients with type II diabetes mellitus and mildly lowering the effect of blood cholesterol, and its mechanism of action is as follows: to increase the sensitivity of the tissues to insulin, to promote the insulin-mediated glucose utilization; increase glucose utilization by non-insulin-dependent tissues (e.g., blood cells, brain, renal medulla, intestines, skin, and other tissues); inhibit hepatic glycogen isomerization and reduce hepatic glucose output; inhibit glucose uptake by intestinal wall cells; inhibit cholesterol biosynthesis and storage, and reduce the levels of triglycerides and total cholesterol in the blood. Metformin is mainly absorbed in the small intestine, its oral bioavailability is 50% to 60%, mainly excreted in its original form by the kidneys, and can be accumulated in the body when renal function is reduced, leading to hyperlactatemia or lactic acidosis and nephrotoxicity. Metformin does not promote fat synthesis or stimulate insulin secretion, and does not lower blood glucose in normal people, and does not cause hypoglycemia when taken alone in type 2 diabetes.

Metformin is clinically used in patients with type 2 diabetes mellitus who are unsatisfied with simple dietary control, especially suitable for those who are obese and accompanied by hyperinsulinemia, which not only lowers blood glucose, but also reduces body weight and hyperinsulinemia. For patients with poor efficacy of certain sulfonylureas, it can be used in combination with sulfonylureas, α-glucosidase inhibitors, thiazolidinediones, which have better glucose-lowering effects than those used alone, and it can also be used in synergistic enhancement of treatment with insulin in order to reduce the dosage of insulin and minimize the adverse effects. Initial dosage should start from a small dose, the initial oral dose of 0.25-1g each time, 2-3 times a day, 1 week later, if still can not achieve the goal of glycemic control, according to the efficacy of the dosage adjustments gradually increase the amount of 1 day should not be more than the maximum amount of 2 g. Ordinary preparations (tablets, capsules) should be taken in the middle of the meal or immediately after the meal, which can reduce gastrointestinal reactions; enteric-coated preparations, slow-release preparations, gastrointestinal reactions are milder, can be taken before meals. Note that enteric-coated preparations and slow-release preparations should be swallowed whole, and should not be chewed or broken to destroy the integrity of the drug particles and affect the slow-release effect of the drug. Special circumstances of gestational diabetes mellitus patients, blood glucose control preferred insulin, prohibit the use of metformin, metformin avoided and alkaline solutions or drinks taken at the same time. If hypoglycemia occurs, oral candy or glucose can relieve symptoms.

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Metformin is one of the most widely used hypoglycemic drugs, the drug has high safety and fewer side effects, which is suitable for diabetic patients to take for a long period of time, but as an oral drug, the stimulation effect on the stomach and intestines is a big problem that we can't ignore, in order to alleviate the side effects of the drug on the stomach and intestines, there are commonly used enteric soluble formulations and slow-release formulations. Enteric formulations by reducing the solubility of the drug in the stomach and reduce the irritation of the gastric mucosa, while the extended-release preparations can be utilized to reduce the number of times the drug is taken by using its long-lasting properties, indirectly achieving the purpose of protecting the gastric mucosa;

For different dosage forms of metformin, the timing of its consumption is still different, such as metformin hydrochloride tablets, which is the ordinary tablet of the drug, and is also the earliest appearance of a dosage form, after taking it will be directly dissolved in the stomach, and the gastric mucous membrane to produce stimulation, so the dosage form is more suitable for meals or postprandial consumption, because the adulteration of the food reduces the drug and the gastric mucous membrane of the direct contact, which reduces the drug's impact on the gastric mucosa;

In addition, metformin extended-release tablets are also more suitable for taking during or after meals, but its enteric-coated preparation can only be taken before meals, because the drug will only dissolve and take effect after entering the intestine, and taking the drug after eating will not only impede the drug from entering the intestine, but also affect the dissolution and absorption of the drug, and even reduce the bioavailability of the drug!

Note: You should check the drug's instructions carefully or consult your doctor for advice before taking the drug!

The above is for reference only!

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Metformin belongs to the biguanide class of hypoglycemic medications, and its main action is to reduce the overproduction of glucose by the liver, and it also appears to improve the sensitivity of the liver and muscles to the action of insulin (reducing insulin resistance).

Type 2 diabetics can be treated with metformin as the first choice, or with metformin in combination with other hypoglycemic agents or insulin for the treatment of type 2 diabetes.

When should I take Metformin? If one reads the instructions for Metformin, one will find that the instructions for Gwaltz are saying that thetake with food; whereas other metformin might say that thetake (medicine) before a meal。

In our clinic, we generally advise patients to take it within 15 minutes before a meal or with the first bite.

The benefits of taking it with a meal are:

1. Most people may be more prone to gastrointestinal reactions such as upset stomach, nausea and vomiting, and diarrhea during the first 2-3 weeks of taking metformin. Simultaneous with food can reduce these side effects;

2. Metformin may be better absorbed when taken with food, as food seems to increase its absorption in the stomach.

However, some patients who have been taking metformin for a long time have also summarized their own medication rules. Some prefer to take it before meals, some during meals or immediately after meals, depending on which time of the day they feel they have more optimal glycemic control and fewer gastrointestinal reactions.

Even though hypoglycemia rarely occurs, it is important to monitor your blood sugar while taking metformin, primarily to monitor the effectiveness of your blood sugar control. In addition, while taking metformin, theDon't drink alcohol.Metformin has a rare side effect called lactic acidosis, alcoholmay increase the likelihood of lactic acidosis.And alcohol use can cause a diabetic's blood sugar to drop too quickly, possibly leading to hypoglycemia.

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Metformin is the most used hypoglycemic medication and is taken essentially from the time diabetes is detected. Metformin is most effective when chosen to be taken with or immediately after a meal for two reasons: to increase efficacy and reduce side effects.

Metformin is taken with or immediately after meals for a number of reasons:

I. Improvement of glucose-lowering effect

We need to elaborate on one of the mechanisms of metformin to lower sugar: the sugar in food is digested into glucose through saliva and the gastrointestinal tract, and glucose is mainly absorbed in the intestines, and the role of metformin is to inhibit the absorption of glucose in the intestines.

Therefore, taking it with or immediately after a meal, when the intestinal glucose concentration is at its highest, reduces intestinal glucose absorption to a greater extent. This is the primary reason metformin is chosen to be taken at mealtime and immediately after a meal.

II. Reduction of metformin irritation of the gastrointestinal tract

The biggest side effect of metformin is gastrointestinal reactions, including symptoms such as diarrhea, nausea, vomiting, bloating, weakness, indigestion, and abdominal discomfort.

Taking it with and immediately after meals reduces irritation of the gastrointestinal tract.

The timing, dosage, and frequency of taking any medication is the result of repeated research and confirmation. Therefore, please read the instructions carefully or consult your doctor before taking the medication and take it correctly.

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Metformin is a common medication for diabetes and is used by many obese type 2 sugar users. Anyone who has taken metformin knows that it can cause gastrointestinal adverse reactions, which can lead to abdominal pain, diarrhea, vomiting, especially when the drug is used for the first time, the symptoms are more intense. Therefore, doctors usually recommend starting with a small dose and gradually increasing it to the normal dosage. So how exactly do you take metformin to cause less adverse reactions? This also depends on the dosage form.

1. General dosage forms.Once taken, it will be dissolved and absorbed in the gastrointestinal tract, so it will cause irritation to the stomach and intestines, so it is recommended to take it during or immediately after meals. If you are using the regular dosage form, those who have a large dosage need to pay attention to the average distribution of medication, do not take all the day's dose.

2. enterosolvent type.Enteric tablet is the outer coating of the tablet wrapped with metformin, this coating will not dissolve in the stomach, but will gradually dissolve and release in the intestines without causing gastric irritation. Therefore, there is no time requirement for taking the enteric soluble form, before, during or after meals.

3. Extended-release dosage forms.It is released and absorbed more slowly in the body, and the drug has a slower duration of action. Metformin extended-release tablets, for example, are released slowly for up to 24 hours after taking them, and they cause less discomfort to the stomach. Extended-release tablets can be taken only once a day due to their long-lasting effect, and can be taken at any time of the day without splitting.

Having said that, I think all the sugar lovers understand that enteric solvent type and extended-release tablets are more free in the way of taking, but they are also more expensive, considering the long-term use of medication, so the sugar lovers can choose according to their own condition and financial situation.

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