Follow all directions on your prescription label and read all medication guides or instruction sheets. Use exactly as directed by your healthcare provider.

Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor’s instructions. Usual adult dose:

● Immediate-release tablets: 500 mg twice a day, or 850 mg once a day. This dose may be

gradually increased by 500 mg a week or 850 mg every two weeks. The maximum daily

dose of metformin is 2,550 mg divided into three smaller doses.

● Extended-release tablets: 500 mg, 750 mg or, 1,000 mg daily with an evening meal. The

dose can be increased by 500 mg a week to a maximum of 2,000 mg. If you take Fortamet

or Glumetza (modified release formulations of metformin), you may be given different

dosing instructions.

Typical child dose:

● Children between 10-16 years old: 500 mg twice a day. The dose can be increased by 500

mg a week to a maximum of 2,000 mg in divided doses.

● Children older than 17 years old: 500 mg of extended-release tablets daily up to a

maximum of 2,000 mg daily.

Do not crush, chew, or break an extended-release tablet (Fortamet, Glucophage XR, Glumetza). Swallow it whole.

Some tablets are made with a shell that is not absorbed in the body. Part of this shell may appear in your stool. This is normal and will not make the medicine less effective.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, and feeling anxious or shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule.

Metformin is only part of a complete treatment program that may also include diet, exercise, weight control, regular blood sugar testing, and special medical care. Follow your doctor’s instructions very closely.

Your doctor may have you take extra vitamin B12 while you are taking metformin. Take only the amount of vitamin B12 that your doctor has prescribed.

If overdose is suspected, seek emergency medical attention. If you forget to take a dose, take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

Store at room temperature; away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

You should not use metformin if you are allergic to it, or if you have:

● severe kidney disease;

● metabolic acidosis or diabetic ketoacidosis; or

● type 1 diabetes.

Metformin should not be given to a child younger than 10 years old. The extended-release form of

the drug should not be given to a child younger than 17 years old.

Do not take metformin if you are pregnant or breastfeeding. Ask your doctor first.

Store at room temperature away from moisture and heat.

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis.

ell your doctor if you have ever had:

● kidney disease (your kidney function may need to be checked before you take this medicine);

● high ketone levels in your blood or urine;

● heart disease, congestive heart failure, stroke;

● liver disease; or

● if you also use insulin, or other oral diabetes medications.