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Glucophage XR (Metformin Hydrochloride) - Summary



Lactic Acidosis:

Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with GLUCOPHAGE or GLUCOPHAGE XR; 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 (>5 mmol/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 >5 µg/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. The risk of lactic acidosis may, therefore, be significantly decreased by regular monitoring of renal function in patients taking GLUCOPHAGE or GLUCOPHAGE XR and by use of the minimum effective dose of GLUCOPHAGE or GLUCOPHAGE XR. In particular, treatment of the elderly should be accompanied by careful monitoring of renal function. GLUCOPHAGE or GLUCOPHAGE XR treatment should not be initiated in patients ≥80 years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced, as these patients are more susceptible to developing lactic acidosis. In addition, GLUCOPHAGE and GLUCOPHAGE XR should be promptly withheld in the presence of any condition associated with hypoxemia, dehydration, or sepsis. Because impaired hepatic function may significantly limit the ability to clear lactate, GLUCOPHAGE and GLUCOPHAGE XR should generally be avoided in patients with clinical or laboratory evidence of hepatic disease. Patients should be cautioned against excessive alcohol intake, either acute or chronic, when taking GLUCOPHAGE or GLUCOPHAGE XR, since alcohol potentiates the effects of metformin hydrochloride on lactate metabolism. In addition, GLUCOPHAGE and GLUCOPHAGE XR should be temporarily discontinued prior to any intravascular radiocontrast study and for any surgical procedure (see also PRECAUTIONS).

The onset of lactic acidosis often is subtle, and accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress. There may be associated hypothermia, hypotension, and resistant bradyarrhythmias with more marked acidosis. The patient and the patient's physician must be aware of the possible importance of such symptoms and the patient should be instructed to notify the physician immediately if they occur (see also PRECAUTIONS). GLUCOPHAGE and GLUCOPHAGE XR should be withdrawn until the situation is clarified. Serum electrolytes, ketones, blood glucose, and if indicated, blood pH, lactate levels, and even blood metformin levels may be useful. Once a patient is stabilized on any dose level of GLUCOPHAGE or GLUCOPHAGE XR, gastrointestinal symptoms, which are common during initiation of therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

Levels of fasting venous plasma lactate above the upper limit of normal but less than 5 mmol/L in patients taking GLUCOPHAGE or GLUCOPHAGE XR do not necessarily indicate impending lactic acidosis and may be explainable by other mechanisms, such as poorly controlled diabetes or obesity, vigorous physical activity, or technical problems in sample handling. (See also PRECAUTIONS.)

Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia).

Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking GLUCOPHAGE or GLUCOPHAGE XR, the drug should be discontinued immediately and general supportive measures promptly instituted. Because metformin hydrochloride is dialyzable (with a clearance of up to 170 mL/min under good hemodynamic conditions), prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin. Such management often results in prompt reversal of symptoms and recovery. (See also CONTRAINDICATIONS and PRECAUTIONS.)



GLUCOPHAGE® (metformin hydrochloride) Tablets and GLUCOPHAGE® XR (metformin hydrochloride) Extended-Release Tablets are oral antihyperglycemic drugs used in the management of type 2 diabetes.

GLUCOPHAGE (metformin hydrochloride) Tablets is indicated as an adjunct to diet and exercise to improve glycemic control in adults and children with type 2 diabetes mellitus.

GLUCOPHAGE XR (metformin hydrochloride) Extended-Release Tablets is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

See all Glucophage XR indications & dosage >>


Media Articles Related to Glucophage XR (Metformin)

Medical News Today: New metformin may help more patients with type 2 diabetes
Source: Featured Health News from Medical News Today [2015.08.20]
A study that overturns ideas about where metformin acts in the body suggests a delayed-release version could help the 40% of type 2 diabetes patients who are unable to use it.

New metformin may help more patients with type 2 diabetes
Source: Diabetes News From Medical News Today [2015.08.20]
A study that overturns ideas about where metformin acts in the body suggests a delayed-release version could help the 40% of type 2 diabetes patients who are unable to use it.

Delayed Release Metformin Sails Through Phase II Testing (CME/CE)
Source: MedPageToday.com - medical news plus CME for physicians [2015.08.20]
(MedPage Today) -- The new version changes the target without changing the formula

Diabetes Drug Metformin May Lower Glaucoma Risk
Source: MedicineNet Glaucoma Specialty [2015.05.29]
Title: Diabetes Drug Metformin May Lower Glaucoma Risk
Category: Health News
Created: 5/28/2015 12:00:00 AM
Last Editorial Review: 5/29/2015 12:00:00 AM

Type 2 Diabetes Can Be Prevented: Why Are We Waiting?
Source: Medscape Diabetes & Endocrinology Headlines [2015.08.17]
Despite the evidence supporting benefit, clinicians have been slow to recommend either healthy lifestyle changes or metformin for diabetes prevention.
Medscape Diabetes & Endocrinology

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Published Studies Related to Glucophage XR (Metformin)

Anagliptin and sitagliptin as add-ons to metformin for patients with type 2 diabetes: a 24-week, multicentre, randomized, double-blind, active-controlled, phase III clinical trial with a 28-week extension. [2015]
We conducted a 24-week, multicentre, double-blind, randomized study with a 28-week extension to compare the efficacy and safety of anagliptin and sitagliptin as an add-on to metformin in patients with type 2 diabetes. Patients inadequately controlled on metformin were randomized to either anagliptin (100 mg twice daily, n = 92) or sitagliptin (100 mg once daily, n = 88)...

Effect of combination therapy with repaglinide and metformin hydrochloride on glycemic control in Japanese patients with typeĀ 2 diabetes mellitus. [2014]
exercise... CONCLUSIONS: Combination therapy with repaglinide and metformin resulted in an

Lipid profiling reveals different therapeutic effects of metformin and glipizide in patients with type 2 diabetes and coronary artery disease. [2014]
CONCLUSIONS: Our findings revealed the differential therapeutic effects of

Metformin for non-diabetic patients with coronary heart disease (the CAMERA study): a randomised controlled trial. [2014]
diabetes... INTERPRETATION: Metformin had no effect on cIMT and little or no effect on

The effect of metformin on apoptosis in a breast cancer presurgical trial. [2013]
presurgical trial... CONCLUSION: Overall, we found no significant modulation of apoptosis by

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Clinical Trials Related to Glucophage XR (Metformin)

Efficacy and Safety of Alogliptin Plus Metformin in Subjects With Type 2 Diabetes [Recruiting]
The purpose of this study is to evaluate the safety and effectiveness of alogliptin combined with metformin, once daily (QD) or twice daily (BID), in participants with Type 2 Diabetes.

Carotid Atherosclerosis: MEtformin for Insulin ResistAnce Study [Recruiting]
Hypothesis: Treatment with metformin in overweight non-diabetic individuals with coronary heart disease and on standard cardiovascular risk reducing agents including statins will have a beneficial impact on carotid artery atherosclerosis compared to placebo.

Rationale: Once subjects have a heart attack, they remain at much higher than average risk of another heart attack and stroke, despite the best current therapies to lower their cholesterol and blood pressure and thin their blood. Many subjects with heart disease also have problems metabolising (i. e. processing) sugar even if they do not have diabetes. There is some evidence that metformin, a drug which improves sugar metabolism, decreases the risk of future heart attacks in diabetic patients. However, whether metformin further reduces the risk of heart disease beyond established treatments in people without diabetes is unknown.

Method: The investigators will test the ability metformin, a drug with proven safety, to slow the progression of furring up (known as atherosclerosis) of blood vessels in non-diabetic subjects with heart disease. This will be achieved by treating 2 groups of subjects with metformin and placebo pills respectively. To measure atherosclerosis, the investigators will carry out ultrasound scans of the big blood vessels in the neck at the start of the study, after 1 year and after 1. 5 years of therapy. The investigators will then be able to assess whether metformin has had a beneficial impact.

Comparison of the Bioavailability of Metformin Between Medium Dose Linagliptin/Metformin Tablets and Medium Dose Glucophage Tablet Given With Linagliptin Tablet [Recruiting]
The data from this study will be used to compare the kinetic profile of metformin 500mg in linagliptin/metformin fixed dose combination tablet versus Canadian metformin reference product administered concomitantly with linagliptin 2. 5 mg tablet.

Study to Assess Safety and Pharmacokinetics (PK) of Double-Blind S-707106 Alone and in Combination With Open-Label Metformin in Patients With Type 2 Diabetes Mellitus [Recruiting]
Primary Objectives:

- to evaluate the safety and PK of multiple-dose oral administration of S-707106 tablet

in fed state in patients with type 2 diabetes mellitus

- to evaluate the safety and PK of multiple-dose oral co-administration of S-707106 and

metformin in fed state in patients with type 2 diabetes mellitus

Secondary Objectives:

- to evaluate the effect of multiple doses of S-707106 on PK of metformin

- to evaluate the effect of multiple doses of metformin on PK of S-707106

Bioavailability of a Fixed Dose Combination Tablet With BI 10773 and Metformin Compared With the Monocomponents and Effect of Food on Bioavailability [Recruiting]
The objective of the current study is to determine the relative bioavailability of a BI 10773 / metformin fixed dose combination tablet compared to single tablets of BI 10773 and metformin when administered together and to assess the effect of food on the bioavailability the fixed dose combination tablet

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Reports of Suspected Glucophage XR (Metformin) Side Effects

Diarrhoea (4)Drug Ineffective (3)Blood Glucose Increased (3)Weight Decreased (2)Anaemia (2)Hypersensitivity (1)Wrong Technique in Drug Usage Process (1)Abasia (1)Drug Interaction (1)Expired Drug Administered (1)more >>


Based on a total of 2 ratings/reviews, Glucophage XR has an overall score of 7. The effectiveness score is 6 and the side effect score is 5. The scores are on ten point scale: 10 - best, 1 - worst.

Glucophage XR review by 45 year old male patient

Overall rating:  
Effectiveness:   Moderately Effective
Side effects:   Moderate Side Effects
Treatment Info
Condition / reason:   Diabetes Type II
Dosage & duration:   2000 mg/day taken 4 times/day for the period of 12 years
Other conditions:   Obstructive sleep apnea
Other drugs taken:   Byetta
Reported Results
Benefits:   Regularly reduced fasting blood glucose by 20-30 points
Side effects:   Initial diarrhea. Must gradually titrate up to the assigned dose, and take with food.
Comments:   I would take one 500 mg pill every time I ate, or 2 500 mg pills at breakfast/dinner. Effects were apparent after 10 days. I am still on this medication, as I no longer have side effects.


Glucophage XR review by 29 year old female patient

Overall rating:  
Effectiveness:   Moderately Effective
Side effects:   Severe Side Effects
Treatment Info
Condition / reason:   Polycystic Ovary syndrome
Dosage & duration:   1500 mg taken everyday for the period of 1 year
Other conditions:   None
Other drugs taken:   None
Reported Results
Benefits:   Less acne. It didn't disappear, though. And a regular menstrual cycle.
Side effects:   Eye and skin photosensitivity to sunlight and artificial light (especially fluorescents). Honey allergy. Diarrhea. Depression
Comments:   I took 2 pills, of 750 mg each of Glucophage XR, every day before going to sleep, during 1 year. Every 6 month sugar levels were controlled by a blood sample. Now i have been prescribed Cabergoline for 1 month.

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Page last updated: 2015-08-20

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