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For many people with diabetes, taking metformin is an effective way to improve blood sugar levels and potentially lose weight.
But the treatment regimen can get confusing, since there are many different types of metformin and dosing approaches available.
Figuring out which type of metformin to take and how much can take time and effort, and it should always be done alongside your doctor.
This article will explain everything you need to know about metformin dosing for each type of metformin.
Key Points:
- Metformin is available in various forms, including standard-release tablets, liquid form, and extended-release tablets. Each type comes with specific dosing instructions to suit different needs.
- Typically, metformin treatment starts with a lower dose, such as 500 milligrams (mg) twice daily or 850 mg once daily. The exact dosage is tailored based on individual health factors under the guidance of a healthcare professional.
- For adults, the daily metformin dosage should not exceed 2,550 mg. It’s crucial to stick to the prescribed dosage, particularly when metformin is used in combination with insulin, to avoid severe side effects and complications.
What are the different ways of taking metformin?
Before diving into the different dosages, it’s important to know that there are several different ways of taking metformin.
Most people take metformin orally in the form of a tablet. There are two kinds of oral tablets: immediate-release (IR) and extended-release (XR or ER).
Regular metformin tablets act more quickly and may be taken more often, whereas extended-release tablets may reduce the severity of side effects and may be taken less often.
Never chew, crush, or break a metformin tablet.
Metformin is also available in liquid form for children and people who have difficulty swallowing pills.
Read more: When to Take Metformin
What metformin dosage do you typically start therapy with?
Metformin is generally a very safe drug for most groups of people, but when you are prescribed metformin, your doctor will probably start you out on a small dose to help avoid negative side effects, such as diarrhea, nausea, and vomiting.
Your doctor will determine your personal dose based on your weight, health status, and health goals. Your recommended starting dose will be on the medication’s instructions that you will receive at the pharmacy.
Typically, most people start on 500 mg of metformin twice a day or 850 mg of metformin once daily. If you’re seeing positive results without negative side effects, your doctor will increase your dose from there as needed.
Read more: When and How You Can Stop Taking Metformin
What is a typical metformin dose?
The following are general guidelines for typical doses. Always check with your doctor. If these guidelines outline less or more metformin than you’re currently taking, do NOT change your dose without consulting your doctor first.
Oral dose, tablets
Adults:
- At first 500 mg twice per day taken with meals or 850 mg taken once per day with an evening meal. No more than 2,550 mg per day.
- If you take metformin with a sulfonylurea (another class of type 2 diabetes drug), your metformin dose will be determined by your doctor
- If you take metformin with insulin, 500 mg metformin per day. No more than 2,500 mg per day.
Children:
- Children 10-16 years old: 500 mg twice per day, taken with meals. No more than 2,000 mg per day.
- Children under 10: To be determined by your child’s doctor.
Oral dose, extended-release tablets
Adults:
- Metformin (brand name Fortamet*): 1,000 mg is typically taken once per day with the evening meal. No more than 2,500 mg per day.
- Metformin (Glucophage XR): 500 mg taken once daily with an evening meal. No more than 2,000 mg per day.
- Metformin (Glumetza): 500 mg taken once daily with an evening meal. No more than 2,000 mg per day.
- Metformin with a sulfonylurea will depend on what your doctor recommends.
- Metformin with insulin will require 500 mg metformin once a day. No more than 2,500 mg per day.
Children:
- To be determined by your child’s doctor.
*Each type of extended-release metformin uses a different method for allowing the medicine to be absorbed slowly in the gastrointestinal tract, and so the different brands of pills are not considered to be interchangeable with one another.
(Note that when using the extended-release form of the tablet, it’s common and not a cause for concern to find part of the tablet in your stool. This occurs after the medication has been absorbed by your body.)
Oral dose, extended-release suspension
Adults:
- 5 mL once per day, taken with an evening meal. No more than 20 mL per day.
Children:
- Children 10-16 years old: 5 mL once per day, taken with an evening meal. No more than 20 mL per day.
- Children under 10: To be determined by your child’s doctor.
Oral dose, solution/sachet
Adults:
- 5 mL twice a day, or 8.5 mL once a day with meals. No more than 25.5 mL per day.
- Metformin with a sulfonylurea will be determined by your doctor.
- Metformin with insulin, at first 5 mL once a day. No more than 25 mL per day.
Children:
- Children 10-16 years old: 5 mL twice a day with meals, no more than 20 mL per day.
- Children under 10: To be determined by your child’s doctor.
Metformin can also be taken as part of other combination therapies. If you take a metformin combination drug, discuss dosing options with your doctor.
How and when do you increase your metformin dose?
First of all, never take more metformin than you’re prescribed.
If you’re new to metformin and are on a lower dose, your doctor will most likely want you to stay on that for several weeks or a month to monitor you for any negative symptoms, including diarrhea, nausea, or vomiting.
If you’re tolerating the medication well, not experiencing difficult side effects, and are seeing improved blood sugar levels, your doctor may want to increase your dose.
This is not something that you can do without your doctor’s guidance, however.
Even if you were to try, your health insurance will only cover the amount of metformin that you’ve had prescribed to you, so if you start increasing your dose without letting your doctor know, you will quickly run out of medication.
However, in most cases, your doctor will have no reason not to increase your dose if you’re doing well on metformin and wish to increase it. This will not happen instantaneously, though. Expect to be on your starting dose of metformin for up to a month after initiating treatment.
What is the right dose for you?
This can only be determined by you and your doctor and will depend on your weight, blood sugar management, and reason for taking metformin.
Higher doses may yield more weight loss, and if you’ve been prescribed metformin (off-label) to aid in losing weight, your dose may be higher to help further combat insulin resistance (a condition in which the body does not use insulin efficiently).
On the other hand, if your body mass index (BMI, a measure of weight relative to height) is lower, you’re younger, or you’re only on metformin for blood sugar management, you may be prescribed a smaller dose.
What is the right dose for weight loss?
The U.S. Food and Drug Administration (FDA) has not approved metformin as a standalone weight-loss drug. However, many people with type 2 or prediabetes who take metformin do experience a modest amount of weight loss.
This is due to increased insulin sensitivity, improved blood sugar levels, and suppressed appetite. Because metformin is not approved for weight loss, there is no recommended dose for weight loss.
However, one study found that people who lost more than 5 percent of their body weight in the first year of the trial taking metformin were able to maintain their weight loss throughout years 6-15 better compared to those who didn’t take metformin.
Weight loss is modest, however. A large study of over 4,000 people with type 2 diabetes found that metformin was only associated with an average of 5 pounds of weight loss over a four-year period.
Metformin is best used together with healthy eating and exercise for healthy weight loss.
What is the maximum daily dose?
The maximum dose per day of metformin is 2,550 mg. If you’ve accidentally taken more than that in a single day, seek emergency medical help immediately, especially if you are on insulin.
Overdosing on metformin can cause fatal low blood sugars and extreme nausea, vomiting, and diarrhea and can be hard to control.
Final thoughts
Navigating the world of metformin dosing can be complex, but it’s a crucial step in effectively managing type 2 diabetes. Remember, the journey begins with a well-considered starting dose and involves careful adjustments over time.
While metformin offers flexibility with its various forms and dosing schedules, it’s important to follow your healthcare provider’s guidance to find the dose that best suits your personal health needs.
Above all, safety should be the top priority. By staying informed, working closely with your doctor, and sticking to the prescribed regimen, you can make metformin a valuable ally in your diabetes management plan.
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