Glycomet (Metformin Hydrochloride)
Also sold as: Glycomet, Glucophage, Obimet, Gluformin
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Tablet 250/500/1000mg +1
Indications
- Type 2 Diabetes Mellitus (first-line)
- PCOS (off-label)
- Pre-diabetes (off-label per ADA)
- Gestational diabetes (alternative to insulin)
Adult Dosing
T2DM
Start 500 mg PO OD with meals, titrate up by 500 mg/week
Target 1-2g/day in divided doses
SR formulation
500-2000 mg PO once daily with evening meal
Pediatric Dosing
Limited indications in pediatrics
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| eGFR > 60 mL/min/1.73m² | No adjustment |
| eGFR 45-59 | Continue but monitor closely; max 2g/day |
| eGFR 30-44 | Reduce to 50% (max 1g/day); reassess regularly |
| eGFR < 30 | CONTRAINDICATED — discontinue |
| Acute illness/contrast | Hold 48 hours before and after IV contrast if eGFR <60 |
Hepatic Adjustment
Avoid in severe hepatic impairment (lactic acidosis risk)
Pregnancy & Lactation
Pregnancy: Category B
Generally safe; used in GDM as alternative to insulin per RCOG. Discuss with endocrinologist.
Lactation: Safe
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| IV iodinated contrast | AKI → lactic acidosis. Hold metformin 48 hours before and after if eGFR <60 | Major |
| Alcohol | Increased lactic acidosis risk | Major |
| Cimetidine, Trimethoprim | Reduced metformin clearance | Moderate |
| Steroids, thiazides, atypical antipsychotics | Reduced glycemic control | Moderate |
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Side Effects
Common
- Diarrhea (30%, dose-related, improves with time)
- Nausea
- Metallic taste
- Vitamin B12 deficiency (long-term)
Serious / Discontinue If
- Lactic acidosis (rare: 0.03/1000 patient-years; check if SOB, weakness, abdominal pain)
- B12 deficiency causing neuropathy
Contraindications
- eGFR <30
- Acute or chronic metabolic acidosis
- Severe hepatic disease
- Hypoxic states (severe HF, sepsis, dehydration)
- Heavy alcohol use
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Glycomet 500 | USV | 20 tab ₹35 |
| Obimet 500 | Abbott | 15 tab ₹28 |
| Glucophage 500 | Merck | 20 tab ₹85 |
| Glycomet GP 1 | USV (with glimepiride) | 15 tab ₹68 |
Monitoring Required
- HbA1c every 3 months
- eGFR annually (every 3-6 months if eGFR <60)
- B12 annually after 4 years of use
- LFT in liver disease
Patient Counseling Points
- Take with meals to reduce GI upset
- Stop and inform doctor before any IV contrast scan
- Avoid heavy alcohol use
- Report severe abdominal pain, breathlessness, fatigue (lactic acidosis)
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- IAP/RSSDI/CSI Guidelines