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Metformin

Type 2 diabetes mellitus (first-line), Prediabetes (off-label), PCOS (off-label)

Indications

  • Type 2 diabetes mellitus (first-line)
  • Prediabetes (off-label)
  • PCOS (off-label)

Adult dosing

  • standard: dose: 500; unit: mg; route: PO BID; interval: Titrate to 1000mg BID over 2-4 weeks; fixed: true; extended release: dose: 500; unit: mg; route: PO daily with dinner; interval: Titrate to 2000mg daily; fixed: true

Contraindications

  • eGFR <30
  • Acute or chronic metabolic acidosis
  • Hold 48h after iodinated contrast

Clinical pearls

  • Start low, go slow — GI side effects (nausea, diarrhea) are dose-limiting; ER formulation is better tolerated
  • No hypoglycemia risk as monotherapy
  • Hold before surgery and resume when eating normally and renal function confirmed stable
  • Lactic acidosis is rare but hold in acute illness with risk of hypoperfusion

Source and review

  • ADA Standards of Care 2024. Last reviewed: 2024-11-01