For many people with diabetes, taking metformin is an effective way to improve blood sugar levels and potentially lose weight.
But it can be confusing when there are so many different types of metformin and dosing methods available.
Figuring out what type of metformin to take and how much can take some time and effort, and should always be done together with your doctor.
This article explains everything you need to know about metformin dosing for each type of metformin.
What are the different ways to take metformin?
Before we get into the different dosages, it’s important to know that there are several different ways to take metformin.
Most people take metformin by mouth in pill form. There are two types of oral tablets: regular and slow-release.
Regular metformin tablets work faster and can be taken more often, while slow-release tablets can reduce the severity of side effects and can be taken less often.
Never chew, crush or break a metformin tablet.
Metformin is also available in sachets to be mixed with water and in liquid form for children or people who have difficulty swallowing.
Read more: When to use metformin
What dose do you usually start treatment with?
Metformin is generally a very safe drug, but when metformin is prescribed, your doctor will likely start you on a low dose to avoid side effects such as diarrhea, nausea, and vomiting.
Your doctor will determine your individual dose based on your weight, health condition, and health goals. Your recommended starting dose will follow the medication instructions you get from your pharmacy.
However, typically, most people will start with 500 mg of metformin twice a day or 850 mg of metformin once a day. If you see positive results with no side effects, your doctor will increase your dose.
Read more: Stopping metformin: when and how can you stop taking metformin
What is the typical dose of metformin?
General guidelines for typical doses are provided below. Always consult your doctor and if these guidelines are more or less metformin than you are currently taking, DO NOT change your dose without consulting your doctor first.
Oral dose, tablets
Adults:
- Initially 500 mg twice daily with meals or 850 mg once daily with evening meal, not to exceed 2550 mg daily
- If you are taking metformin with a sulphonylurea, the dose of metformin will be determined by your doctor
- If you are taking metformin with insulin, 500 mg metformin a day, but not more than 2500 mg a day
Kids:
- Children 10-16 years: 500 mg twice daily, taken with meals, no more than 2000 mg daily
- Children under 10 years: to be determined by the doctor
Oral dose, extended release tablets
Adults:
- Metformin (Fortamet): 1,000 mg is usually taken once a day with an evening meal, no more than 2,500 mg per day
- Metformin (Glucophage XR): 500 mg once daily with evening meal, no more than 2000 mg daily
- metformin (Glumetza): 500 mg once daily with evening meal, no more than 2,000 mg per day
- Metformin with a sulfonylurea will depend on your doctor’s prescription
- Metformin with insulin will require 500 mg of metformin once a day, no more than 2,500 a day
Kids:
- To be determined by a physician
Oral dose, extended-release suspension
Adults:
- 5 ml once a day, taken with the evening meal, not more than 20 ml per day
Kids:
- Children 10-16 years: 5 ml once a day, taken with the evening meal, no more than 20 ml a day
- Children under 10 years: to be determined by the doctor
Oral dose, solution/sachet
Adults:
- 5 ml twice daily or 8.5 ml once daily with meals, no more than 25.5 ml daily
- Metformin with a sulfonylurea will be prescribed by your doctor
- Metformin with insulin, initially 5 ml once a day, no more than 25 ml a day
Kids:
- Children 10-16 years: 5 ml 2 times a day with meals, no more than 20 ml a day
- Children under 10 years: to be determined by the doctor
Metformin can also be taken as part of other combination therapies. If you are taking a combination drug with metformin, discuss dosing options with your doctor.
How and when do you increase your metformin dose?
Above all, never take more metformin than prescribed.
If you are new to metformin and on a lower dose, your doctor will most likely want you to stay on it for several weeks or a month to monitor you for any side effects, including diarrhea, nausea, or vomiting.
If you tolerate the drug well, don’t experience harsh side effects, and see an improvement in your blood sugar levels, your doctor may want to increase your dose.
However, this is not something that can be done without the guidance of a doctor.
Even if you try, your health insurance will only cover the amount of metformin you’ve been prescribed, so if you start upping your dose without telling your doctor, you’ll quickly run out of medication.
However, in most cases, your doctor will have no reason not to increase your dose if you are doing well on metformin and want to increase it. However, it won’t happen right away. Expect to take your initial dose of metformin for up to a month after starting 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 control and why you are taking metformin.
Higher doses may result in more weight loss, and if you’ve been prescribed metformin (off-label) to help with weight loss, your dose may be higher to help fight insulin resistance more.
On the other hand, if your body mass index (BMI) is lower, you are younger, or you are only taking metformin to control your blood sugar, you may be prescribed a lower dose.
What is the right dose for weight loss?
The Food and Drug Administration (FDA) does not approve metformin as a standalone weight loss drug. However, many people with type 2 or prediabetes who take metformin experience little weight loss.
This is due to increased insulin sensitivity, improved blood sugar levels, and suppressed appetite. Since it is not approved for weight loss, there is no recommended dosage for weight loss.
However, one study found that those who lost more than 5% of their body weight in the first year of the study while taking metformin were able to maintain their weight loss for 6-15 years than those who did not take metformin.
However, the weight loss is small. 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 in conjunction with healthy eating and exercise for healthy weight loss.
What is the maximum daily dose?
The maximum daily dose of metformin is 2550 mg. If you have accidentally taken more in one day, seek emergency medical attention immediately, especially if you are on insulin.
Metformin overdose can cause fatally low blood sugar and extreme nausea, vomiting and diarrhea and can be difficult to control.
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