From the Guidelines
The starting dose of metformin for adults with type 2 diabetes should be 500 mg once or twice daily with food, and titrated gradually to the maximum effective dose. This approach is supported by the 2017 American Diabetes Association standards of medical care in diabetes, which recommends metformin monotherapy as the initial treatment for most patients with type 2 diabetes, unless there are contraindications 1. The initial dose of 500 mg once or twice daily with food helps minimize gastrointestinal side effects, such as nausea, vomiting, and diarrhea.
Key Considerations
- The dose can be increased gradually, usually by adding 500 mg weekly, until reaching the target dose, with a maximum recommended dose of 2000 mg daily divided into two or three doses.
- Metformin should be taken with meals to minimize gastrointestinal effects.
- Renal function should be assessed before starting therapy, as metformin is contraindicated in patients with significantly impaired kidney function (eGFR <30 mL/min/1.73m²) 1.
- Patients should be advised to stop taking their medication if they experience nausea, vomiting, or dehydration, and to consult their healthcare provider for further guidance.
Monitoring and Titration
- Regular monitoring of blood glucose levels, kidney function, and vitamin B12 levels should be performed to assess the effectiveness and safety of metformin therapy 1.
- The dose of metformin can be adjusted based on the patient's response to therapy, with the goal of achieving and maintaining optimal glycemic control.
From the FDA Drug Label
The recommended starting dose of metformin hydrochloride tablets are 500 mg orally twice a day or 850 mg once a day, given with meals. The recommended starting dose of metformin hydrochloride tablets for pediatric patients 10 years of age and older is 500 mg orally twice a day, given with meals.
The starting dose of metformin is 500 mg orally twice a day or 850 mg once a day for adults, and 500 mg orally twice a day for pediatric patients 10 years of age and older, given with meals 2.
From the Research
Metformin Starting Dose
- The provided studies do not directly mention the starting dose of metformin 3, 4, 5, 6, 7.
- However, the studies discuss the use of metformin in patients with type 2 diabetes, its benefits, and potential risks, such as lactic acidosis 4, 6, 7.
- The studies suggest that metformin can be used as a first-line agent in the management of type 2 diabetes, but its use may need to be cautious in patients with renal impairment 4, 5, 6, 7.
- The American Diabetes Association recommends starting metformin at a dose of 500 mg orally twice a day, but this information is not present in the provided studies.
- It is essential to consult the prescribing information or clinical guidelines for the recommended starting dose of metformin, as it may vary depending on the patient's condition and other factors.