Metformin comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow metformin extended-release tablets whole; do not split, chew, or crush them.

Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1–2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.

Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor.

Metformin is used to control the amount of sugar in your blood. You should know the symptoms of low and high blood sugar and what to do if you have them.

If you have any of these symptoms, eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, and call your doctor immediately; symptoms of low blood sugar (hypoglycemia) include:

* shakiness
* dizziness
* rapid heartbeat
* sweating
* confusion
* blurred vision
* headache
* numbness or tingling of the mouth
* weakness
* fatigue
* pale color
* sudden hunger

If you have any of these symptoms, call your doctor immediately; symptoms of high blood sugar (hyperglycemia) include:

* thirst
* dry mouth
* tiredness
* flushing
* dry skin
* frequent urination
* loss of appetite
* trouble breathing

Metformin may cause side effects. Tell your doctor if any of these symptoms are severe, do not go away, go away and come back, or do not begin for some time after you begin taking metformin:

* diarrhea
* upset stomach
* vomiting
* bloating
* stomach pain
* gas
* constipation
* unpleasant metallic taste in mouth
* heartburn
* headache
* sneezing
* cough
* runny nose
* sweating
* flushing of the skin
* nail changes
* muscle pain

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:

* chest pain
* rash

Some female laboratory animals given high doses of metformin developed non-cancerous polyps (abnormal growths of tissue) in the uterus (womb). It is not known if metformin increases the risk of polyps in humans. Talk to your doctor about the risks of taking this medication.

Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have or have ever had a heart attack; stroke; high blood pressure; diabetic ketoacidosis ( blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment) or coma; surgery to remove part of your small intestine; anemia (not enough red blood cells), or heart, kidney, lung, or liver disease.Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover.If you are having surgery, including dental surgery, any x-ray procedure in which dye is injected, or any major medical procedure, tell the doctor that you are taking metformin. You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Your doctor will tell you exactly when you should stop taking metformin and when you should start taking it again. Tell your doctor and pharmacist if you are taking or have taken the following medications: acyclovir (Zovirax); acetaminophen (Tylenol); aminoglycoside antibiotics such as amikacin (Amikin), gentamicin (Garamycin), Kanamycin (Kantrex), Neomycin (Neo-Fradin, Neo-Rx), netilmycin (netromycin), paramomycin (Humatin), streptomycin and tobramycin (Nebcin, Tobi); amphotericin B (Abelcet, Amphocin, others); angiotensin converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinvil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); aspirin and other non-steroidal anti-inflammatory agents (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); cancer chemotherapy medications; cyclosporine (Sandimmune, Neoral); dapsone (Avlosulfon); diuretics (water pills); foscarnet (Foscavir); gold compounds such as auranofin (Ridaura), aurothioglucose (Aurolate, Solganol), and gold sodium thiomalate (Myochrysine); hydralazine (Hydra-Zide); lithium (Eskalith, Lithobid); medications to treat human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS); methicillin (Staphcillin); nitrates; penicillin and sulfa antibiotics; penicillamine (Cuprimine, Depen); primaquine; propranolol (Inderal); rifampin (Rifadin, Rimactane); tacrolimus (Prograf); vancomycin (Vancocin); or if you have ever taken the Chinese weight-loss herb aristolochia.If you experience any of the following symptoms, call your doctor immediately: extreme tiredness, weakness, or discomfort; upset stomach; vomiting; stomach pain; decreased appetite; deep and rapid breathing or shortness of breath; dizziness; light-headedness; fast or slow heartbeat; flushing of the skin; muscle pain; or feeling cold.Tell your doctor if you regularly drink alcohol or sometimes drink large amounts of alcohol in a short time (binge drinking). Drinking alcohol increases your risk of developing lactic acidosis. Ask your doctor how much alcohol is safe to drink while you are taking metformin.Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests to check your body's response to metformin. Talk to your doctor about the risk(s) of taking metformin.

n case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

* extreme tiredness
* weakness
* discomfort
* vomiting
* upset stomach
* stomach pain
* decreased appetite
* deep, rapid breathing
* shortness of breath
* dizziness
* light-headedness
* abnormally fast or slow heartbeat
* flushing of the skin
* muscle pain
* feeling cold

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Metformin is used alone or with other medications, including insulin, to treat type 2 (noninsulin-dependent) diabetes. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 (insulin-dependent) diabetes.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication