About metformin

Insulin is a hormone which is made naturally in your body, in the pancreas. It helps to control the levels of sugar (glucose) in your blood. If your body does not make enough insulin, or if it does not use the insulin it makes effectively, this results in the condition called diabetes (diabetes mellitus).

People with diabetes need treatment to control the amount of sugar in their blood. This is because good control of blood sugar levels reduces the risk of complications later on. Some people can control the sugar in their blood by making changes to the food they eat but, for other people, medicines like metformin are given alongside the changes in diet.

Metformin has multiple effects on the body which lead to lower blood sugar levels. It increases the action of insulin and the amount of sugar absorbed by the cells in your body. It also reduces the amount of sugar made by your liver and absorbed from your food.

Metformin can be given on its own, or alongside insulin or another antidiabetic medicine. There are a number of tablets available which contain metformin in combination with one of these other antidiabetic medicines (brands include Jentadueto®, Competact®, Komboglyze®, Janumet®, and Eucreas®). Taking a combination tablet like these can help to reduce the total number of tablets needing to be taken each day.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking metformin it is important that your doctor knows:

• If you have any problems with the way your kidneys work or with the way your liver works.

• If you have recently been severely unwell.

• If in the previous two days you have had an X-ray where a dye was injected.

• If you are pregnant or breastfeeding. (Metformin can be taken whilst pregnant or feeding a baby, but it is important that your doctor knows about it.)

• אם אי פעם הייתה לך תגובה אלרגית לתרופה.

• אם אתה נוטל תרופות אחרות כלשהן. זה כולל כל תרופה שאתה נוטל שניתן לרכוש ללא מרשם, כמו גם תרופות צמחיות ומשלימות.

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about metformin and will provide you with a full list of the side-effects which you may experience from taking it.

• Take metformin exactly as your doctor tells you to. You will be started on a low dose (usually one dose a day) and then your dose will gradually be increased. This allows your doctor to make sure that you have the dose that is right for you, and also helps to reduce the risk of unwanted side-effects.

• Try to take metformin at the same time(s) each day, as this will help you to remember to take it regularly. Take your doses during a meal or just after a snack.

• If you have been given modified-release metformin tablets (these have the letters 'SR' or 'XL' after the brand name), the tablets are designed to release metformin slowly and evenly. You must swallow these tablets whole - do not break or chew the tablets, as your body may absorb the metformin too quickly.

• If you forget to take a dose, make sure that you remember to take your next dose when it is due. Do not take two doses together to make up for a forgotten dose.

• It is important that you keep your regular doctor's and clinic appointments. This is so your progress can be monitored. You will need regular check-ups with an eye clinic and a foot clinic as well as with your doctor and diabetes clinic.

• Your doctor may recommend that you test for sugar (glucose) in your blood or urine regularly to check that your diabetes is being controlled. Your doctor or diabetes nurse will show you how to do this.

• Do not drink alcohol, as it can affect the control of your blood sugar and can increase the risk of lactic acidosis (see below).

• If you have been given advice by your doctor about changes to your diet, stopping smoking or taking regular exercise, it is important for you to follow the advice you have been given.

• Check with your doctor before taking up any new physical exercise, as this will have an effect on your blood sugar levels and you may need to check your blood or urine levels more regularly.

• Make sure you know what it feels like if your blood sugar is low. This is known as hypoglycaemia, or a 'hypo'. Although metformin is unlikely to cause low blood sugar, other medicines that you are taking for diabetes alongside it may. The first signs of hypoglycaemia are feeling shaky or anxious, sweating, looking pale, feeling hungry, having a feeling that your heart is pounding (palpitations), and feeling dizzy. If you are a driver you should take special care, as your ability to concentrate may be affected if your diabetes is not well controlled. You may be advised to check your blood sugar levels before you travel and have a snack with you on long journeys.

• If you are due to have an operation or any medical treatment, you should tell the person carrying out the treatment that you have diabetes and that you are taking metformin.

• If you get unusually thirsty, pass urine more frequently, and feel very tired, you should let your doctor know. These are signs that there is too much sugar in your blood and your treatment may need adjusting.

• Treatment for diabetes is usually lifelong. Continue to take metformin unless you are advised otherwise by your doctor.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with metformin. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to metformin, speak with your doctor or pharmacist for further advice.

• שמור את כל התרופות מחוץ להישג ידם וראייתם של ילדים.

• יש לאחסן במקום קריר ויבש, הרחק מחום ואור ישיר.