metformin
hydrochloride
Fortamet, Gen-Metformin (CAN),
Glucophage, Glucophage XR,
Glumetza, Glycon (CAN), Novo-
Metformin (CAN), Riomet
Nursing Considerations
• Give metformin tablets with food, which
decreases and slightly delays absorption,
thus reducing risk of adverse GI reactions.
Give E.R. tablets with evening meal; don’t
break or crush them.
• Expect prescriber to alter dosage if patient
has a condition that decreases or delays
gastric emptying, such as diarrhea, gastroparesis,
GI obstruction, ileus, or vomiting.
• Expect to assess BUN and serum creatinine
level before and during long-term
therapy in those at increased risk for lactic
acidosis.
•Monitor patient’s hepatic function, as
ordered, because impaired hepatic function
may significantly reduce the liver’s
ability to clear lactate, predisposing the
patient to lactic acidosis.
•Monitor patient’s blood glucose level to
evaluate drug effectiveness. Assess for
hyperglycemia and the need for insulin
during times of increased stress, such as
infection and surgery.
•Withhold drug, as ordered, if patient
becomes dehydrated or develops hypoxemia
or sepsis because these conditions
increase the risk of lactic acidosis.
• Iodinated contrast media used in radiographic
studies increases risk of renal
failure and lactic acidosis during metformin
therapy. Expect to withhold drug
for 48 hours before and after testing.
PATIENT TEACHING
• Instruct patient to take metformin tablet
at breakfast if taking drug once a day or at
breakfast and dinner if taking drug twice a
day. Instruct him to take E.R. tablets once
daily with evening meal and to swallow
them whole without crushing or chewing.
• Direct patient to take drug exactly as prescribed
and not to change the dosage or
frequency unless instructed.
• Stress importance of following prescribed
diet, exercising regularly, controlling
weight, and checking blood glucose level.
• Teach patient how to measure blood glucose
level and recognize hyperglycemia
and hypoglycemia. Urge him to notify prescriber
of abnormal blood glucose level.
• Caution patient to avoid alcohol, which
can increase the risk of hypoglycemia.
• Instruct patient to report early signs of lactic
acidosis, including drowsiness, hyperventilation,
malaise, and muscle pain.
• Advise patient to expect laboratory testing
of glycosylated hemoglobin every
3 months until blood glucose is controlled.
