Metformin

Metformin is an oral medication commonly prescribed to manage blood sugar levels in people with type 2 diabetes. It works by decreasing glucose production in the liver, improving the body's sensitivity to insulin, and reducing the amount of sugar absorbed by the intestines. 

Metformin is sometimes used off-label to treat conditions like PCOS, obesity, and overweight. Common side effects include gastrointestinal issues like nausea, diarrhea, and abdominal discomfort.

Metformin hydrochloride tablets are indicated:

• As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus

Biguinide

For metformin hydrochloride, the most common adverse reactions (>5%) are:

• Diarrhea

• Nausea/vomiting

• Flatulence

• Weakness

• Indigestion

• Abdominal discomfort

• Headache

The cost of metformin varies depending on your insurance plan, which pharmacy you use, the dose, and quantity. Without insurance, metformin may cost between $10 and $30 for 60 tablets (typically a month’s supply). Insurance plans may cover all or some of the cost of these medications.

You may be eligible for coupons or discount cards that can help bring down the cost. Ask your provider or pharmacist if you qualify.

Personalized Weight Loss Medication Kits (which may feature metformin along with a combination of other medications) are available through the Hers platform starting at $69 per month. This price includes the many benefits of the Hers app, such as unlimited messaging with your care team, recipes and healthy eating tips, and behavior change exercises.

Metformin is available with a prescription from a licensed healthcare provider. Your provider will determine if the medication is right for you based on factors like your symptoms and medical history. 

If you’re interested in metformin, you can connect with a licensed healthcare provider on the Hims platform. They will create a personalized weight loss treatment plan that fits your needs. For those who qualify, Hims offers access to metformin starting at $69 a month. 

When you access weight loss medication through the Hims platform, your medication is shipped directly to your door. You get all the supplies you need, along with instructional videos, ongoing provider support through the app, and a wealth of holistic health resources like meal plans, recipes, and fitness content. 

Interested in Weight Loss by Hims? Get started with our free online weight loss assessment.   

• Severe renal impairment (eGFR below 30 mL/min/1.73 m²)

• Hypersensitivity to metformin

• Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma

• Drug interactions: Carbonic anhydrase inhibitors, drugs that reduce metformin clearance (such as ranolazine, vandetanib, dolutegravir, and cimetidine), alcohol

• Lactic acidosis: See Boxed Warning

• Vitamin B12 deficiency: Metformin may lower vitamin B12 levels

• Low blood sugar with concomitant use with insulin and insulin secretagogues

• Females and males of reproductive potential: Potential for an unintended pregnancy

WARNING: LACTIC ACIDOSIS

Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. Symptoms included malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Laboratory abnormalities included elevated blood lactate levels, anion gap acidosis, increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL.

Risk factors include renal impairment, concomitant use of certain drugs, age >65 years old, radiological studies with contrast, surgery and other procedures, hypoxic states, excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groups are provided in the Full Prescribing Information.

If lactic acidosis is suspected, discontinue metformin hydrochloride tablets and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended.

Other drugs are available that can help manage type 2 diabetes, improve blood sugar control, and help with weight loss. If you’re interested in finding an alternative to metformin, chat with a provider to learn more.

Examples of medications used to manage type 2 diabetes include:

• Dipeptidyl peptidase 4 (DPP-4) inhibitors:

  • Januvia^® (sitagliptin)

  • Nesina^® (alogliptin)

  • Onglyza^® (saxagliptin)

  • Tradjenta^® (linagliptin)

• Injectable glucagon-like peptide 1 (GLP-1) receptor agonists:

  • Adlyxin^® (lixisenatide)

  • Bydureon^® (exenatide extended-release)

  • Byetta^® (exenatide)

  • Ozempic^® (semaglutide)

  • Trulicity^® (dulaglutide)

  • Victoza^® (liraglutide)

• The oral GLP-1 receptor agonist Rybelsus^® (semaglutide)

• The injectable dual GLP-1/gastric inhibitory peptide (GIP) receptor agonist Mounjaro^® (tirzepatide)

• Sodium-glucose cotransporter 2 (SGLT2) inhibitors:

  • Brenzavvy^® (bexagliflozin)

  • Farxiga^® (dapagliflozin)

  • Invokana^® (canagliflozin)

  • Jardiance^® (empagliflozin)

  • Steglatro^® (ertugliflozin)

• Sulfonylureas:

  • Amaryl^® (glimepiride)

  • Diabeta^®, Glynase^®, and Micronase^® (glyburide)

  • Glucotrol^® and Glucotrol XL^® (glipizide)

• Thiazolidinediones (TZDs):

  • Actos^® (pioglitazone)

  • Avandia^® (rosiglitazone)

• Insulin

Examples of other medications used to help with weight loss include:

• Wegovy^® (semaglutide) 

• Contrave^® (naltrexone-bupropion) 

• Qsymia^® (phentermine-topiramate)

• Saxenda^® (liraglutide) 

• Xenical^® or Alli^® (orlistat)

*This information is from the metformin hydrochloride label used by Epic Pharma, LLC. See the Full Prescribing Information for more complete information. Metformin may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient metformin.