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Metformin Prescription Question

R

Reaux

New Member
Relationship to Diabetes
Type 2
Last Friday my GP prescribed me Metformin 500mg, there was a little hiccup with him putting the prescription through the EPS so I had to chase it up with the receiption team. Initially it was showing on the NHS app as 86 tablets however when another GP fully put it through for my chosen pharmacy it changed to 56 tablets. When I picked them up today the pharmacist said to start with 1 a day and call if I had any side effects (etc etc)

One thing that wasn't clear (and in hindsight I should have asked more questions) was the dosage. The GP said to take 1 at breakfast and increase as needed (or directed, little foggy on exactly what he said). For context I also need to have a A1c bloods follow up in 3 months from last Friday to check levels.

My question is, neither on the NHS app where it lists my medication or on the box does it say when I should increase my dose or how I should determine if it's needed - on the box it just says 1 with breakfast then increase as directed. Should I only be taking 1 a day until my next bloods review and they direct me to change up my dosage or do I monitor my levels with a finger pick test and increase the dosage myself to 1 with each meal after a week or so?

Apologies if this seems like a stupid question but this is my first repeat prescription.
 
Hi @Reaux, I think the normal approach with Metformin is to start you on 1 x 500mg pill a day for the first week, moving to 2x tablets, one each in the morning and evening. Week three is two in morning and one in evening and finally week 4 is two in morning and evening. It is possible that if your doctor felt your HbA1c was low enough that you don't need to increase the dosage, but I would expect the instructions to be on the prescription or for you to get a separate mail or text from the surgery with instructions. I would probably call the surgery and ask them to check with the doctor or Diabetes nurse dependent on who is doing the prescribing.
 
Remind us what your HbA1c was?
If it was high at diagnosis then they will likely want you to work up to the full dose which is usually 4x500mg tablets. My HbA1c was 114 at diagnosis and I was advised to start with one for the first week and then increase it each week by another tablet up to 4 a day by the 4th week. If you get bad side effects then it would be wise to hold off increasing the dose until the side effects hopefully settle down and then increase or if they are really bad then the GP/nurse/pharmacist can usually prescribe the slow release version which is often kinder on the digestive system.

It is important to take Metformin with food to reduce the risk of digestive upset and I used to take them mid meal so that there was something on my stomach when I took them and more food on top afterwards, so sort of sandwich them. That worked pretty well for me. I suffered a bit of flatulence and some loose stools but nothing unmanageable and the odd bit of colicky pain but on the whole it wasn't a problem.
 
Goodness what a woolly prescription advice. I think your best bet is to contact your doctor for clarification.
Most people on the forum seem to be either prescribed a fixed dose which is reviewed with the next hba1c result, or put on a gradually increasing dose over a period of time.
I started on 500mg which was increased to 1000mg over a month. This helped with the digestive system side effects until I got used to the medication. I take slow release metformin and tolerate it well. Mild side effects for a few days each time the dose increased. I have been on the maximum dose for several months. One tablet with breakfast and one with evening meal.
Hope you get a definitive answer from your GP and that you don't suffer any serious side effects. If you have problems there are alternatives available.
 
I started on one a day with food. One week later two a day with food. I chose to take one with breakfast and one with lunch but if I went without breakfast I took one lunch and one supper. I havesome water and take just before I finish my meal.

First two weeks i was bunged up next two weeks i got looser then on fifth week I was reduced to two aday and a new drug added.
From the start I was given SR which are slow release and said to be kinder to the stomach.
6 months later it was reduced to one a day.
Keep a food diary plus motions plus exercise.

Good luck
 
Depending on what your HbA1C is and how committed you are to making lifestyle changes then 1 metformin may well be sufficient. However it is usual to build up the dose over a few weeks to allow the body to adjust and minimise any stomach issues.
However do check with your GP or nurse as those instructions were not adequate and could confuse.
 
rebrascora said:
Remind us what your HbA1c was?
If it was high at diagnosis then they will likely want you to work up to the full dose which is usually 4x500mg tablets. My HbA1c was 114 at diagnosis and I was advised to start with one for the first week and then increase it each week by another tablet up to 4 a day by the 4th week. If you get bad side effects then it would be wise to hold off increasing the dose until the side effects hopefully settle down and then increase or if they are really bad then the GP/nurse/pharmacist can usually prescribe the slow release version which is often kinder on the digestive system.

It is important to take Metformin with food to reduce the risk of digestive upset and I used to take them mid meal so that there was something on my stomach when I took them and more food on top afterwards, so sort of sandwich them. That worked pretty well for me. I suffered a bit of flatulence and some loose stools but nothing unmanageable and the odd bit of colicky pain but on the whole it wasn't a problem.
Click to expand...
My HbA1c was 76 mmol/mol and my fasting blood sugar was 7.2 mmol/L at diagnosis. Took my first one today with breakfast at around 11AM. I've had to urgently run to the bathroom once at around 2:30pm so far - no other side effects so far.
Leadinglights said:
Depending on what your HbA1C is and how committed you are to making lifestyle changes then 1 metformin may well be sufficient. However it is usual to build up the dose over a few weeks to allow the body to adjust and minimise any stomach issues.
However do check with your GP or nurse as those instructions were not adequate and could confuse.
Click to expand...
Understood, I'll definetely call and check - just wasn't sure if I was missing something on my end.
 
Reaux said:
My HbA1c was 76 mmol/mol and my fasting blood sugar was 7.2 mmol/L at diagnosis. Took my first one today with breakfast at around 11AM. I've had to urgently run to the bathroom once at around 2:30pm so far - no other side effects so far.

Understood, I'll definetely call and check - just wasn't sure if I was missing something on my end.
Click to expand...
You may be OK with just the one if you are making some substantial dietary changes but If they say to increase then it is better to wait until any stomach problems settle when on just the one before increasing but if you still have a dodgy stomach after a couple of weeks then there is a slow release version of metformin which is supposed to be gentler on the stomach.
 
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