Acronyms
- ER - Extended-release
- IR - Immediate-release
- Met - Metformin
- P - Drugs with pediatric dosing
Metformin IR
Glucophage®, Riomet®
Glucophage®, Riomet®
Dosage forms
Glucophage® tablet
- 500 mg
- 850 mg
- 1000 mg
Riomet® solution
- 500 mg/5 ml
- Comes in 120 ml and 480 ml bottle
- Comes in cherry and strawberry flavor
Dosing
Type 2 diabetes (adults)
- Starting: 500 mg twice a day or 850 mg once daily
- Maintenance: 850 - 2550 mg/day
- Max: 2550 mg/day
- Doses above 850 mg/day should be given in 2 - 3 divided doses
- Increase dose by 500 mg a week or 850 mg every two weeks
- Take with meals
Type 2 diabetes (children ≥ 10 years old)
- Starting: 500 mg twice a day
- Max: 2000 mg/day
- Increase daily dose by 500 mg at weekly intervals
- Take with meals
Generic / Price
- Glucophage - YES/$
- Riomet - YES/$$ (300 ml)
Other
- Gradually increase dose to minimize gastrointestinal side effects
- Store Riomet at room temperature
- When switching between metformin IR and ER formulations, the daily dose remains the same as long as it does not exceed the product's maximum recommended daily amount
Metformin ER
Glucophage XR®
Glucophage XR®
Dosage forms
Tablet, extended-release
- 500 mg
- 750 mg
Dosing
Type 2 diabetes
- Starting: 500 mg once daily with evening meal
- Maintenance: 500 - 2000 mg/day
- Max: 2000 mg/day
- May be given in 1 - 2 divided doses
- Increase dose in increments of 500 mg at 1 week intervals
- Take with meals
Generic / Price
- YES/$
Other
- Do not crush, cut, or chew tablet
- Tablet shell may be seen in stool. This is normal.
- When switching between metformin IR and ER formulations, the daily dose remains the same as long as it does not exceed the product's maximum recommended daily amount
Metformin ER
Fortamet®
Fortamet®
Dosage forms
Tablet, extended-release
- 500 mg
- 1000 mg
Dosing
Type 2 diabetes
- Starting: 1000 mg once daily with evening meal
- Maintenance: 1000 - 2500 mg once daily
- Max: 2500 mg once daily
- Increase dose in increments of 500 mg at 1 week intervals
- Take with evening meal. Take with full glass of water.
Generic / Price
- YES/$-$$
Other
- Do not crush, cut, or chew tablet
- Tablet shell may be seen in stool. This is normal.
- For patients on insulin therapy, a starting dose of 500 mg is recommended
- When switching between metformin IR and ER formulations, the daily dose remains the same as long as it does not exceed the product's maximum recommended daily amount
Metformin ER
Glumetza®
Glumetza®
Dosage forms
Tablet, extended release
- 500 mg
- 1000 mg
Dosing
Type 2 diabetes
- Starting: 500 mg once daily with evening meal
- Maintenance: 500 - 2000 mg once daily
- Max: 2000 mg once daily
- Increase dose in increments of 500 mg at 1 - 2 week intervals
- Take with evening meal
Generic / Price
- YES/$$
Other
- Do not crush, cut, or chew tablet
- Tablet shell may be seen in stool. This is normal.
- When switching between metformin IR and ER formulations, the daily dose remains the same as long as it does not exceed the product's maximum recommended daily amount
Janumet®
Sitagliptin + metformin
Sitagliptin + metformin
Dosage forms
Tablet
- Sitagliptin - Metformin
- 50 mg - 500 mg
- 50 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 50/500 mg twice daily with meals
- Max: 50/1000 mg twice daily with meals
- Take with meals
Generic / Price
- NO/$$$$
Other
- Do not break or cut Janumet
Janumet® XR
Sitagliptin + metformin ER
Sitagliptin + metformin ER
Dosage forms
Tablet, extended-release
- Sitagliptin - Metformin ER
- 50 mg - 500 mg
- 50 mg - 1000 mg
- 100 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 100/1000 mg once daily with evening meal
- Max: 100/2000 mg once daily
- Take with evening meal
Generic / Price
- NO/$$$$
Other
- Do not split, crush, or chew tablets
- There have been reports of incompletely dissolved Janumet XR tablets seen in the feces. It is not known whether this material seen in feces contains active drug. If tablet is repeatedly seen in feces, assess adequacy of glycemic control.
Jentadueto®
Linagliptin + metformin
Linagliptin + metformin
Dosage forms
Tablet
- Linagliptin - Metformin
- 2.5 mg - 500 mg
- 2.5 mg - 850 mg
- 2.5 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 2.5/500 mg twice daily
- Max: 2.5/1000 mg twice daily
- Take with meals
Generic / Price
- NO/$$$$
Jentadueto® XR
Linagliptin + metformin ER
Linagliptin + metformin ER
Dosage forms
Tablet, extended-release
- Linagliptin - Metformin ER
- 2.5 mg - 1000 mg
- 5 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 5/1000 mg once daily with a meal
- Max: 5/2000 mg once daily
- Take with a meal
Generic / Price
- NO/$$$$
Other
- Do not split, chew, crush, or dissolve tablet
- Incompletely dissolved tablets have been reported with other metformin ER products. If a tablet is seen in the feces, assess adequacy of glycemic control.
Kazano®
Alogliptin + metformin
Alogliptin + metformin
Dosage forms
Tablet
- Alogliptin - Metformin
- 12.5 mg - 500 mg
- 12.5 mg - 1000 mg
Dosing
Type 2 diabetes
- Dosing: 12.5/500 - 12.5/1000 mg twice daily
- Max: 12.5/1000 mg twice daily
- Take with food
Generic / Price
- NO/$$$$
Other
- Do not split tablets
Kombiglyze™ XR
Saxagliptin + metformin ER
Saxagliptin + metformin ER
Dosage forms
Tablet, extended-release
- Saxagliptin - Metformin ER
- 5 mg - 500 mg
- 5 mg - 1000 mg
- 2.5 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 5/500 mg once daily with evening meal
- Max: saxagliptin 5 mg/day; metformin 2000 mg/day
- Take with evening meal
Generic / Price
- NO/$$$$
Other
- Do not crush, cut, or chew tablets
- Occasionally, the inactive ingredients of Kombiglyze XR will be eliminated in the feces as a soft, hydrated mass that may resemble the original tablet
Zituvimet®
Sitagliptin + metformin
Sitagliptin + metformin
Dosage forms
Tablet
- Sitagliptin - Metformin
- 50 mg - 500 mg
- 50 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 50/500 mg twice daily with meals
- Max: 50/1000 mg twice daily with meals
- Do not split or divide tablets
- For patients taking metformin 850 mg twice daily, the recommended starting dose of Zituvimet is 50/1000 mg twice daily
Generic / Price
- NO/$$$$
Zituvimet® XR
Sitagliptin + metformin ER
Sitagliptin + metformin ER
Dosage forms
Tablet, extended-release
- Sitagliptin - Metformin ER
- 50 mg - 500 mg
- 50 mg - 1000 mg
- 100 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 100/1000 mg once daily with a meal
- Max: 100/2000 mg once daily with a meal
- Patients taking two Zituvimet XR tablets should take the two tablets together once daily
- For patients taking metformin 850 mg or 1000 mg twice daily, the recommended starting dose of Zituvimet XR is two 50/1000 mg tablets taken together once daily
- Do not split, crush, or chew tablets
- Incompletely dissolved Zituvimet XR tablets may be eliminated in the feces. If tablets are repeatedly seen, patients should report this finding to their provider, and glycemic control should be assessed.
Generic / Price
- NO/$$$$
Actoplus met®
Pioglitazone + metformin
Pioglitazone + metformin
Dosage forms
Tablet
- Pioglitazone - Metformin
- 15 mg - 500 mg
- 15 mg - 850 mg
Dosing
Type 2 diabetes
- Starting: 15/500 mg twice daily or 15/850 mg once daily
- Max: pioglitazone 45 mg/day | metformin 2550 mg/day
- Titrate to effect
- May be given in one or two divided doses
- Take with food to decrease GI upset
Generic / Price
- YES/$$
Actoplus met XR®
Pioglitazone + metformin ER
Pioglitazone + metformin ER
Dosage forms
Tablet, extended-release
- Pioglitazone - Metformin ER
- 15 mg - 1000 mg
- 30 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 15/1000 - 30/1000 mg once daily
- Max: pioglitazone 45 mg/day | metformin ER 2000 mg/day
- Titrate to effect
- May be given in one or two divided doses
- Take with food to decrease GI upset
Generic / Price
- NO/$$$$
Other
- Swallow whole. Do not crush, cut, or chew tablet.
- Inactive ingredients may occasionally be eliminated in the feces as a soft mass that may resemble the original tablet
Avandamet®
Rosiglitazone + metformin
Rosiglitazone + metformin
Dosage forms
Tablet
- Rosiglitazone - Metformin
- 2 mg - 500 mg
- 2 mg - 1000 mg
- 4 mg - 500 mg
- 4 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 2/500 mg twice daily
- Max: rosiglitazone 8 mg/day | metformin 2000 mg/day
- Titrate to effect
- Take with food to decrease GI upset
Generic / Price
- NO/$$$$
Glucovance®
Glyburide + metformin
Glyburide + metformin
Dosage forms
Tablet
- Glyburide - Metformin
- 1.25 mg - 250 mg
- 2.5 mg - 500 mg
- 5 mg - 500 mg
Dosing
Type 2 diabetes
- Starting: 1.25/250 mg once or twice daily with meals
- Max: glyburide 20 mg/day; metformin 2000 mg/day
- Increase dose in increments of 1.25/250 mg/day at intervals of 2 weeks
- Take with meals
Generic / Price
- YES/$
Metaglip®
Glipizide + metformin
Glipizide + metformin
Dosage forms
Tablet
- Glipizide - Metformin
- 2.5 mg - 250 mg
- 2.5 mg - 500 mg
- 5 mg - 500 mg
Dosing
Type 2 diabetes
- Starting: 2.5/250 - 2.5/500 mg once or twice daily with meals
- Max: glipizide 20 mg/day; metformin 2000 mg/day
- Increase dose in increments of 2.5/250 mg/day at intervals of 2 weeks
- Take with meals
Generic / Price
- YES/$
Invokamet®
Canagliflozin + metformin
Canagliflozin + metformin
Dosage forms
Tablet
- Canagliflozin - Metformin
- 50 mg - 500 mg
- 50 mg - 1000 mg
- 150 mg - 500 mg
- 150 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 50/500 mg twice daily
- Maintenance: 50/500 - 150/1000 mg twice daily
- Max: 150/1000 mg twice daily
- Take with food
Generic / Price
- NO/$$$$
Invokamet® XR
Canagliflozin + metformin ER
Canagliflozin + metformin ER
Dosage forms
Tablet, extended-release
- Canagliflozin - Metformin ER
- 50 mg - 500 mg
- 50 mg - 1000 mg
- 150 mg - 500 mg
- 150 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 50/500 mg once daily
- Maintenance: 50/500 - 300/2000 mg once daily
- Max: 300/2000 mg once daily
- Take with morning meal
Generic / Price
- NO/$$$$
Other
- Swallow tablets whole. Do not crush, cut, or chew.
Segluromet®
Ertugliflozin + metformin
Ertugliflozin + metformin
Dosage forms
Tablet
- Ertugliflozin - Metformin
- 2.5 mg - 500 mg
- 2.5 mg - 1000 mg
- 7.5 mg - 500 mg
- 7.5 mg - 1000 mg
Dosing
Type 2 diabetes
- Dosing: 2.5/500 mg - 7.5/1000 mg twice a day
- Max: 7.5/1000 mg twice a day
- Individualize starting dose based on patient's current regimen
- Take with meals
Generic / Price
- NO/$$$$
Synjardy®
Empagliflozin + metformin
Empagliflozin + metformin
Dosage forms
Tablet
- Empagliflozin - Metformin
- 5 mg - 500 mg
- 5 mg - 1000 mg
- 12.5 mg - 500 mg
- 12.5 mg - 1000 mg
Dosing
Type 2 diabetes (adults and children ≥ 10 years old)
- Starting: 5/500 mg twice daily
- Maintenance: 5/500 - 12.5/1000 mg twice daily
- Max: 12.5/1000 mg twice daily
- Take with meals
Generic / Price
- NO/$$$$
Synjardy® XR
Empagliflozin + metformin ER
Empagliflozin + metformin ER
Dosage forms
Tablet, extended-release
- Empagliflozin - Metformin ER
- 5 mg - 1000 mg
- 10 mg - 1000 mg
- 12.5 mg - 1000 mg
- 25 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 5/1000 mg once daily
- Maintenance: 5/1000 - 25/2000 mg once daily
- Max: 25/2000 mg once daily
- Take with morning meal
Generic / Price
- NO/$$$$
Other
- Swallow tablets whole. Do not crush, cut, or chew.
Xigduo™ XR
Dapagliflozin + metformin ER
Dapagliflozin + metformin ER
Dosage forms
Tablet, extended-release
- Dapagliflozin - Metformin ER
- 5 mg - 500 mg
- 5 mg - 1000 mg
- 10 mg - 500 mg
- 10 mg - 1000 mg
Dosing
Type 2 diabetes (adults and children ≥ 10 years old)
- Starting: 5/500 mg once daily
- Maintenance: 5/500 - 10/2000 mg once daily
- Max: 10/2000 mg once daily
- Take with food in the morning
- Swallow tablets whole. Do not crush, cut, or chew.
- Inactive ingredients may be eliminated in the feces as a soft, hydrated mass that may resemble the original tablet
Generic / Price
- NO/$$$$
Trijardy® XR
Empagliflozin + linagliptin + metformin ER
Empagliflozin + linagliptin + metformin ER
Dosage forms
Tablet, extended-release
- Empagliflozin - Linagliptin - Metformin ER
- 5 mg - 2.5 mg - 1000 mg
- 10 mg - 5 mg - 1000 mg
- 12.5 mg - 2.5 mg - 1000 mg
- 25 mg - 5 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting:
- For patients switching from metformin with or without linagliptin, use a dosage that gives a similar total daily dose of metformin and a total daily dose of empagliflozin 10 mg and linagliptin 5 mg
- For patients switching from metformin and any regimen containing empagliflozin with or without linagliptin, use a dosage that gives a similar total daily dose of metformin, the same total daily dose of empagliflozin, and linagliptin 5 mg
- Max: Empagliflozin 25 mg/day | Linagliptin 5 mg/day | Metformin ER 2000 mg/day
- Take once daily with a meal in the morning
Generic / Price
- NO/$$$$
Other
- Swallow tablets whole. Do not crush, cut, dissolve, or chew.
- Incompletely dissolved tablets may be seen in the feces. Patients should report this finding to their healthcare provider, and the provider should assess their glycemic control.
- Kidney disease
- Kidney disease increases the risk of lactic acidosis, and the original metformin prescribing information contained strict precautions for use in renal impairment. However, years of widespread use showed that it was safe in mild-to-moderate disease, causing the FDA to revise its guidance, as described below, in 2016.
- FDA recommendations for prescribing metformin in kidney disease
- Obtain an eGFR before prescribing metformin and at least annually thereafter. Check more frequently in patients at risk for kidney disease (e.g., elderly).
- Metformin is contraindicated in patients with an eGFR < 30 ml/min
- Starting metformin in patients with an eGFR of 30 - 45 ml/min is not recommended
- If eGFR falls to 30 - 45 ml/min in a patient taking metformin, assess the risk/benefit of continuing it
- Liver disease dosing
- Significant liver disease is a risk factor for lactic acidosis, and metformin should be used with caution in these patients
PRICE ($) INFO
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $151
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
BIBLIOGRAPHY
- Manufacturer's package insert
- 2 - PMID 21617112
- 3 - PMID 12651978
- 4 - PMID 11045142