Pharmacist Steve

[Karen from Indiana]

Could I pick your brain for a moment? I have a question about my metformin. I was on 2 500 mg pills with breakfast and supper but told Dr I usually didnt take it with supper so she decided to have me take it all at breakfast. Well, that is 4 large pills in addition to the other 5 I have to take in the a.m. so I asked her could we switch it to 1000 mg pills. She ok'd that and told me to titrate the dose up. OK, no problem..but...its killing my stomach (at least thats what I think is doing it) I skip a day taking it and no stomach problems. Take it again and wham...my question is why would I react to taking the 1000 mg pills this way when taking the same dose in the 500 mgs didnt cause a problem? Is there a difference?

[BrokenBladder]

Bumping this for Steve!!

[Pharmacist.steve]

Could I pick your brain for a moment? I have a question about my metformin. I was on 2 500 mg pills with breakfast and supper but told Dr I usually didnt take it with supper so she decided to have me take it all at breakfast. Well, that is 4 large pills in addition to the other 5 I have to take in the a.m. so I asked her could we switch it to 1000 mg pills. She ok'd that and told me to titrate the dose up. OK, no problem..but...its killing my stomach (at least thats what I think is doing it) I skip a day taking it and no stomach problems. Take it again and wham...my question is why would I react to taking the 1000 mg pills this way when taking the same dose in the 500 mgs didnt cause a problem? Is there a difference?

It may have something to do with tablet not breaking apart fast enough and contact with the stomach lining. As a guess... break the 1000mg tablets in half or quarters before taking them.. see if it makes a difference in your stomach problems.

[mrsdoubtfyre]

Some people just cannot handle high dose metformin.

You could try extended relief products-- ER generic or Fortamet.
http://www.fortamet.com/ The Fortamet 1000mg is a huge tablet though and many cannot swallow it.

But it has been my experience that the metformin once it begins to cause
GI cramping and diarrhea, is for good.

I took metformin for about a year for insulin resistance--not diabetes.
I could not tolerate immediate release forms. Extended release helped, but over time the GI issues came back.

I believe it causes acidosis, and also watch for dizziness. I had a terrible time with metformin after about a year and had to go off of it.

Long term use of metformin also depletes B12 levels...so you should have that checked, periodically. Anything lower than 400 should be supplemented.