Table 2—

Titration of metformin

1)Begin with low-dose metformin (500 mg) taken once or twice per day with meals (breakfast and/or dinner).
2)After 5–7 days, if GI side effects have not occurred, advance dose to 850 or 1,000 mg before breakfast and dinner.
3)If GI side effects appear as doses advanced, can decrease to previous lower dose and try to advance dose at a later time.
4)The maximum effective dose is usually 850 mg twice per day, with modestly greater effectiveness with doses up to 3 g per day. GI side effects may limit the dose that can be used.
5)Based on cost considerations, generic metformin is the first choice of therapy. A longer-acting formulation is available in some countries and can be given once per day.
  • GI, gastrointestinal.