Extended‑Release Metformin Initiation and Management

Dosing and Titration

• Initiate extended‑release metformin at 500 mg once daily with the evening meal and increase by 500 mg each week as tolerated, aiming for a total daily dose of 1,000–2,000 mg based on glycemic response and gastrointestinal tolerability. 1

Administration with Food

• Taking the extended‑release tablet with or after food markedly improves gastrointestinal tolerability, reducing the incidence of nausea, abdominal discomfort, and diarrhea. 3

Vitamin B12 Monitoring

• Periodically assess vitamin B12 status—especially after several years of therapy or when anemia or peripheral neuropathy develops—to detect metformin‑associated B12 deficiency. 1

Combination Therapy

• Metformin should be continued when additional glucose‑lowering agents (including insulin) are added, provided the patient tolerates it and no contraindications exist. 1, 6