Metformin is a widely prescribed antihyperglycemic agent designed to improve glucose tolerance in patients with type 2 diabetes. In fact, it was the second-most commonly prescribed drug in the U.S. in 2021.
Barbara Madej, RPh.
Metformin effectively controls blood sugar by lowering both basal and postprandial plasma glucose. In other words, unlike other oral antihyperglycemic agents, metformin works by decreasing hepatic glucose production, reducing intestinal absorption of glucose, and enhancing insulin sensitivity thereby increasing peripheral glucose uptake and utilization.
Why metformin?
Metformin stands out because it does not typically cause hypoglycemia or hyperinsulinemia, which are common concerns with other diabetes medications, such as sulfonylureas (e.g., Glimepiride, Glipizide). This makes metformin a safer option for many patients. During metformin therapy, insulin secretion remains stable and fasting insulin levels, as well as daylong plasma insulin response, may decrease.
Metformin is typically part of a broader diabetic management strategy that includes diet, exercise, weight control, blood sugar testing, and often multiple other diabetic medications. While metformin is effective, it should be used in conjunction with these other interventions for optimal results.
Side effects
Common side effects of metformin include diarrhea, nausea, vomiting, flatulence, and a metallic taste in the mouth. To minimize these effects, metformin is usually started at a low dose taken with food.
Special considerations in dentistry
Dr. Lisa Chan.
- Metallic taste: Metformin can cause a metallic taste, which may affect a patient's perception of oral health and treatment.
- Glossitis risk: Metformin can also cause vitamin B12 deficiency, which may lead to glossitis (inflammation of the tongue).
- Drug interactions that reduce metformin efficacy: Quinolone antibiotics (e.g., ciprofloxacin, levofloxacin) and steroids can reduce metformin's efficacy. Always check for potential interactions using tools like the Digital Drug Handbook before prescribing medications.
- Epinephrine risk: Epinephrine in combination with metformin may elevate the risk of hyperglycemia.
- Lactic acidosis risk: One significant risk associated with metformin is lactic acidosis, a rare but serious complication that can be fatal. Symptoms include unusual muscle pain, feeling cold, trouble breathing, dizziness, fatigue, stomach pain, vomiting, and irregular heart rate. Ensure a thorough patient history and medication review. Avoid prescribing the following medications to avoid an increased risk of lactic acidosis:
- Antibiotics: cephalexin (Keflex), trimethoprim
- Antifungal: ketoconazole
- Surgical considerations: Withholding food and fluids during surgical procedures can increase the risk of volume depletion, hypotension, and renal impairment. Coordinate with the patient's physician to manage metformin use around surgery.
- Hypoglycemia: Always keep an emergency source of sugar in the office, such as fruit juice, honey, raisins, grapes, glucose tablets, hard candy, regular (nondiet) soda, or a glucagon pen.
Leveraging cutting-edge technology to navigate medication risks
Metformin is a vital medication for managing type 2 diabetes, but it requires careful consideration of potential side effects and interactions. As dentists, being informed about these factors is crucial to providing the best patient care and ensuring safer, more effective treatments. The MedAssent DDS Digital Drug Handbook is an invaluable tool for dentists, as it dissects what your patients are taking into dentistry-specific bullet points, enhancing your standard of care without cutting into productivity. Check out the site to learn more about ending smile denial.
Barbara Madej, RPh, is a licensed pharmacist who has dedicated her life to serving her home country of Canada, as well as her new home of Los Angeles, after receiving her degree in pharmacy from the University of Saskatchewan. Madej co-founded MedAssent Rx in 2015, drawing from her decades of experience in pharmacy and putting her passion to action.
Teresa Mendoza, PharmD, received her degree in biochemistry and a minor in Chicano/a studies from the University of California, Los Angeles (UCLA). She earned her Doctor of Pharmacy degree from the University of California, San Francisco School of Pharmacy. Mendoza has held many executive positions involving service to the community and higher education advocacy. She is a contributor to MedAssent DDS as a medical/pharmaceutical communications specialist, where she leads the blog, white paper, and continuing education content.
Aubrey Glassberg is a project manager at MedAssent DDS and plays a pivotal role in content creation and editorial review for the company. She received a bachelor's degree in world arts and culture from the University of California, Los Angeles. In addition to her editorial duties, Glassberg oversees various projects within the company, including medication database project management.
Dr. Lisa Chan has devoted her career to promoting equity in care in both dentistry and her community. She brings over 35 years of diverse experience in dentistry to her role. Chan received her Doctor of Dental Surgery degree from the University of Southern California Herman Ostrow School of Dentistry. Her background includes significant positions such as a hospital dentist at Kaiser Permanente, a private practice dentist in Los Angeles, and a consultant for the California State Dental Board. Chan co-founded MedAssent DDS with the mission of elevating patient safety through integrated care.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
