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DM2 Biguanides-Metformin (Glucophage) Cheat Sheet by

treatment of type 2 diabetes mellitus

Medication Names


Therap­eutic Use

Type 2 diabetes mellitus

Adverse Drug Reactions

Lactic acidosis (rare, but potent­ially fatal)
Nausea, diarrhea, vomiting
Unpleasant metallic taste
Vitamin defici­encies (vitamin B12, folic acid)


Monitor for indica­tions of lactic acidosis.
For signs of lactic acidosis, stop drug therapy immedi­ately.
Expect that severe lactic acidosis will require hemodi­alysis.
Monitor for persistent nausea, vomiting, or diarrhea
Monitor fluid intake and output.
Monitor for indica­tions of vitamin B12 or folic acid defici­ency.
Recommend the approp­riate supple­ments.
Monitor renal function upon initial therapy and yearly afterward


Diarrhea, Dehydr­ation
Pituitary insuff­iciency
Gastro­int­estinal obstru­ction.
Older adults

Drug Admini­str­ation

Give orally twice a day with the morning and evening meals (immedi- ate-re­lease) or once a day with the evening meal (exten­ded­-re­lease)
Make sure clients swallow the extend­ed-­release form whole and do not crush or chew it.

Patient Education

Avoid drinking alcohol.
Report weakness, fatigue, lethargy, or hyperv­ent­ila­tion.
If these symptoms develop, stop taking the drug and seek medical care immedi­ately
Expect these effects to diminish as drug therapy continues
Lie down when feeling nauseated
Maintain adequate carboh­ydrate and fluid intak
Report weakness, fatigue, pallor, or reddened tongue.


Diabetic ketoac­idosis
Cardio­pul­monary, hepatic, or renal insuff­iciency
Heart failure
Severe infection
Acute myocardial infarction
Lactic acidosis


Alcohol and cimetidine (Tagamet) increase the risk of lactic acidosis.
Any contrast medium containing iodine increases the risk of acute renal failure, thus worsening lactic acidosis
Nifedipine (Proca­rdia), furosemide (Lasix), morphine, antifu­ngals, and many other drugs increase hypogl­ycemic effects.


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