Metsol (metformin)

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How does it work?

Metsol oral solution contains the active ingredient metformin hydrochloride. (NB. Metformin tablets are also available without a brand name, ie as the generic medicine.) Metformin is used to help control blood sugar levels in people with type 2 or non-insulin dependent diabetes (NIDDM).

People with diabetes have a deficiency or absence of a hormone produced by the pancreas called insulin. Insulin is the main hormone responsible for the control of sugar in the blood. In type 2 diabetes the pancreas does not produce sufficient insulin and the cells of the body are resistant to the low levels of insulin circulating in the blood. Insulin would normally make the cells remove sugar from the blood, hence in type 2 diabetes blood sugar levels can rise too high.

Metformin hydrochloride is a type of antidiabetic medicine known as a biguanide. It works in a number of ways to decrease the amount of sugar in the blood of people with type 2 diabetes.

Firstly, it reduces the amount of sugar produced by cells in the liver. Secondly, it increases the sensitivity of muscle cells to insulin. This enables the cells to remove sugar from the blood more effectively. Finally, it also delays absorption of sugar from the intestines into the bloodstream after eating. Overall, metformin reduces blood sugar levels both between and directly after meals.

Metformin is used as a first line treatment of type 2 diabetes in people who are overweight. It is used when diet and exercise have failed to control blood sugar levels. It can also be used in combination with other antidiabetic medicines to provide better control of blood sugar.

What is it used for?

- Type 2 (non-insulin dependent) diabetes, when diet alone has failed to fully control blood sugar.
- Polycystic ovary syndrome (unlicensed use).

Warning!

- Your doctor may want you to check your blood sugar level from time to time while you are taking this medicine. Make sure you discuss how to do this and how often with your GP, pharmacist or diabetes specialist.
- When used on its own, metformin does not cause low blood sugar levels. However, you may get low blood sugar if you take metformin in combination with other antidiabetic medicines. If this applies to you, you should make sure that you are aware of the symptoms of hypoglycaemia (these may include cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness or weakness, confusion, difficulty in concentration, excessive hunger, temporary vision changes, headache or nausea) and what to do if you experience these symptoms. Discuss this with your GP, pharmacist or diabetes specialist.
- Metformin can cause a rare but serious condition called lactic acidosis, which is an excess of lactic acid in the blood. It is more likely to occur in people with decreased kidney function.

Drinking excessive amounts of alcohol, particularly on an empty stomach or if you have liver problems, can also increase the risk of lactic acidosis. Your doctor will monitor you for this side effect, but symptoms that might indicate it's development include rapid and/or deep breathing and non-specific symptoms such as feeling weak, sick or generally unwell, vomiting, abdominal pain, or unusual muscle pains or discomfort. You should stop taking this medicine and consult your doctor if you experience any of these.
- Your kidney function should be monitored regularly while you are taking this medicine. Your doctor will usually want to check your kidney function once or twice a year, or more frequently if you are elderly or have any existing kidney problems.
- Your doctor will ask you to stop taking this medicine temporarily if you are going to have a certain type of X-ray involving an injection of iodinated dye (contrast agent). Tell your doctor that you are taking metformin if you are due to have this type of X-ray. You should not start taking this medicine again until 48 hours after the X-ray, and only after your kidney function has been tested and found to be normal.
- Consult your doctor about your diabetes treatment if you are due to have surgery under a general anaesthetic. In these situations blood sugar is normally controlled by insulin, so your doctor may ask you to stop taking this medicine 48 hours before surgery.

Not to be used in

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- Diabetic keto-acidosis.
- Diabetic pre-coma (due to ketoacidosis in severe and inadequately treated diabetes).
- Decreased kidney function.
- Kidney failure.
- Decreased liver function.
- Dehydration.
- Severe infections or trauma.
- Reduced blood flow to vital internal organs (shock).
- People who have stopped breathing (respiratory failure).
- Heart failure.
- People who have recently had a heart attack.
- Alcohol intoxication.
- Alcoholism.
- Pregnancy.
- Breastfeeding.
- Children under ten years of age.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- This medicine should not be used during pregnancy. Control of diabetes mellitus in pregnancy is usually achieved using insulin, because this provides a more stable control of blood sugar.

If you get pregnant while taking this medicine, or are planning a pregnancy, you should seek medical advice from your doctor.
- This medicine passes into breast milk. As it could have side effects on a nursing infant, mothers who need to take this medicine should not breastfeed. It is important to seek medical advice from your doctor.

Label warnings

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- Take this medication with or after food.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Disturbances of the gut such as nausea, vomiting, diarrhoea or abdominal pain.
- Loss of appetite.
- Metallic taste.
- Elevated levels of lactic acid in the blood (lactic acidosis).
- Decreased absorption of vitamin B12 during long-term use.
- Skin reactions such as rash, itching or flushing.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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