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Dosing & administration
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
Renal impairment
Consult protocols for adjustment.
Liver impairment
Consult protocols for adjustment.
Use during pregnancy
1st trimester
Generally safe. Often continued in patients with PCOS or pre-existing T2DM through the first trimester.
2nd trimester
Safe. Effective for blood glucose control; may reduce insulin requirements.
3rd trimester
Safe. No increased risk of neonatal hypoglycemia compared to insulin alone.
Clinical note
Widely used for gestational diabetes mellitus (GDM) and type 2 diabetes in pregnancy. Crosses the placenta, with fetal concentrations approximating maternal concentrations. Despite this, no teratogenicity has been demonstrated in large human studies. Long-term follow-up data (MiG TOFU trial) showed increased childhood adiposity in metformin-exposed offspring; clinical significance is uncertain. Many clinicians use it as adjunct or alternative to insulin for GDM.
Breastfeeding
Safe. Compatible with breastfeeding. Infant exposure through milk is low.
