Metformin in Pregnancy
Up to Antenatal Corticosteroids to Reduce Neonatal Morbidity (RCOG Green-top 7) - Sonia Clark
Chris Bond DSM, East Lancashire Hospitals.I would be grateful if anyone can let me know if they have any written guidelines for the use of metformin in pregnancy ie criteria for commencing,doses used etc. Thanks
I work with two diabetologists, one will start as low as 500mg OD but will increase to 2.5g daily if necessary. The other will always start at 500mg TDS and won't go any higher - just goes straight to insulin if the metformin isn't working. They both will start metformin if any BMs are above 7-8 two or three times in a row ie at breakfast 2 or 3 times in a week.
The diabetologist I work with usually starts with 500mg OD progressing to a maximum of 2g. Usually start with evening meal but this is flexible. Will add in insulin if blood glucose still raised or if woman cannot tolerate an increase at any point.
Both teams of doctors I work with (on two hospital sites) go up to 1g 2 x daily, starting on 500mg 2 x daily for the first 3 days. We have developed an information sheet for the woman which is attached if it helps.
we do not have a guidance for the use of Metformin in pregnancy. We usually start at 500mg BD but have been known to start on OD. we do not usually exceed 1.5g.
It is used as a first line except if :the gestation is above 36 weeks.
saying all that it depends on the individual bllod glucose levels and as we have clinics 4 sites the individual consultants
hi Ladies,
We start with 500g for those meals where the BMs are abouve target and increase to a maximum of 1g TDS athough it is dependant on how the metformin is tolloerated and Gestation, and what the consultant feels is appropriate at the time. we do phase the tablets in over a few days though.
Juliet
Hi
For women who do not achieve targets on diet we start Metformin MR 500mgs with evening meal and increase every 4 days if tolerated until on 2G daily. I did have one lady last week who had to stop it as she had regular contractions for 8 hours, diarrhoea and nausea at 33 weeks. We are just in process of doing a leaflet but there is a good one on the perinatal institutes website
Jane
hi
At Ipswich we do use metformin with our gestationals but not routinely as first line treatment. we assess individual blood glucose readings, womans bmi, and her thoughts on the use of an unleicenced drug. we know metformin is more effective if blood glucose levels are below 10mmol,therefore if i had a patient whos readings were all above 10, then insulin would be my first treatment. we might add in metformin later on if insulin levels were getting high.
we too have an information leaflet for patients and we start them on 500mgs once a day for 3 days, then increase to twice a day then out max dose would be 500mgs tds.
