Is 500 mg of Metformin a high dose?

Ah, a question from one of my favorite readers:

Question: I have been taking Metformin 500mg a day… Is this a high dose? It seems like it is high.

Answer: Dear Reader, thank you for your question! This allows me not only to answer your specific question, but also talk about medication doses in general.{{more}}

First, the dose you are taking is actually the LOWEST dose of Metformin on the market, and it is commonly used as the starting dose just to get people used to the medication before increasing it-most people with diabetes need much more than 500mg of Metformin. We sometimes make a joke in clinic that 500mg of Metformin is like sprinkling a little bit of the drug on some food for taste. The usual dose of Metformin for people with diabetes is between 1000mg to 2000mg per day in total, usually divided up throughout the day. So even though the 500mg looks big, don’t let that number scare you because it s actually a very small dose in this case.

The second point to remember is that medication dosages are quite different, even between medications that sound similar. The strengths and formulations between one medication and another can be like night and day, so 1mg in one pill may be a very little dose while 1mg in anther pill may be a high dose. Same goes for big numbers. I have had patients come to my clinic from another doctor and tell me they refuse to take a medication their doctor gave them: “Did you see how big a dose he/she started me on? He trying to kill me with this medication!” Then only to find out that their doctor actually started them on a small dose.

The third point is sometimes tough to accept and some of this is my own opinion, so you may take it or leave it. The way I see it, the actual number of the dose is not the issue. The important point is whether or not the medication is helping you at the current dose, and if it is doing any harm. For me, these issues decide whether or not the dose is right, not the actual number as long as I stay within recommended guidelines. The question should be: is this dose of Metformin controlling my sugars? And if not, what is the next step: more Metformin or another medication? Because the truth is that some of us need little medication and some need a lot, all for the same goal of keeping us healthy. So try to get past the numbers and focus on the ultimate goal of getting healthy by getting those sugars down. This perspective will help when you feel like you are taking a wheelbarrow of medication.

The final lesson is that you should ask your doctor about the dosing when a medication is prescribed for you, especially if the number itself seems especially high or low. What is the harm in asking, right? You have been sitting in the clinic for goodness-knows-how-long anyway, what is another two minutes? (And yes, I will keep encouraging you to ask questions-this is how you take charge of your own health).

Until next week, stay healthy Vincies!

Anita Ramsetty, MD
endodocs@endocrinehelp.com
Medical Director Endocrine Care Group
www.endocrinehelp.com
Tel: 843-798-4227