Metformin vs metformin ER
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stacicali
Posts: 137 Member
Can anyone give me insight as to the difference -is one version more powerful than the other? I have been on regular metformin 1000 mg twice a day for almost 20 years, and recently (possibly foolishly) allowed my pharmacist to talk me into the ER version. He swore it was the exact same efficacy, just smoother. My concern is that when I googled this question, there seems to be a different maximum dose for each type, so does that mean one is more powerful? I'm pregnant and got a half-hearted, not-really-paying-attention nod of approval from my OB for the switch, but I'm still a little concerned.
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I would go and see your doctor. I know some pharmacy change there medical for cheaper ones, is down to how cheap they can get it to save themselves money.1
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I was prescribed the same dosage when switched from regular to ER, after admitting I couldn't keep up with increasing my dosage because it was becoming intolerable on stomach and hard to remember three pills a day. The message from my doctor was that I'd a) be more likely to take the full dosage everyday (due to being able to take all at once and b) because it would be much easier on the digestive track. Both were very true for me. My dosage was 500x3 meals on regular and now 750x2 at dinnertime with ER. He said the total dosage is what was important not the type. Not sure if that helps but it's one more doctors opinion!
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As a veteran of metformin wars and a fan of Dr. Bernstein, my BG and digestive woes have both improved
since dumping carbs and switching to brand Glocophage XR.
After a fair amount of experimenting, I'm on 2500mg - 1000mg before bed to combat Dawn Phenomenon, 1000mg when I wake up, and 500mg in the early afternoon. Taking with food no longer seems to be necessary.
http://community.myfitnesspal.com/en/discussion/10394798/t2d-glucophage-name-brand-metformin-generic
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Thank you, everyone! I did a little experiment for 24 hours with the extended version, and I have to say the results were impressive, especially with fasting morning glucose. The only problem is that I've discovered a lot of extended release pills contain phthalates (the chemicals currently being removed from children's toys because of endocrine disruption), so I will be switching to brand name Glucophage XR immediately and fight my insurance for re-imbursement later.2
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Thank you, everyone! I did a little experiment for 24 hours with the extended version, and I have to say the results were impressive, especially with fasting morning glucose. The only problem is that I've discovered a lot of extended release pills contain phthalates (the chemicals currently being removed from children's toys because of endocrine disruption), so I will be switching to brand name Glucophage XR immediately and fight my insurance for re-imbursement later.
Good catch! How did you figure this out?1 -
I'm looking forward to pushing for IR, possibly 3 times a day, since my problem is not fasting numbers or long term numbers, but rather the spikes associated with each meal, which seems to be the likely culprit pushing up my numbers (A1C is higher than fasting levels would average out to indicate).... Gotta do more research before I approach my doc with it. I know I am the exception to nearly everyone else on the med, though. LOL1
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@RalfLott - I happened to see the warning about phthalates in generic extended release a few places while googling the difference between metformin vs metformin ER. And I'd like to say a big shame on Mylan Pharmaceuticals for not responding to my email or phone call requesting if their generic contained phthalates. I guess that means that suspicious "polyvinyl" I saw on the inactive ingredients may be one. It's funny because my pharmacist had no idea how to identify phthalates either, so be careful with any extended release pill, particularly generics. Crazy how they will remove this stuff from kids' toys but not our medicine! http://www.prevention.com/health/healthy-living/dangers-pthalates-pill-coating1
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That scares me because there's a lot of cellulose coating and such, too, which while not plastic, is wood, and that's not food for us either... I'm scared to go look things up now...1
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Th@RalfLott - I happened to see the warning about phthalates in generic extended release a few places while googling the difference between metformin vs metformin ER. And I'd like to say a big shame on Mylan Pharmaceuticals for not responding to my email or phone call requesting if their generic contained phthalates. I guess that means that suspicious "polyvinyl" I saw on the inactive ingredients may be one. It's funny because my pharmacist had no idea how to identify phthalates either, so be careful with any extended release pill, particularly generics. Crazy how they will remove this stuff from kids' toys but not our medicine! http://www.prevention.com/health/healthy-living/dangers-pthalates-pill-coating
Thanks x1000 for the warning!
Any idea about brand Glucophage XR?0 -
Mine, by manufacturer BMS lists this ingredient: povidone. A search shows this link. I don't know about you, but absolutely none of that sounds good!!!! It says it is a "film former" and not a "plasticizer," and not a phthalate....but still does NOT sound good.
https://en.wikipedia.org/wiki/Polyvinylpyrrolidone
PVP is also used in many technical applications:
as an adhesive in glue stick and hot-melt adhesives
as a special additive for batteries, ceramics, fiberglass, inks, and inkjet paper, and in the chemical-mechanical planarization process
as an emulsifier and disintegrant for solution polymerization
to increase resolution in photoresists for cathode ray tubes (CRT)[6]
in aqueous metal quenching
for production of membranes, such as dialysis and water purification filters
as a binder and complexation agent in agro applications such as crop protection, seed treatment and coating
as a thickening agent in tooth whitening gels[7]
as an aid for increasing the solubility of drugs in liquid and semi-liquid dosage forms (syrups, soft gelatine capsules) and as an inhibitor of recrystallisation
as an additive to Doro's RNA extraction buffer[citation needed]
as a liquid-phase dispersion enhancing agent in DOSY NMR [8]
https://packageinserts.bms.com/pi/pi_glucophage.pdf1 -
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Yeah, so it's like the co-morbidity of the phthalates? The ugly red-headed stepchild (per the euphemism?)0
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GLUCOPHAGE XR contains 500 mg or 750 mg of metformin hydrochloride as the active ingredient. GLUCOPHAGE XR 500 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, microcrystalline cellulose, and magnesium stearate.
On first blush, I thought nothing looked plasticy, so I had the pharmacist fill 3 months worth for $200. He assure me there were no phthalates in there. However, I just found this ☹️:
http://newresearchfindingstwo.blogspot.com/2012/11/veggie-capsules-may-be-far-from-natural.html?m=1
The hypromellose according to that link could conceivably be classified as a phthalate. Dang it.1 -
GLUCOPHAGE XR contains 500 mg or 750 mg of metformin hydrochloride as the active ingredient. GLUCOPHAGE XR 500 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, microcrystalline cellulose, and magnesium stearate.
On first blush, I thought nothing looked plasticy, so I had the pharmacist fill 3 months worth for $200. He assure me there were no phthalates in there. However, I just found this ☹️:
http://newresearchfindingstwo.blogspot.com/2012/11/veggie-capsules-may-be-far-from-natural.html?m=1
The hypromellose according to that link could conceivably be classified as a phthalate. Dang it.
Arrgh.
Any idea which ingredients in which generics cause full-on GI warfare?
Any attempt to substitute Metformin IR for XR, timed strategically throughout the day to mimic the blood levels of XR, to avoid the phthalate problem?
Thanks again!
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GLUCOPHAGE XR contains 500 mg or 750 mg of metformin hydrochloride as the active ingredient. GLUCOPHAGE XR 500 mg tablets contain the inactive ingredients sodium carboxymethyl cellulose, hypromellose, microcrystalline cellulose, and magnesium stearate.
On first blush, I thought nothing looked plasticy, so I had the pharmacist fill 3 months worth for $200. He assure me there were no phthalates in there. However, I just found this ☹️:
http://newresearchfindingstwo.blogspot.com/2012/11/veggie-capsules-may-be-far-from-natural.html?m=1
The hypromellose according to that link could conceivably be classified as a phthalate. Dang it.
FFS - Seriously?
Hypromellose or hydroxypropyl methylcellulose (HPMC)[10] is an inert, viscous and elastic semi-synthetic phthalate[11] polymer. Latter is worth repeating.
Please note: Hypromellose classifies as:
a semi-synthetic and
a polymer and
a phthalate!
Are the designations of "Polymer" and "Phthalate" raising warning flags yet?
I'm just so over meds...0 -
<Dump>0
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Can anyone give me insight as to the difference -is one version more powerful than the other? I have been on regular metformin 1000 mg twice a day for almost 20 years, and recently (possibly foolishly) allowed my pharmacist to talk me into the ER version. He swore it was the exact same efficacy, just smoother. My concern is that when I googled this question, there seems to be a different maximum dose for each type, so does that mean one is more powerful? I'm pregnant and got a half-hearted, not-really-paying-attention nod of approval from my OB for the switch, but I'm still a little concerned.
An extended release formulation (ER, XR, SR, LA, etc.) is designed to stretch the release of that dose over a longer period of time as the dosage form moves through your gut. The idea is improve patient compliance in taking meds: fewer doses to remember to take a day, lessened side effects from the gradual release if the drug can cause GI effects (metformin can do this), etc. This is common with many drugs to have immediate release (IR) and an ER version. There are also games that are played to create different ER versions by manufacturers so that they can create a new patent for the formulation. Thus, the Glucophage XR, Fortamet, Glumetza. They have sole rights while the patent is in effect and when it expires other manufacturers then create "generic" versions. Your question about potency is a little harder to answer because what happens is that after taking any drug with frequency, you start to achieve a steady state as the drug accumulates in your body. With some drugs (like insulin) there might be a need to target an instance (like regular insulin with food) and with others the timing is not critical you just need the drug at a certain level within your system, more or less, at all times. Hope that helps.
As far as your pharmacist asking if you would switch, that's either a clinical decision made by the pharmacist because, generally, compliance is better as I said earlier, or it's coming from a financial perspective. The latter is not likely the "greedy" pharmacist, I can assure you, but probably your insurance or the pharmacy benefits manager (PBM) driving it. Those entities are always looking at the costs and spreads and trying to maximize their profits. It's possible the pharmacy company could be the driver - some create clinical programs that target certain drugs to move to ER dosing and some do it for financial reasons (and generally claim it's clinical).
For the other comments on formulation ingredients, I can't offer much other than to say I would not assume the brand name is always the best when it comes to containing chemicals (fillers) you desire to avoid. Rather, look at them all.2
