4000 mg Metformin per day

[ValNP]

My husband was going to bed and mentioned that he was running out of his metformin. I said that is not possible I got him a 90 supply. Well, the last instruction he remembers from his physician was to double his dose. Guess what before the new script of 1000 mg BID was written he was taking 2 500mg tabs BID. So he just continued that when he filled the new prescription. So since January 17th he has been taking 4000mg per day. I can't believe it. I am so frustrated and angry. I told him he has to call his physician and have a creatinine drawn tomorrow.

[MC1906]

I would think he shouldnt exceed 2500mg. It may also depend on if he is taking extended release tabs. Another variable might be if he is on insulin. I would definitely call the physician and request some labs be drawn. Does the prescription bottle say to take that amount?

[ValNP]

I guess I didn't describe the situation properly. He was mistaken by the instructions of the physician. The physician said that the dose he was taking needed to be doubled. Instead of reading the label and seeing that the doctor doubled the dosage from 500mg BID to 1000mg BID. My husband took it upon himself to take 2 pills in the morning and 2 pills at night of the 1000mg dose. He had a lab slip for routine labs to be done anyway. I told my husband to call the physician and tell him what he has done and even if the physician does not order a separate BMP that he should get the BMP that was already ordered. I feel we should know what his creatinine is.... I will update the post after I find out what his creatinine level is. The reason for the post was mainly to share with others that even a NP can have someone in her house that completely does not understand their medication instructions.

[traumaRUs, MSN, APRN]

These directions can be very confusing for pts. I too sometimes have my pts double their doses for instance, their BP meds and then when I e-prescribe the script for the next refill I always write in capital letters NEW DOSE - READ LABEL!

I also document immensely.

[MC1906]

ValNP.....I hope that things work out. Please keep us updated.

Trauma, good idea....I'll keep that in mind!

[FNPdude74]

Patient education is important as well as clear med instructions. However, I think the absolute harm in that dose since January may be quite low. Lactic acidosis risk is quite low and overall, rare, but there is still that risk. BUT...like you said 4000 mg is a lot, and to me it may be questionable as to how his physiological functioning is esp his kidneys. Go back to the provider! The relative harm may be slightly higher than a person taking the maximum dosage everyday.

[ValNP]

Got the result of his creatinine. I was very surprised to hear it is 1.5 (and very thankful). The plan is to resume the correct dose of metformin in a couple days & repeat the creatinine in a month.

[FNPdude74]

How old is he btw? Yeah, I sort of figured that since it's been only a few months of that dose of metfotmin, the creatinine level would not be dangerously high. I'd start to be concerned if it was around greater than 1.6 to begin with.

[ValNP]

He is 55 and overweight. I don't know what his baseline creatinine was, but I feel so much better now. He hasn't been a very compliant diabetic (as far as diet and checking his sugar). He has finally agreed to go to a diabetic self management class and we are going to get a glucometer that download to computer so he can bring his results his provider appointments.