Tablets should be taken in divided doses with meals in combination therapy with either a sulfonylurea or insulin, diabetic control should be checked by blood sugar readings because of the possibility of glycaemia.
The dose should be increased gradually. One 500 mg tablet 3 times a day or two 850 mg tablets 2 times a day is often enough to give good diabetic control. This may be achieved within a few days, but it is not unusual for the full effect to be delayed for up to 2 weeks. If control is incomplete, a cautious increase in dosage to a maximum of 3 g daily is justified. Once control has been obtained, it may be possible to reduce the dosage. When combined with existing sulfonylurea therapy, which is not given adequate control, one 500 mg tablet should be added initially, the dosage of Metformin being gradually increased until optimal control is obtained. Often, the sulfonylurea may be reduced and in some patients, withdrawn. Metformin can then be continued as the sole therapy.