How should we manage metformin-induced diarrhea?
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To minimize metformin-induced diarrhea, patients should be initiated on 500 mg once or twice daily or 850 mg once daily of immediate-release metformin (metformin-IR), which should be slowly titrated over several weeks depending on patient response until the goal dose is reached (SOR: C, consensus guidelines). Switching patients who are unable to tolerate metformin-IR to the extended-release (XR) formulation may improve gastrointestinal (GI) symptoms (SOR: B, retrospective cohort study).
Evidence Based Practice 16(6): 08.