However, apart from a review published about the comparison between metformin IR and metformin XR, 3 no randomized clinical trials have been conducted to directly compare the two formulations. The XR formulation has been designed to allow a more gradual release of the drug in the main absorption site, ie, in the upper gastrointestinal tract, thus improving its tolerability and improving patients’ compliance due to a reduction in the frequency of administration and a decrease in adverse events. Compared to conventional IR formulation, the XR offers some advantages first of all the possibility to take the drug once a day and also a better gastrointestinal tolerability, with equal effectiveness. 2 However, recently, extended-release (XR) metformin has become available. We have already studied the powder formulation showing that it increased the degree of patients’ satisfaction toward the antidiabetic treatment and led to an improvement in glycemic control. The powder formulation was designed to overcome the problem of the considerable size of the tablets, which made them difficult to swallow, especially for elderly patients or those with dysphagia. 1 Until now, metformin was available as an immediate release (IR) formulation to be taken thrice a day, at dosages of 500, 850, and 1,000 mg, in tablet or powder.
Metformin reduces plasma glucose levels by acting at several levels metformin reduces hepatic glucose production in the liver by inhibiting gluconeogenesis and glycogenolysis metformin increases muscular insulin sensitivity by improving the uptake and utilization of peripheral glucose moreover, metformin slows intestinal absorption of glucose. In the absence of contraindications, metformin is the first choice drug for the treatment of diabetes.
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