The starting dose for Metformin ER is usually 500 mg once daily, taken with an evening meal. From there, your clinician adjusts the dose based on how you respond and how well you tolerate it.
A typical titration pattern looks like this:
- Weeks 1 to 2: 500 mg once daily. A low starting dose to let your body adjust. This minimizes GI side effects in the first few weeks.
- Weeks 3 to 4: Often increased to 1,000 mg once daily (or sometimes 500 mg twice daily, depending on the formulation), if the starting dose is well-tolerated.
- Beyond week 4: Further adjustments based on response and clinical goals. Common doses for PCOS sit in the 1,000 mg to 2,000 mg per day range, taken once or sometimes split into two doses.
- Maximum dose: typically 2,000 mg per day for Metformin ER. Some patients may go slightly higher under clinical supervision, but 2,000 mg is the standard upper limit.
A few practical points:
- Take it with food. Specifically with an evening meal for the once-daily dose. This both reduces GI side effects and gives the slow-release formulation a consistent baseline.
- Don't crush, chew, or split the tablet. Metformin ER tablets are designed to release gradually — breaking them defeats the extended-release mechanism and can cause GI side effects that the formulation is meant to prevent.
- Take it at roughly the same time each day. Consistency helps maintain steady levels.
If GI side effects are bothersome in the first few weeks — especially nausea, loose stools, or stomach upset — message your Oana clinician before stopping. These effects are most common in the first two to three weeks and often resolve as your body adjusts. If they don't, dose adjustments or alternative formulations (including Topical Metformin) are options.
Your dose is determined by your clinician based on your case, not by a generic protocol. The numbers above are typical ranges, not a script to follow on your own.