Metformin is administered orally. It is produced in active form. It is recommended to take this medication with food, but this decreases bioavailability by delaying absorption (Wilbur, 2013). This drug undergoes first-pass metabolism in the liver. On an empty stomach, the bioavailability of metformin is approximately 50% to 60% and it takes 4 to 8 hours to reach peak plasma levels, while steady-state plasma levels are achieved within 24 to 48 hours ( US Food and Drug Administration [FDA], 2008). Metformin is eliminated via first-order kinetics with a half-life of approximately 17 hours and is almost exclusively excreted unchanged in the urine via tubular secretion (FDA, 2008). Metformin is prescribed for the long-term treatment of type II diabetes mellitus. . It can be used alone or in combination with other diabetes management medications as part of a health plan that includes proper diet and exercise. Metformin, which has a low affinity for binding to plasma proteins, limits glucose production in the hepatic system, reduces glucose absorption in the intestine, and improves insulin sensitivity by improving absorption and glucose usage (FDA, 2008). This medication does not cause a rise in insulin, making a patient less likely to become hypoglycemic than other common antihyperglycemic medications. The most common side effects associated with metformin are gastrointestinal disorders; some of which are serious enough to cause patients to discontinue the drug. These include diarrhea, nausea, vomiting, and indigestion (Wilbur, 2013). Patients should see a decrease in these side effects with continued use. Taking metformin with food helps with these gastrointestinal side effects... half of the document ......immunization schedules recommended by ion for the age group 0 to 18 years, the following should be considered vaccinations: Meningococcal; 1 dose of Menactra or Menveo Tetanus, diphtheria and acellular pertussis (Tdap); 1 dose with toxoid booster every 10 years Human papillomavirus; There are 3 series of doses at 0, 1-2 and 6 months. The patient should also receive annual flu shots. (Centers for Disease Control and Prevention, 2016) The patient should be evaluated for egg allergy before vaccinations are administered. Common side effects of these vaccines may include low-grade fever and discomfort at the injection site. The Tdap vaccine is contraindicated in patients with a history of Guillain-Barré syndrome (Arcangelo, 2013). As with any vaccine, a previous reaction to these vaccines or any of their components constitutes a contraindication to administration of the vaccine.