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                Metformin is a biguanide antihyperglycemic used in conjunction with diet and exercise for glycemic control in type 2 diabetes mellitus. It is also used off-label for insulin resistance in polycystic ovary syndrome (PCOS). Metformin comes in two forms: tablet and solution. Both forms are taken by mouth.

Mechanism of Action

Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes mellitus, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. With metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma insulin response may decrease.

Drug Interactions

➳ Carbonic Anhydrase Inhibitors e.g. Topiramate, zonisamide, acetazolamide or dichlorphenamide.

➳ Drugs that Reduce Metformin Hydrochloride Tablets Clearance e.g. Ranolazine, vandetanib, dolutegravir, and cimetidine.

➳ Alcohol

➳ Insulin Secretagogues or Insulin

➳ Drugs Affecting Glycemic Control eg. Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products.

Indications

Metformin hydrochloride tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus.

Side Effects

➥ Abdominal or stomach discomfort

➥ Cough or hoarseness

➥ Diarrhea 

➥ Nausea 

➥ Decreased appetite

➥ Fast or shallow breathing 

➥ Fever or chills 

➥ General feeling of discomfort 

➥ Lower back or side pain 

➥ Muscle pain or cramping 

➥ Painful or difficult urination 

➥ Sleepiness

Serious side effects

➥ Lactic acidosis.

➥ Hypoglycemia (low blood sugar)

➥ Low vitamin B12 levels.

Contraindications

✘ Severe renal impairment (eGFR below 30 mL/min/1.73 m2)

✘ Hypersensitivity to metformin

✘ Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma.

Reference

1. Drug Bank Online : Metformin

2. Medical News Today

3. MyoClinic 

4. Metformin Prescribing Information