DrugFriday: Metformin

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DFMetformin

Metformin is an oral hypoglycemic agent or anti diabetes drug belonging to the class Biguanides.

Mechanism Of Action:

Metformin acts as an insulin sensitizing agent, thus reducing insulin resistance. It also decreases glucose production by liver and intestinal glucose absorption.

Metabolism:

Metformin is metabolized mainly through kidneys and is excreted through urine. It is dialysable.

Indications:

Type 2 Diabetes: Metformin counters insulin resistance, the chief pathology of Type 2 Diabetes,thus reducing insulin levels.
PCOS: A large percentage of PCOS patients have insulin resistance or type 2 Diabetes for which Metformin is indicated. It also reduces signs of Insulin resistance.
Obesity: Metformin is anorexigenic and promotes weight loss.

Dosage:

In type 2 Diabetes, maximum 2500 mg a day, in divided doses is given as monotherapy or in combination
In PCOS, 850-1000 mg a day is given generally as monotherapy
In kidney impairment, dose is adjusted as per creatinine clearance.

Caution:

  • Caution is advised in congestive heart failure, fever, trauma, surgery, the elderly or hepatic impairment
  • Instruct patients to avoid heavy alcohol use
  • Suspend therapy prior to any type of surgery
  • Rare, but serious, lactic acidosis can occur due to accumulation
  • May cause ovulation in anovulatory and premenopausal PCOS patients
  • May be necessary to discontinue therapy with metformin and administer insulin if patient is exposed to stress (fever, trauma, infection)

Adverse Effects:

  • Hypoglycemia
  • Diarrhea
  • Flatulence
  • Weakness
  • Myalgia
  • Lactic acidosis (rare)
  • Low serum vitamin B-12
  • Nausea/vomiting

Interactions:

The major interactions are with contract agents and with ethanol.
Minor interactions are with amiodarone, antibiotics like quinilones, antiviral drugs etc.

Use In Pregnancy:

Metformin is a category B drug in pregnancy, meaning studies in humans have not shown major teratogenicity.

Common Brand Names In India:

Glycomet, Glyciphage, Carbophage, Cetapin

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