Glucophage (Metformin Hydrochloride)

Glucophage is indicated for the management of several endocrine and metabolic disorders, primarily to improve glycemic control and address insulin resistance.

• Type 2 diabetes mellitus, used together with diet, exercise, and other antidiabetic agents.
• Polycystic ovary syndrome (PCOS), to reduce insulin resistance and help regulate menstrual cycles.
• Prediabetes, to lower fasting glucose and decrease the risk of progression to overt diabetes.
• Gestational diabetes, as an alternative when insulin therapy is not feasible (off‑label).

Like all medications, Glucophage may cause side effects; they are generally categorized by frequency and severity.

Common

• Nausea, vomiting, or general stomach upset, especially when therapy is initiated.
• Diarrhea, which may be watery and occur several times daily.
• Abdominal discomfort, cramping, or bloating that often improves with continued use.
• A metallic or bitter taste in the mouth that usually resolves over time.

Serious

• Lactic acidosis, a rare metabolic complication characterized by rapid breathing, muscle pain, and feeling cold; requires immediate medical attention.
• Severe skin reactions, including Stevens‑Johnson syndrome or toxic epidermal necrolysis, presenting with rash, blistering, and fever.
• Persistent vomiting or inability to retain fluids, leading to dehydration and electrolyte imbalance.

Before starting Glucophage, patients and clinicians should consider several precautionary measures to ensure safe and effective therapy.

• Assess kidney function; avoid use in severe renal impairment.
• Monitor liver enzymes, as hepatic disease may increase risk of lactic acidosis.
• Evaluate for heart failure or recent myocardial infarction, conditions that heighten lactic acidosis risk.
• Use caution in older adults, who may have reduced renal clearance.
• Review all concomitant medications for potential interactions, especially contrast agents used in imaging studies.
• Advise patients to report unexplained muscle pain, weakness, or rapid breathing promptly.

Glucophage can interact with other medicines, affecting its efficacy or increasing the risk of adverse effects.

Avoid

• Iodinated contrast media used for radiographic procedures, which can impair renal function.
• Cimetidine, a histamine H2‑receptor antagonist that may increase metformin plasma levels.
• Certain antivirals such as didanosine, which can raise the risk of lactic acidosis.

Use with caution

• Diuretics, especially loop diuretics, which may affect hydration and renal function.
• Beta‑blockers, as they can mask symptoms of hypoglycemia.
• Alcohol, because excessive intake may increase the risk of lactic acidosis.