Glucophage (Metformin Hydrochloride)

Glucophage is indicated for the long‑term management of hyperglycemia in adults with type 2 diabetes mellitus, typically as part of a comprehensive treatment plan that includes diet and exercise.

• Used as monotherapy when diet and exercise alone do not achieve glycemic control.
• Combined with other oral antidiabetic agents such as sulfonylureas or thiazolidinediones.
• May be prescribed alongside basal insulin in patients requiring additional glucose lowering.
• Considered for use in overweight or obese patients to aid weight management.
• Employed to reduce the risk of diabetes‑related microvascular complications when glycemic targets are met.

The safety profile of Glucophage includes a range of adverse effects that vary in frequency and severity.

Common

• Gastrointestinal upset such as nausea, abdominal discomfort, or diarrhea.
• Metallic taste in the mouth.
• Decreased appetite or mild weight loss.
• Vitamin B12 deficiency with prolonged use.

Serious

• Lactic acidosis, a rare but potentially fatal metabolic complication.
• Severe hypoglycemia when combined with insulin or insulin secretagogues.
• Acute pancreatitis presenting with abdominal pain and elevated enzymes.

Before initiating Glucophage, clinicians should evaluate several clinical factors to minimize risks and ensure appropriate use.

• Assess renal function; contraindicated in patients with severe renal impairment.
• Review hepatic status, as liver disease may increase lactic acidosis risk.
• Monitor for signs of heart failure, especially during dose escalation.
• Evaluate for alcohol abuse, which can potentiate lactic acidosis.
• Check baseline vitamin B12 levels and re‑check periodically.
• Use caution in elderly patients due to higher susceptibility to adverse effects.
• Discontinue before any radiographic studies using iodinated contrast agents.

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

Avoid

• Concurrent use with iodinated contrast media without appropriate interruption.
• Co‑administration with potent CYP450 inhibitors that may alter metformin clearance.
• Combining with high‑dose alcohol intake.

Use with caution

• Sulfonylureas or insulin, which may increase hypoglycemia risk.
• Cimetidine, which can raise metformin plasma concentrations.
• Diuretics that may affect renal function and metformin excretion.
• Corticosteroids, which can raise blood glucose levels.