Glucophage (Metformin Hydrochloride)

Glucophage is indicated for several metabolic conditions where improving insulin sensitivity and lowering hepatic glucose output are therapeutic goals.

• Management of type 2 diabetes mellitus as an adjunct to diet and exercise.
• Off‑label treatment of polycystic ovary syndrome to improve ovulatory function.
• Adjunctive therapy for pre‑diabetes to delay progression to diabetes.
• Off‑label use in gestational diabetes when other options are unsuitable.
• May be used in combination with other antidiabetic agents to achieve glycemic targets.

Side effects of Glucophage vary in frequency; some are mild and occur in many patients, while others are rare but may require medical attention.

Common

• Nausea or upset stomach.
• Diarrhea or loose stools.
• Metallic taste in the mouth.
• Decreased appetite.
• Unintended weight loss.
• Abdominal discomfort or cramping.

Serious

• Lactic acidosis, a rare but life‑threatening condition.
• Severe hypoglycemia when combined with insulin or sulfonylureas.
• Vitamin B12 deficiency with long‑term use.
• Skin rash or hypersensitivity reactions.
• Hepatotoxicity or elevated liver enzymes.

Before starting Glucophage, certain health factors should be evaluated to minimize risks.

• Assess renal function; avoid use in severe renal impairment.
• Evaluate liver disease status, as hepatic dysfunction can increase lactic acidosis risk.
• Use cautiously in patients with congestive heart failure.
• Limit alcohol consumption, which may potentiate lactic acidosis.
• Monitor for vitamin B12 levels during prolonged therapy.
• Consider dose adjustments in elderly patients.
• Discuss pregnancy and breastfeeding status with a healthcare provider.

Glucophage can interact with several medicines, affecting its safety and effectiveness.

Avoid

• Iodinated contrast agents used for imaging studies.
• Cimetidine, which can increase metformin plasma concentrations.
• Certain antivirals such as didanosine that may raise the risk of lactic acidosis.
• High‑dose diuretics that may impair renal clearance.

Use with caution

• Other antidiabetic drugs (insulin, sulfonylureas) due to hypoglycemia risk.
• Corticosteroids, which can raise blood glucose levels.
• Beta‑blockers that may mask hypoglycemia symptoms.
• ACE inhibitors or ARBs that affect renal function.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs) that may reduce kidney perfusion.