Glucophage (Metformin Hydrochloride)

Glucophage is indicated for the treatment of type 2 diabetes mellitus and is used as part of a comprehensive diabetes management plan.

• Improves glycemic control when combined with diet and exercise.
• Can be used as monotherapy in patients with newly diagnosed type 2 diabetes.
• May be added to insulin or other oral antidiabetic agents when additional glucose lowering is required.
• Occasionally prescribed off‑label for polycystic ovary syndrome under specialist supervision.
• Used in renal‑adjusted dosing for patients with mild to moderate kidney impairment, following clinical guidelines.

Side effects of Glucophage vary in frequency; most are mild and transient, while rare reactions may require medical attention.

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 long‑term use.
• Elevated liver enzymes.

Serious

• Lactic acidosis, a rare but potentially life‑threatening condition.
• Severe skin reactions, including Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Persistent or worsening kidney dysfunction.

Before starting Glucophage, healthcare providers assess several clinical factors to minimize risks and ensure safe use.

• Assess renal function; contraindicated in severe renal impairment.
• Evaluate liver disease status, as hepatic dysfunction can increase lactic acidosis risk.
• Review any history of alcohol abuse, which may potentiate metabolic complications.
• Monitor for signs of hypoglycemia when used with insulin or sulfonylureas.
• Adjust dose in elderly patients due to altered pharmacokinetics.
• Consider vitamin B12 levels during long‑term therapy.
• Discontinue before any iodinated contrast imaging that may affect kidney function.

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

Avoid

• Iodinated contrast agents used for radiographic studies; may precipitate acute kidney injury.
• Cimetidine, which can raise metformin plasma concentrations.
• Certain antivirals such as dolutegravir that may increase metformin exposure.

Use with caution

• Insulin or sulfonylureas, as combined therapy raises hypoglycemia risk.
• Diuretics that may affect renal clearance of metformin.
• ACE inhibitors or ARBs in patients with compromised renal function.