Glucophage (Metformin Hydrochloride)

Glucophage (metformin hydrochloride) is indicated primarily for the treatment of type 2 diabetes mellitus.

• As monotherapy in patients with newly diagnosed type 2 diabetes.
• In combination with other oral antidiabetic agents when glycemic control is inadequate.
• As an adjunct to diet and exercise to improve overall blood glucose management.
• Occasionally used off‑label for polycystic ovary syndrome under specialist supervision.
• Combined with basal insulin to reduce insulin dose requirements and mitigate weight gain.
• Prescribed for patients with impaired fasting glucose as part of a preventive strategy when lifestyle measures alone are insufficient.

Glucophage may cause a range of adverse effects, most of which are mild and transient, while a few can be serious and require medical attention.

Common

• Gastrointestinal upset such as nausea, abdominal discomfort, or diarrhea.
• Metallic taste in the mouth.
• Decreased appetite or mild weight loss.
• Mild skin rash or itching.
• Indigestion or heartburn.
• Transient headache or dizziness.

Serious

• Lactic acidosis, a rare but life‑threatening condition characterized by rapid breathing and muscle pain.
• Severe hypoglycemia when combined with insulin or sulfonylureas.
• Significant vitamin B12 deficiency with long‑term use.
• Acute renal failure in patients with pre‑existing kidney disease.
• Hepatotoxicity manifested by elevated liver enzymes.
• Acute renal failure in patients with pre‑existing kidney disease.

When prescribing Glucophage, clinicians consider several precautionary factors to ensure safe and effective therapy.

• Assess renal function before initiation and periodically thereafter; metformin is contraindicated in severe renal impairment.
• Evaluate hepatic function, as liver disease may increase the risk of lactic acidosis.
• Review any history of alcohol misuse, which can potentiate metformin‑associated acidosis.
• Monitor for signs of vitamin B12 deficiency during long‑term treatment.
• Adjust dose or discontinue during radiographic procedures using iodinated contrast agents.
• Use caution in elderly patients due to higher susceptibility to gastrointestinal side effects and renal decline.

Glucophage can interact with several medicines, affecting blood glucose levels or increasing the risk of adverse reactions.

Avoid

• Iodinated contrast agents used for imaging studies; metformin should be stopped before and after the procedure to prevent lactic acidosis.
• Cimetidine, which can increase metformin plasma concentrations.
• Trimethoprim, which may increase metformin levels and risk of lactic acidosis.

Use with caution

• Insulin or sulfonylureas, as combined therapy may cause hypoglycemia.
• Corticosteroids, which can raise blood glucose and may require dose adjustments.
• Alcohol, especially heavy consumption, which can precipitate lactic acidosis.
• Beta‑blockers, which can mask symptoms of hypoglycemia.