Meladine Sr (Metformin Hydrochloride)

• Metformin is a biguanide antidiabetic that improves glycaemic control in type 2 diabetes and related metabolic conditions.
• Type 2 diabetes mellitus: improves blood glucose control and reduces HbA1c.
• Prediabetes (impaired glucose tolerance): lowers the risk of progression to overt diabetes.
• Polycystic ovary syndrome: improves insulin resistance and may help regulate menstrual cycles.

• Metformin Hydrochloride reduces hepatic gluconeogenesis and increases peripheral glucose uptake by activating AMP‑activated protein kinase (AMPK). This leads to decreased liver glucose output and enhanced insulin sensitivity in muscle and adipose tissue, resulting in lower circulating blood glucose levels.

Metformin is generally well tolerated, but a range of adverse reactions have been reported.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Diarrhea: frequent loose stools, especially at treatment initiation.
• Abdominal discomfort: cramping or bloating.
• Metallic taste: transient alteration of taste perception.
• Weight loss: modest reduction in body weight.
• Vitamin B12 deficiency: decreased absorption with long‑term use.

Serious or Rare Side Effects

• Lactic acidosis: rare but potentially fatal metabolic acidosis.
• Severe skin reactions: such as Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatic failure: marked elevation of liver enzymes.
• Hypoglycaemia: when combined with insulin or sulfonylureas.
• Pancreatitis: inflammation of the pancreas.
• Severe gastrointestinal bleeding: uncommon but reported.

• Metformin should be used with caution and under medical supervision.
• Renal function assessment: avoid or adjust dose in patients with impaired kidney function.
• Hepatic function monitoring: use cautiously in liver disease due to lactic acidosis risk.
• Lactic acidosis risk: discontinue if patient develops severe infection, hypoxia, or acute heart failure.
• Blood glucose monitoring: regular checks to assess therapeutic response.
• Alcohol consumption: limit intake as alcohol can increase lactic acidosis risk.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Metformin may interact with several medicines, requiring attention to avoid adverse outcomes.

Major Interactions (Avoid)

• Iodinated contrast agents: can precipitate acute renal failure and lactic acidosis.
• Cimetidine: increases metformin plasma concentrations.
• Alcohol: heightens risk of lactic acidosis.
• Carbamazepine: may reduce metformin efficacy.
• Rifampin: may decrease metformin plasma levels.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may mask hypoglycaemia symptoms.
• Diuretics: can affect renal clearance of metformin.
• ACE inhibitors: monitor renal function and electrolytes.
• NSAIDs: may impair renal function, increasing metformin exposure.
• Warfarin: occasional reports of altered INR, monitor coagulation status.