Metforal (Metformin Hydrochloride)

• Metforal is a biguanide used to improve glycaemic control in disorders of glucose metabolism.
• Type 2 diabetes mellitus: improves fasting and post‑prandial blood glucose levels.
• Prediabetes (impaired glucose tolerance): reduces risk of progression to overt diabetes.
• Polycystic ovary syndrome: may improve insulin resistance and menstrual regularity.

• Metformin lowers hepatic glucose production by inhibiting mitochondrial respiratory-chain complex I, which reduces gluconeogenesis. It also enhances peripheral insulin sensitivity by increasing glucose uptake in muscle and adipose tissue and improves lipid metabolism, contributing to overall glycaemic control without stimulating insulin secretion.

Metforal may cause a range of adverse reactions.

Common Side Effects

• Gastrointestinal upset: nausea, abdominal discomfort, or dyspepsia.
• Diarrhoea: frequent loose stools, especially during treatment initiation.
• Metallic taste: transient alteration in taste perception.
• Loss of appetite: reduced desire to eat.

Serious or Rare Side Effects

• Lactic acidosis: a rare but life‑threatening metabolic complication.
• Severe skin reactions: such as Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatic dysfunction: elevated liver enzymes or hepatitis.
• Vitamin B12 deficiency: may develop with long‑term use.
• Pancreatitis: inflammation of the pancreas.

• Metforal requires careful patient assessment and monitoring.
• Renal function: assess eGFR before initiating and periodically thereafter.
• Liver disease: use with caution in patients with hepatic impairment.
• Cardiovascular risk: monitor for signs of lactic acidosis, especially in heart failure.
• Alcohol intake: avoid excessive consumption to reduce lactic acidosis risk.
• Pregnancy and breastfeeding: discuss potential risks with a healthcare professional.
• Store at ambient temperature: keep in the original container, protect from moisture.

Metforal can interact with several medicines, affecting its safety or efficacy.

Major Interactions (Avoid)

• Iodinated contrast agents: may precipitate acute renal failure.
• Cimetidine: can increase metformin plasma concentrations.
• Nucleoside reverse transcriptase inhibitors (e.g., didanosine): heightened risk of lactic acidosis.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may mask hypoglycaemia symptoms.
• Diuretics: can affect renal clearance of metformin.
• ACE inhibitors or ARBs: monitor renal function and electrolytes.