Metforem (Metformin Hydrochloride)

Metforem is a Biguanide that acts on glucose metabolism to manage hyperglycaemia.

• Type 2 diabetes mellitus: lowers blood glucose by reducing hepatic glucose output and increasing peripheral insulin sensitivity.
• Prediabetes (impaired fasting glucose): helps delay progression to overt diabetes through improved insulin action.
• Polycystic ovary syndrome (PCOS): assists in correcting insulin resistance associated with the condition.

• Metformin primarily inhibits mitochondrial respiratory‑chain complex I, decreasing hepatic gluconeogenesis and reducing glucose production. It also enhances insulin‑mediated glucose uptake in skeletal muscle and adipose tissue by activating AMP‑activated protein kinase (AMPK), which improves peripheral insulin sensitivity and promotes utilization of glucose.

Metforem may cause a range of adverse reactions.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhoea: frequent loose stools, especially at treatment initiation.
• Abdominal discomfort: cramping or bloating.
• Metallic taste: transient alteration of taste perception.
• Loss of appetite: reduced desire to eat.
• Flatulence: increased intestinal gas.

Serious or Rare Side Effects

• Lactic acidosis: rare but potentially fatal metabolic acidosis.
• Severe hypoglycaemia: usually when combined with other glucose‑lowering agents.
• Vitamin B12 deficiency: may develop with long‑term therapy.
• Hepatic dysfunction: abnormal liver enzymes or hepatitis.
• Allergic skin reactions: rash, urticaria, or Stevens‑Johnson syndrome.
• Pancreatitis: inflammation of the pancreas, presenting with abdominal pain.

Metforem requires careful patient assessment and monitoring.

• Renal function assessment: avoid or adjust dose in patients with impaired renal clearance.
• Hepatic function monitoring: use with caution in liver disease.
• Blood glucose monitoring: regularly check glucose to avoid hypoglycaemia, especially when combined with insulin.
• Contraindicated in metabolic acidosis: do not use in patients with ketoacidosis or severe acidosis.
• Use with caution in elderly: increased susceptibility to renal impairment and dehydration.
• Store at ambient temperature: keep in the original container, protect from moisture and heat.

Metforem can interact with several medicines, altering its efficacy or safety.

Major Interactions (Avoid)

• Iodinated contrast agents: may precipitate acute renal failure, increasing risk of lactic acidosis.
• Cimetidine: can raise metformin plasma concentrations, heightening toxicity risk.
• Alcohol: potentiates lactic acidosis, especially in patients with hepatic disease.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may mask symptoms of hypoglycaemia.
• Diuretics (especially thiazides): can affect renal clearance of metformin.
• ACE inhibitors or ARBs: monitor renal function and electrolytes.
• Thyroid hormones: may require adjustment of glycaemic control.