Metformina Basi (Metformin Hydrochloride)

Metformin is an oral antidiabetic agent used in the management of disorders related to glucose metabolism.

• Type 2 diabetes mellitus: lowers fasting and postprandial blood glucose levels, improving overall glycemic control.
• Prediabetes (impaired glucose tolerance): reduces the risk of progression to type 2 diabetes when used as part of lifestyle intervention.
• Polycystic ovary syndrome (PCOS): improves insulin sensitivity, which may help regulate menstrual cycles and reduce androgen levels.
• Gestational diabetes mellitus (off‑label): may be considered when diet alone is insufficient, under specialist supervision.

• Metformin primarily inhibits mitochondrial respiratory‑chain complex I, leading to activation of AMP‑activated protein kinase (AMPK). This cascade suppresses hepatic gluconeogenesis, decreases intestinal glucose absorption, and enhances peripheral glucose uptake in muscle and adipose tissue, thereby improving insulin sensitivity without directly stimulating insulin secretion.

Metformin may be associated with a range of adverse reactions, most of which are mild and dose‑related.

Common Side Effects

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

Serious or Rare Side Effects

• Lactic acidosis: rare but life‑threatening metabolic disturbance.
• Severe hypoglycemia: uncommon when used alone.
• Vitamin B12 deficiency: may develop with long‑term therapy.
• Hepatic dysfunction: elevated liver enzymes in rare cases.
• Skin rash: hypersensitivity reactions including Stevens‑Johnson syndrome.
• Acute pancreatitis: infrequent inflammatory condition of the pancreas.

Metformin requires careful assessment of patient-specific factors before and during therapy.

• Renal function: assess eGFR before initiating and monitor periodically.
• Hepatic function: avoid use in patients with severe hepatic impairment.
• Lactic acidosis risk: discontinue if patient develops conditions that predispose to hypoxia (e.g., heart failure, severe infection).
• Vitamin B12: monitor levels during long‑term therapy to detect deficiency.
• Pregnancy and lactation: use only if potential benefits justify potential risks.
• Store at ambient temperature: keep below 25 °C, protect from moisture and light in the original container.

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

Major Interactions (Avoid)

• Iodinated contrast agents: may precipitate acute renal failure; suspend metformin before and after the procedure.
• Cimetidine: can increase metformin plasma concentrations, raising risk of toxicity.
• Alcohol abuse: enhances risk of lactic acidosis.
• Renal impairment: metformin accumulation can occur; adjust dose or discontinue.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may mask symptoms of hypoglycemia.
• Diuretics (loop, thiazide): can affect renal clearance of metformin.
• Corticosteroids: may raise blood glucose, requiring dose adjustment.
• Thyroid hormones: may affect glucose metabolism, requiring monitoring.