Mikubrel Sr (Metformin Hydrochloride)

Metformin Hydrochloride is indicated for conditions affecting glucose metabolism and insulin sensitivity.

• Type 2 diabetes mellitus: improves glycaemic control and reduces HbA1c levels.
• Prediabetes (high‑risk individuals): helps delay progression to overt diabetes.
• Polycystic ovary syndrome: reduces insulin resistance and may improve ovulatory function.

• Metformin Hydrochloride reduces hepatic gluconeogenesis, decreases intestinal glucose absorption, and enhances peripheral insulin sensitivity by activating AMP‑activated protein kinase (AMPK). These actions collectively lower fasting plasma glucose and improve overall glycaemic control without directly stimulating insulin secretion.

Metformin Hydrochloride is associated with several 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 in taste perception.
• Weight loss: modest reduction in body weight.
• Vitamin B12 deficiency: decreased absorption over long‑term use.

Serious or Rare Side Effects

• Lactic acidosis: rare but life‑threatening metabolic disturbance.
• Severe skin reactions: such as Stevens‑Johnson syndrome.
• Hepatic dysfunction: elevated liver enzymes.
• Hypoglycaemia: when combined with other glucose‑lowering agents.
• Anemia: due to reduced red blood cell production.
• Electrolyte imbalance: especially with prolonged diarrhoea.

Metformin Hydrochloride requires careful monitoring and patient education.

• Renal function: assess eGFR before initiation and periodically thereafter.
• Hepatic function: evaluate liver enzymes prior to treatment.
• Heart failure: avoid in decompensated states due to lactic acidosis risk.
• Vitamin B12 status: monitor levels during long‑term therapy.
• Hypersensitivity: discontinue if allergic reactions occur.
• Store at room temperature: keep in the original container, protect from moisture and heat.

Metformin Hydrochloride can interact with several medications, altering its efficacy or safety.

Major Interactions (Avoid)

• Iodinated contrast agents: increase risk of lactic acidosis.
• Alcohol: potentiates lactic acidosis.
• Cimetidine: may raise metformin plasma concentrations.
• Trimethoprim: can impair renal clearance of metformin.
• Rifampicin: reduces metformin exposure.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may mask hypoglycaemia symptoms.
• ACE inhibitors: monitor renal function and potassium.
• Diuretics: assess for dehydration and renal impairment.
• Other antidiabetic agents: adjust dosing to avoid hypoglycaemia.
• Corticosteroids: may increase blood glucose, requiring dose adjustments.