1. Introduction

Metformin is a widely prescribed oral medication for type 2 diabetes mellitus. It belongs to the biguanide class of drugs. Metformin helps control high blood sugar by improving the body’s response to insulin and reducing glucose production in the liver. It is often considered first-line therapy for type 2 diabetes due to its effectiveness, safety profile, and potential cardiovascular benefits.

2. Composition

• Active Ingredient: Metformin Hydrochloride
• Available Forms:
  • Tablets (commonly 500 mg, 850 mg, 1000 mg)
  • Extended-release tablets
  • Oral solution (liquid)
• Inactive Ingredients: These vary by brand but may include fillers, binders, and coatings for tablet stability.

Brand Names in Pakistan: Glucophage, Diabformin, Diaformin, and generic Metformin tablets.

3. Uses

Metformin is primarily used for:

1. Type 2 Diabetes:
   • Lowers fasting and postprandial blood glucose levels.
   • Improves insulin sensitivity in muscle and liver.
2. Polycystic Ovary Syndrome (PCOS):
   • Helps regulate menstrual cycles and improve insulin resistance.
3. Weight Management in Diabetic Patients:
   • Often associated with modest weight reduction.
4. Prevention of Diabetes:
   • In people with prediabetes at high risk of developing type 2 diabetes.

4. Mechanism of Action

• Reduces hepatic glucose production (liver).
• Increases insulin sensitivity in muscle and fat tissue.
• Decreases intestinal absorption of glucose.

This leads to lower blood sugar levels without causing significant hypoglycemia, unlike some other diabetes medications.

5. Side Effects

Metformin is generally well-tolerated, but some common side effects include:

Common (mild):

• Nausea, vomiting
• Diarrhea, abdominal discomfort, bloating
• Loss of appetite
• Metallic taste

Rare but serious:

• Lactic acidosis: A very rare but life-threatening condition; symptoms include extreme fatigue, muscle pain, breathing difficulties, dizziness, or irregular heartbeat.
• Vitamin B12 deficiency (with long-term use)

Tips to reduce side effects:

• Take with meals to reduce gastrointestinal discomfort.
• Start with a lower dose and gradually increase as tolerated.

Important:
Metformin should be used under medical supervision, especially in patients with kidney, liver, or heart problems. Regular monitoring of kidney function is recommended.

Here’s a comparison table of Metformin with other commonly used oral diabetes medications in Pakistan: