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Key Points

  • Metformin (Glucophage)
    • Mechanism
      • Improves insulin sensitivity
      • Increases peripheral glucose uptake and use
      • Decreases hepatic production and intestinal absorption of glucose
    • Clinical Use
      • Hyperglycemia in Type II Diabetes Mellitus
        • Prevents blood sugar spikes after meals
        • First choice medication for Type II diabetes
        • Preferred over insulin because it does not cause hypoglycemia
      • Polycystic ovary syndrome (PCOS)
        • Off-label use
    • Side Effects and Adverse Reactions
      • Lactic acidosis
        • Rare, but lethal and if the following signs and symptoms are noticed, the provider should be notified:
          • Hyperventilation (fast, shallow breathing)
          • Drowsiness
          • Muscle pain
          • Fatigue, chills
        • Increased risk when taken with IV contrast
          • Discontinue prior to IV contrast iodine exposure (CT scan, cardiac catheterization) and resume 48 hours after
        • Increased risk when taken with alcohol
        • Avoid in patients with liver or kidney disease
      • Gastrointestinal disturbances
        • Nausea, vomiting
        • Metallic taste in mouth
      • Malabsorption of amino acids, B12, and folic acid