Biguanides
(Metformin)
Embedded Files
Introduction
Illustrated mechanism of action
Examples of Medication Brand Names (with Images)
Indication
Side Effects
Precautions & Contraindications
Monographs
Reference
1-Introduction
Biguanides are a class of oral medications primarily used in the treatment of type 2 diabetes mellitus. The most commonly prescribed drug in this class is (metformin), which is considered the first-line treatment due to its efficacy, safety profile, and additional health benefits.
_History of metformin
-Metformin was rediscovered in the search for antimalarial agents in the (1940s) and, during clinical tests, proved useful to treat influenza when it sometimes lowered blood glucose. This property was pursued by the French physician Jean Sterne, who first reported the use of metformin to treat diabetes in (1957)
Illustrated mechanism of action
Metformin has been shown to act via both AMP-activated protein kinase (AMPK)-dependent and AMPK-independent mechanisms; by inhibition of mitochondrial respiration but also perhaps by inhibition of mitochondrial glycerophosphate dehydrogenase, and a mechanism involving the lysosome.
Metformin has been shown to act via both AMP-activated protein kinase (AMPK)-dependent and AMPK-independent mechanisms; by inhibition of mitochondrial respiration but also perhaps by inhibition of mitochondrial glycerophosphate dehydrogenase, and a mechanism involving the lysosome.
Examples of Medication Brand Names
Metformin
metformin HCL 500mg
Janumet
sitagliptin/metformin
50mg/1000mg
Andoglycemic
metformin HCL
1000mg
Glucophage
metformin HCL
1000mg
Indication
Type 2 diabetes mellitus (T2DM)
Prediabetes
Type 1 diabetes mellitus (T1DM)
Gestational diabetes mellitus (GDM)
Polycystic ovary syndrome (PCOS)
Antitumor or antiaging effect of metformin
Cardiovascular or neuroprotective effects
Antipsychotic-induced weight gain
side effects
-Feeling sick (nausea)
-Being sick (vomiting)
-Diarrhoea
-Stomach-ache
-Loss of appetite
-A metallic taste in the mouth
Precautions &Contraindications of Metformin
1. Severe Renal Impairment
eGFR (estimated Glomerular Filtration Rate) less than 30 mL/min/1.73m².
2. Acute Metabolic Acidosis (including Lactic Acidosis)
Metformin increases the risk of lactic acidosis, a rare but serious condition.
3. Severe Hepatic Impairment Liver dysfunction can reduce the body’s ability to clear lactate and metabolize the drug properly.
4. Conditions Associated with Hypoxia Such as acute heart failure, recent myocardial infarction, or shock—these increase the risk of lactic acidosis.
5. Use of Iodinated Contrast Media Metformin should be temporarily discontinued before and after radiological procedures involving iodinated contrast to avoid kidney complications.
6. Pregnancy (with caution) Generally avoided unless clearly needed; insulin is usually preferred, but metformin may be used in certain cases like PCOS under medical supervision.
7. Hypersensitivity Allergy to metformin or any of its components.
Drug_monograph_(2)[1] sherif (4).pdfMonograph 0f Metformin
Monograph 0f Metformin
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