Biguanides

Question 1

Metformin (g)

Answer 1

Glucophage (XR); Glumetza; Riomet (b)

Question 2

MOA

Answer 2

decreases hepatic glucose production, decreases intestinal glucose absorption, improves insulin sensitivity.

Question 3

common adverse effects

Answer 3

diarrhea (most common)
nausea
Vit B12 depletion

Question 4

rare adverse effects

Answer 4

BLACK BOX WARNING: lactic acidosis

Question 5

counseling pts.

Answer 5

GI effects are transient (~2 weeks).
take with food to help with nausea.
start low and go slow.

Question 6

clinical pearls

Answer 6

1st line med for T2DM.
Max effective dose: 2,000 mg
if pts cannot tolerate IR formulation, can try ER.
avoid with poor renal function.