Biguanides (Oral Hypoglycemics)

Question 1

Biguanides

Answer 1

metformin (Glucophage)

Question 2

Therapeutic Uses

metformin (Glucophage)

Answer 2

Type 2 diabetes (drug of choice for initial therapy)
Prevention of Type 2 diabetes in high risk patients Gestational diabetes
Polycystic ovary syndrome

Question 3

Mechanism of Action

metformin (Glucophage)

Answer 3

Primarily decreases glucose production in the liver (gluconeogenesis); also enhances insulin uptake by muscle

Question 4

Adverse Effects

metformin (Glucophage)

Answer 4

Decreased appetite, nausea, diarrhea, weight loss (average 7 to 8 lbs – may be an added benefit of this drug), decreased absorption of vitamin B12 & folic acid. Rarely lactic acidosis.

Question 5

Administration

metformin (Glucophage)

Answer 5

Taken orally with a meal to avoid GI related adverse effects

Question 6

Contraindications/Precautions

metformin (Glucophage)

Answer 6

Renal. Manufacturer guidelines state that this agent is contraindicated in patients with
poor renal function. Avoid in patients > 85 years old due to impaired renal function. Avoid in clinical situations predisposing to renal dysfunction: certain surgeries or 48 hours after administration of iodinated radiocontrast dye.