ENDO + REPRO: METFORMIN

Question 1

METFORMIN: INDICATIONS

Answer 1

• T2DM

Question 2

METFORMIN: MOA

Answer 2

• Lowers BG by increasing the response (sensitivity) to insulin
• Suppresses hepatic glucose production (glycogenolysis and gluconeogenesis)
• Increases glucose uptake and utlitisation by skeletal muscle and suppresses intestinal glucose absorption
• Reduces weight gain and gain induce weight loss, which can prevent worsening of insulin resistance and slow deterioration of DM

Question 3

METFORMIN: ADVERSE EFFECTS

Answer 3

• GI upset (nausea, vomiting, taste disturbance, anorexia and diarrhoea)
• Lactic acidosis

Question 4

METFORMIN: WARNINGS

Answer 4

• Severe renal impairment
• Dose reduction for moderately renally impaired patients
• AKI
  Severe tissue hypoxia
• Hepatic Impairment
• Withhold in acute alcohol intoxication
• Use with caution in chronic alcohol over use

Question 5

METFORMIN: INTERACTIONS

Answer 5

• Metformin must be withheld before and for 48 hours after injection of IV contrast media (e.g. for CT scans, coronary angiography) when there is an increased risk of renal impairment, metformin accumulation and lactic acidosis
• Other drugs (e.g. ACE inhibitors, NSAIDs, diuretics) with potential to impair renal function should also be used with caution (e.g. with renal function monitoring) in combination with metformin. Prednisolone, thiazide and loop diuretics elevate blood glucose, hence oppose the actions and reduce efficacy of metformin.