Metformin -Quick revision card

1st line oral agent -Type 2 diabetes insulin sensitizer-enhances insulin sensitivity by increasing both peripheral glucose uptake and utilization inhibits hepatic glucose production by various mechanisms ( reduces hepatic production of glucose , decreases intestinal absorption ) helps reduce LDL cholesterol and triglyceride levels prevents CV complications of diabetes ( reduces MI by 39 % and coronary deaths by 50 % UKPDS ) can lead to mild weight loss due to anorectic effect does not cause hypoglycemia( rare )

Use in PCOS was to investigate the role of insulin resistance in the pathogenesis of the syndrome - evidence of use is conflicting

GI side effects ( diarrhoea )○ increases gl uptake in intestine -increases lactase conc , increases plasma GLP-1 conc , increases bile acid pool within the intestine and alters the microbiome Vitamin B12 and folate deficiency Lactic acidosis ( higher risk in subjects with CKD ) severe renal failure ( avoid GFR < 30 )

Immediate release 500 & 850 mg Oral solution 500 mg /mL Titrate dose slowly Usual maximum is 2gm daily Maximum recommended is 3 gm daily in 3 divided doses.

MR 500 mg and 750 mg tablets consider in adults who are intolerant of...