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VOL: 101, ISSUE: 40, PAGE NO: 37


- Metformin/Glucophage.


- Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin.


- Biguanide.


- Diabetes mellitus.

- Polycystic ovary syndrome.


- Renal impairment.

- Ketoacidosis.

- Should be stopped if tissue hypoxia is likely (for example, in respiratory failure, sepsis, a recent myocardial infarction or hepatic impairment).

- If iodine-containing X-ray contrast media have been used, metformin should be stopped until renal function is normal.

- General anaesthesia (metformin should be stopped two days before and restarted when renal function is normal).

- Pregnancy.

- Breastfeeding.


- Serum creatinine should be measured before treatment and twice a year thereafter during treatment.


- Anorexia.

- Nausea.

- Gastrointestinal problems including vomiting, diarrhoea and heartburn.

- Abdominal pain.

- Thrombocytopenia.

- Metallic taste in the mouth.

- Headache.

- Weakness.

- Dizziness.

- Drowsiness.

- Tinnitus.

- Fatigue.

- Vertigo.

- Agitation.

- Rash.


- Lactic acidosis.

- Decreased vitamin B12 absorption.

- Erythema.

- Hypoglycaemia.


- Risk of lactic acidosis is increased with alcohol.

- Hypoglycaemic effect of metformin is enhanced by monoamine oxidase inhibitors.


- Tablets/slow-release tablets.


- Metformin is the drug of choice for overweight patients for whom dieting has not controlled diabetes. Can also be used in patients who are not overweight and when diabetes cannot be controlled with sulphonylurea treatment.

- Advantages include lower incidence of weight gain.

- Gastrointestinal complaints are more common with higher doses.

- To avoid lactic acidosis do not use in patients with even mild renal problems.

- Store in a tight container in a cool place.

- Side-effects are common and advice about taking the drug with food or using slow-release tablets can help.


- Take with meals to avoid gastrointestinal problems.

- Notify health care staff of lactic acidosis symptoms, including hyperventilation, fatigue and myalgia.

- Must be taken daily and not discontinued abruptly.

- The patient must inform the prescriber if they have any long-term liver or kidney problems, heart failure, or if they are a heavy drinker or taking any other medication.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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