Metformin: new benefits in the light of evidence-based medicine

Characteristics of the drug

Metformin is considered a hypoglycemic drug that is often prescribed to diabetic patients. The drug can be purchased at pharmacies in tablet form. The product has an average cost of 93 – 465 rubles. Analogues of the drug are Siofor, Metformin - Teva. The active ingredient of the drug is metformin hydrochloride. Tablet forms can have the following dosages: 500 mg, 850 mg, 1000 mg.

The active substance inhibits the process of gluconeogenesis in the liver tissue and reduces the concentration of fatty acids. The medicine prevents the oxidation of fat molecules. The product facilitates the absorption of glucose molecules. Metformin is not able to change the amount of insulin in the blood. The drug promotes weight loss.

Metformin is permitted for use in diabetic patients. The medicine can be used in adult patients and children over 10 years of age. The drug can be used simultaneously with insulin or as monotherapy.

Restrictions on prescribing the medicine:

• metabolic acidosis;
• coma, precoma in patients with diabetes;
• serious impairment of the kidneys and liver;
• severe infectious pathology;
• hypoxic conditions (heart pathologies, respiratory dysfunction);
• intravenous administration of drugs containing iodine for X-ray examinations and computed tomography;
• poisoning from alcohol-containing drinks and medications;
• patients under 10 years of age;
• allergy to the components of the drug.

The medicine should be used carefully in patients with serious pathologies of the kidneys and liver, patients over 60 years of age. The drug should be used carefully in patients 10-12 years of age.

The medicine is not prescribed during pregnancy and breastfeeding. In this group of patients, the effect of the drug on the body has not been fully studied. The drug should not be combined with alcohol-containing drugs and drinks, glucocorticosteroid hormones, diuretics, antihypertensive drugs and other drugs.

A serious complication of Metformin overdose is lactic acidosis. High dosages can also provoke a hypoglycemic state. Lactic acidosis and hypoglycemia can lead to a deterioration in the patient's condition, which is life-threatening.

Metformin

Metformin

(English
metformin
) is a hypoglycemic (diabetic-lowering) drug of the biguanide class for the treatment of type 2 diabetes mellitus, especially in overweight patients, as well as for the treatment of obesity in patients with type 2 diabetes.

Metformin is a chemical compound

Metformin, as a chemical substance, is N,N-dimethylimdicarboimide diamide. The empirical formula of metformin is C4H11N5. Molecular weight 129.164 g/mol.

Metformin is a drug

Metformin is the international nonproprietary name (INN) of the drug. According to the pharmacological index, metformin belongs to the group “Hypoglycemic synthetic and other drugs”. According to ATC, metformin is included in the group “A10 Drugs for the treatment of diabetes mellitus” and has the code A10BA02. Metformin is used as part of various combined oral hypoglymic drugs. A number of combinations are assigned separate ATX codes:

• A10BD02 Metformin and sulfonamides
• A10BD03 Metformin and rosiglitazone
• A10BD05 Metformin and pioglitazone
• A10BD07 Metformin and sitagliptin
  

  Sugamet XR (metformin + evogliptin)

• A10BD08 Metformin and vildagliptin
• A10BD10 Metformin and saxagliptin
• A10BD11 Metformin and linagliptin
• A10BD13 Metformin and alogliptin
• A10BD14 Metformin and repaglinide (since 2014)
• A10BD15 Metformin and dapagliflozin (since 2014)
• A10BD16 Metformin and canagliflozin (since 2015)
• A10BD17 Metformin and acarbose (since 2015)
• A10BD18 Metformin and gemigliptin (since 2015)
• A10BD20 Metformin and empagliflozin (from 2021)
• A10BD22 Metformin and evogliptin (from 2021)
• A10BD23 Metformin and ertugliflozin (from 2021)
• A10BD25 Metformin, saxagliptin and dapagliflozin (since 2019)
• A10BD26 Metformin and lobeglitazone (from 2021)

Indications for use of metformin

Metformin is indicated for diabetes mellitus (including those combined with obesity):

• non-insulin-dependent (type 2), including in overweight patients and no effect of treatment due to diet changes
• insulin-dependent (type 1), as an adjunct to insulin, to prevent increased obesity

The American Diabetes Association recommends the use of metformin as first-line treatment for patients with type 2 diabetes.
Metformin should be prescribed immediately when a patient has type 2 diabetes mellitus, unless there are contraindications to its use*. *Pharmacologic Therapy for Type 2 Diabetes: Synopsis of the 2017 American Diabetes Association Standards of Medical Care in Diabetes // Ann Intern Med. 2021, DOI: 10.7326/M16-2937.

Indications for the use of metformin in the treatment of obesity

The World Gastroenterological Organization includes metformin in the list of drugs used in the treatment of obesity in patients with a body mass index of at least 27 kg/m2 (WGO. Obesity. Practical recommendations):

• patients with obesity and diabetes
• women with obesity and polycystic ovary syndrome
• obese patients receiving antipsychotic drugs leading to insulin resistance

At the same time, there are studies proving the ineffectiveness of the use of metformin for the treatment of obesity in children and adolescents under 18 years of age (S. McDonagh etal, JAMA Pediatr. Dec 16, 2013).

How to take metformin and dosage

Metformin is taken orally during or after meals, several times a day. The dose is selected depending on the level of glucose in the blood and taking into account whether the patient receives insulin or not. If the patient does not receive insulin, the initial dose in the first 3 days is 500 mg of metformin 3 times a day or 1 g 2 times a day. The next 10 days - 1 g of metformin 3 times a day. Next, the dose is prescribed based on the level of glucose in the blood and urine. The maintenance dose is 100-200 mg per day.

Side effects of metformin

Side effects during metformin therapy: metallic taste in the mouth, anorexia, diarrhea, nausea, vomiting, flatulence, abdominal pain, which decreases when taken with meals, rash, dermatitis, lactic acidosis (rare).

Metformin is dangerous for patients with high creatinine levels

Metformin is recommended as first line treatment for patients with type 2 diabetes. However, it is contraindicated in patients with impaired renal function due to the possible risk of lactic acidosis. Metformin should be used with caution in the treatment of patients with mild to moderate chronic kidney disease. Metformin use in patients with type 2 diabetes and a serum creatinine concentration greater than 530 µmol/L are associated with a significantly increased risk of all-cause mortality compared with the risk of mortality in patients not taking metformin (Hung SC, Chang YK, Liu JS, et al. Metformin use and mortality in patients with advanced chronic kidney disease: national, retrospective, observational, cohort study. Lancet Diabetes Endocrinol 2015;3:605–14).

Professional medical publications regarding the use of metformin

• Polunina T.E. Pathology of the gastrointestinal tract in diabetes mellitus // Effective pharmacotherapy. Gastroenterology. 2011. No. 5. pp. 36–42.

Many people with diabetes have problems with anorectal function, they have a constant feeling of urgency and a constant need to go to the toilet.
The use of metformin is also often the cause of frequent bowel movements. Therefore, to understand the causes of symptoms (diarrhea, fecal incontinence, frequent stools), it is important to find out from the patient exactly what symptoms were observed before starting to take metformin (Leites Yu.G. et al.). On the website in the literature catalog there is a section “Endocrinological diseases associated with gastrointestinal diseases” containing, among other things, works addressing the treatment of diabetes.

Use of metformin during pregnancy, breastfeeding, children and the elderly

Metformin is not recommended for pregnant and nursing mothers, children and persons over 65 years of age.
Metformin has been assigned a risk category for the fetus when used by pregnant women according to the FDA "B" (animal studies have not revealed the risk of negative effects on the fetus; there have been no adequate studies in pregnant women).

In the United States, metformin is not recommended for children under 10 years of age, and metformin in the form of extended-release capsules is not recommended for children under 17 years of age.

Trade names of drugs with the active substance metformin

The following drugs with the only active ingredient metformin are (were) registered in Russia: Bagomet, Glycon, Gliminfor, Gliformin, Glucophage, Glucophage Long, Langerin, Metadiene, Metospanin, Metfogamma 500, Metfogamma 850, Metfogamma 1000, Metformin, Metformin MV-Teva, Metformin-BMS, Metformin-Canon, Metformin-Richter, Metformin-Teva, Metformin hydrochloride, Nova Met, NovoFormin, Siofor 500, Siofor 850, Siofor 1000, Sophamet, Formetin, Formin Pliva.
Brands of metformin in the USA: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet.

Some instructions from manufacturers for the medical use of drugs containing the only active ingredient metformin (pdf):

• “Metformin-Richter. Information for medical workers and specialists”, Gedeon Richter company
• “Instructions for medical use of the drug Glucophage”, film-coated tablets, 500, 800 and 1000 mg, Nycomed company, 08/14/2012.
• “Instructions for medical use of the drug Glucophage Long,” extended-release tablets, 500 mg, Nycomed company, 09/03/2012 with Amendment No. 1 of 02/08/2013.
• “Instructions for medical use of the drug Glucophage Long”, extended-release tablets, 750 mg, Nycomed company, 03/01/2011 with Amendment No. 2 of 04/08/2013.
• US instructions (in English): “Glucophage (metformin hydrochloride), Tablets. Glucophage XR (metformin hydrochloride), Extended-Release Tablets”, January 2009

Metformin protects cells from radiation exposure

Researchers from ITEB RAS, Pushchino have found that metformin helps remove dysfunctional cells from animal tissues, accelerates the removal of fragments of dead cells and fragments of their DNA from the body.
increasing their survival after exposure to ionizing radiation, and thus protects cells from the effects of radiation (S. Abdullaev, G. Minkabirova, E. Karmanova, V. Bruskov, A. Gaziev. Metformin prolongs survival rate in mice and causes increased excretion of cell-free DNA in the urine of X-irradiated rats, Mutation Research/Genetic Toxicology and Environmental Mutagenesis, V. 831, 2021, pp 13-18, ISSN 1383-5718) Metformin has contraindications, side effects and application features, it is necessary consultation with a specialist.

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Rules for writing a prescription

Metformin is dispensed at pharmacies, subject to a prescription. The Latin prescription for Metformin must be written correctly. If there are errors in the document, it will be rejected by the pharmacist.

In Latin, the prescription for Metformin allows you to prescribe the form of the drug, dosage, and rules of administration. The document begins with the word Recipe (take). It is written on a new line. The word Recipe can be abbreviated as follows: Rp. This designation must be followed by a period and a colon (Rp.:).

After the word Recipe, write the name of the drug in Latin, the dosage and form of the medicine. In this case, the doctor will write the following: “Tabulettas Metformini 1.0.” The word Tabulettas can be abbreviated as Tab.

After describing the dose, form and name of the medicine, the doctor prescribes in the second line of the prescription the number of forms that the pharmacist must dispense. Example: “Da tales doses numĕro 30” - give out such doses in number 30. This sentence can be shortened as follows: D. td N 30.

After the number of doses, the doctor prescribes a signature. The signature reveals the rules for using the drug. The third line of the document begins with the word Signa (indicate). It is abbreviated as follows: S. In the signature, the doctor writes how many tablets the patient should take, and how often. This concludes the writing of the prescription. After the signature there is a sign - #. It indicates that the recipe is complete.

In Latin, the prescription for Metformin is written as follows:

• Rp.: Tab. Metformini 1.0
• DTD N 30
• S. 1 tablet 2 times a day with meals
• #

First aid

Most deaths from alcohol poisoning are associated with delayed medical care. If you suspect severe intoxication, you should urgently call a doctor.

Before his arrival:

• do not leave the person alone, even if he has fallen asleep or lost consciousness. If he starts to feel sick, he may choke on the vomit;
• It is better if the patient stays awake; you should not let him fall asleep;
• if he is vomiting but cannot get up, place him on his side to prevent him from choking;
• if there are no problems with swallowing, you can give a sorbent. This will reduce the absorption of alcohol from the stomach.

What not to do:

• give a person to drink alcohol, coffee, milk, etc.;
• send him under a cold or contrast shower or into the bath;
• try to induce vomiting, rinse the stomach (danger of internal bleeding);
• force him to walk, stand on his feet (it’s better to sit him down or lay him down comfortably).

In cases of alcohol poisoning, people most often die due to breathing problems. It is associated with the accumulation of vomit in the oral cavity and trachea. If a person is not breathing, is wheezing, or wheezing, the upper respiratory tract needs to be cleared. To do this, place him on his side, and remove the vomit with his fingers without pushing it deeper. If the victim is unconscious, he should lie so that the tongue does not fall into the larynx.

Health care

Before hospitalization the following is performed:

• breathing control. To ensure ventilation of the lungs, the oral cavity is cleared of vomit, and the tongue is fixed with a holder. It is possible to use an airway; in case of coma, intubation is necessary;
• gastric lavage. If the patient is unconscious, it is performed through a probe;
• maintenance therapy. Intravenous administration of glucose solution, vitamins, insulin or other drugs - the set is determined by the patient’s condition;
• symptomatic treatment. Relieving pain, restoring normal breathing, lowering blood pressure, etc.;
• if the body temperature is low, the person freezes - warming up (with heating pads).

After providing primary care for acute ethanol poisoning, doctors at the NarcoDoc clinic recommend hospitalization in a hospital. In the clinic, they continue to monitor the patient’s condition, treat him, and relieve possible complications of intoxication.

Contact our specialists for treatment of alcoholism followed by rehabilitation, call: +7