Metformin Pharmacology Summary
Mechanisms of Action:
• Suppresses gluconeogenesis by the liver
• Increases insulin-mediated glucose utilization in peripheral tissues, particularly after meals
• Various debated mechanisms within the gut
Administration Notes:
• 500mg once daily → 500mg 2x/daily → 1000mg 2x/day, Take with meals
Major Advantages:
• Most effective oral agent
• Does not cause hypoglycemia
• Low cost
Contraindications:
• Chronic kidney disease:
Do not initiate if eGFR < 45 mL/minute/1.73 rm2
Do not continue if eGFR < 30 mL/minute/1.73 m2
• Severe liver disease
Common Side Effects and Toxicities:
• GI side effects (e.g. diarrhea, nausea) — mitigated by slow titration
• B12 deficiency (consider routine monitoring)
• Initial concerns about causing lactic acidosis appear to be overstated
- Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedi
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