Administration of metformin in clinical medicine; an updated mini-review on current findings

Mahrang Hedaiaty

doi:10.15171/npj.2018.14

Abstract

Metformin is in the biguanide class that has been considered as the treatment for insulin resistance diabetes and polycystic ovarian disease. Many mechanisms have been suggested for it such as inhibition of the mitochondrial respiratory chain and mitochondrial glycerophosphate dehydrogenase, activation of adenosine monophosphate-activated protein kinase, inhibition of glucagon-induced elevation of cyclic adenosine monophosphate with reduced activation of protein kinase A, an effect on gut microbiota and activation of adenosine monophosphateactivated protein kinase. Metformin is a suppressor for transforming growth factor-β1 via directly binding and interact with transforming growth factor-β1 receptor. Lactic acidosis is one of the adverse and noxious effects of metformin. Nowadays, metformin has an important role in inflammation pathways and antioxidant pathways that can prevent or decrease kidney fibrosis, cardiac remodeling in hypertensive heart disease, and cell death in cerebral ischemia, kidney crystal formation, immunological diseases and cancer. Although there has been strong evidence for the potential harm caused by metformin, several studies have shown beneficial effects for it. Hence, it is necessary to revision and modification in contraindications for prescription of this drug

Highlights

Metformin (1, 1-dimethylbiguanide hydrochloride) is in the biguanide class that was discovered in 1922 and introduced as a medication in 1957 [1]
Many physicians believe that metformin prescription should be stopped with the presentation of severe kidney disease [7] or diabetic ketoacidosis state [8] but there is novel information about its beneficial effects
The search was performed by using combinations of the following key words and or their equivalents; chronic kidney disease, diabetes mellitus, hypertension, acute kidney injury, type 2 diabetes, end-stage renal disease, kidney, lactic acidosis, renal failure, metformin, nephrotoxicity, mitochondrial dysfunction, metformin-associated lactic acidosis, glucose transporter 4, adenosine monophosphate-activated

Summary

Introduction

Metformin (1, 1-dimethylbiguanide hydrochloride) is in the biguanide class that was discovered in 1922 and introduced as a medication in 1957 [1]. Metformin hydrochloride is soluble in water but is insoluble in acetone, ether and chloroform It has been considered as first-line therapy for insulin resistance diabetes (type 2 diabetes) as a monotherapy and combined with other medication such as pioglitazone, vildagliptin and sitagliptin [3]. It does not induce hypoglycemia [4]. There are recommendations that metformin is contraindicated in patients with renal dysfunction, abnormal creatinine clearance [9], conditions such as cardiovascular shock, septicemia and metabolic acidosis [10]

Materials and Methods

Findings

Conclusion