Abstract
Metformin or dimethyl biguanide is the oral antidiabetic drug with the most extensive experience of prescribing in the clinical practice of type 2 diabetes mellitus. In this chapter, we reviewed the indications, contraindications, and adverse drug reactions (ADR) of metformin. The most significant adverse drug reactions of metformin are lactic acidosis, allergies, hypoglycemia, vitamin B12 deficiency, altered taste, and gastrointestinal intolerance. Metformin is contraindicated in severe chronic diseases (hepatic, renal, and cardiac failure) or acute complications of diabetes (ketoacidosis and hyperosmolar state). Metformin is considered by all international guidelines the first-line treatment in type 2 diabetes mellitus (T2DM) together with medical, nutritional therapy. It is one of the most prescribed molecules worldwide. Furthermore, metformin can also be prescribed for other diseases like polycystic ovary syndrome or prediabetes (impaired glucose tolerance/fasting hyperglycemia). Recent studies have shown positive results concerning the use of metformin for cardiovascular or neuroprotective effects; also, several scientific papers are suggesting an antitumor or antiaging effect of metformin. Having such an excellent efficiency in practice, thus predicting its sustainability on the pharmaceutical market, research is directed toward characterizing metformin action on bacteria genera in the gut. Modifying the microbiota composition by pre- and probiotics could improve metformin action.
Highlights
Metformin or dimethyl biguanide has its origin in traditional herbal medicine (Galega officinalis or goat’s rue) that is rich in guanidine
We will review in the following pages the indications, contraindications, and adverse drug reactions (ADR) of metformin and the single biguanide approved globally for use nowadays
A randomized clinical trial used metformin in a rapidly escalated dose after a chronic obstructive pulmonary disease (COPD) exacerbation and showed no amelioration in glycemic profile. This could be since mean in-hospital glycemia was assessed and it usually takes 1–2 weeks for metformin to reach its maximum hypoglycemic potential; there were no cases of lactic acidosis, and mean serum lactate was similar in the intervention and placebo group [87]
Summary
Metformin or dimethyl biguanide has its origin in traditional herbal medicine (Galega officinalis or goat’s rue) that is rich in guanidine. Guanidine was proven to have the capacity to lower blood glucose and was used as an antidiabetic treatment from the 1920s to 1930s. The medicine was valued again between the 1940s and 1950s when Jean Sterne observed the low blood glucose values of patients that were treated with metformin for influenza. We will review in the following pages the indications, contraindications, and adverse drug reactions (ADR) of metformin and the single biguanide approved globally for use nowadays. An ADR according to the World Health Organization is “a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of a disease, or the modification of physiological function.”. A contraindication represents “something (such as a symptom or condition) that makes a particular treatment or procedure inadvisable” [3]
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