June 4, 2023

General overview of metformin (brand name Glucophage)

Hi guys my name is tyler i’m a registered pharmacist in the state of ohio and today i wanted to go over the drug metformin also known as glucophage which is the brand name this information might be helpful if you take metformin or someone you know takes this drug so it’s going to get into it please bear with me this is my first video uploads so let’s see how it goes

So the uses of metformin the main use is for type 2 diabetes and unless there are contraindications which i’ll get into a little bit it’s the first line therapy for type 2 diabetes and this is a recommendation from the american diabetes association and the reason why is because it does work quite well you can see a drop and you’re able to see you around 1.5% some

Other good things there’s a low chance that we take this drug alone it will cause hypoglycemia or low blood sugar and another positive thing is that you normally don’t see weight gain and it can actually help you lose some weight in some instances which is seen as a positive and the way it works is by decreasing gluconeogenesis this is the process that essentially

Your liver produces glucose from non carbohydrate sources in your body and so basically decreases your the glucose output from your liver and also metformin helps insulin sensitivity in places like your muscles and your liver making it easier for glucose to enter those cells some of the uses for metformin that are off-label so they haven’t been approved by the fda

For these but doctors do see positive outcomes when using metformin for these so they include polycystic ovary syndrome or pcos fatty liver not due to alcohol pre-diabetes some doctors want to try to prevent you from going to a full but diagnosis and also some cases that can be used for weight loss and real quick i just want to do with the contraindications from

Metformin so basically people who have any of these should not take the drug or they should at least correct the problem before using it first we have lower kidney function and this is based on creatinine clearance which creatinine clearance may not be a totally accurate measure of kidney function but it’s really the best we have that might be a topic for another

Video so when i was in school is said anyone lower than 60 milliliters per minute that was a contraindication for using metformin but that has been changing now the cutoff is usually seen around 30 milliliters per minute some other ones liver disease which is either fully developed or progressing alcohol abuse and also dehydration you want to get this taken care of

Before either starting the drug or if you start getting sick and your fluids are low you may want to actually stop taking metformin for a while and this is mainly because your kidneys need to have fluids filtering through them i’m for metformin to leave the body now i want to go over side effects for metformin there is another one that is not on this slide i’ll

Mention at the end of the video and it’s also black box warning and that’ll be the final slide so for side effects the most common is gastrointestinal issues so this would include diarrhea nausea vomiting gas things of that nature and in some cases this can be pretty severe this is actually a major reason why some people do not take metformin area or they have to

Stop is because of these side effects so some possible ways to counteract them or to take metformin with food so it is easier on the stomach there are also extended release versions of metformin that really the drug slowly instead of all at once however these versions are usually much more expensive than this theorem immediate release so if you try these extended

Release formulations you might have a higher copay all your insurance may not cover them at all so just something to think about before you try switching other less common side effects include headache and the lack of energy and then we have the most serious side effect of metformin and this is something called lactic acidosis so basically this is a life-threatening

Event that requires an emergency medical attention immediately good thing is it’s very very rare the incidence is around 9 cases for a hundred-thousand person years so basically it means for every hundred thousand people taking metformin for a year there are around nine cases so very low chance that this could happen this still does something to be aware of and

One pretty bad thing about lactic acidosis is there really aren’t any telltale symptoms it’s impossible ones are nausea vomiting a general tire feeling hyperventilation and this is more likely to happen and people with decreased kidney function that’s why we worry about creating clearance and also dehydration if your kidneys aren’t filtering your blood this can’t

Predispose you to like the gassy doses but really you can honestly happen to anyone even if your kidneys are working fine so i mean in summary like a decid osis it’s very very rare but just something you want to watch out for some things you want to monitor while you’re taking metformin this very quickly obviously you’ll want to have your a1c checked if you’re

Taking it for diabetes at least and like i said you can’t expect to drop around 1.5 percent when you get up to the recommend knossos said it does work quite well like i said also get your serum creatinine checked at least once per year especially if you’re someone that’s kind of between the 30 to 60 creatinine clearance you may want to get it checked more often

Than that and then my final topic is i want to discuss vitamin b12 this is something that really isn’t as why they’ve known as it should be there is a black box warning with metformin that it can lower your vitamin b12 levels and this actually happens to 30% of patients that take metformin and they have found that when you take metformin it decreases your absorption

Of b12 from your diet or if you even take a multivitamin and this can lead to decreased levels in your blood it also appears that the longer you take metformin the better chance you can have it developing this issue so it is important to keep tabs on your b12 levels i would suggest getting your level checked when you first start metformin and then after that at least

Two to three years quickly just some symptoms of b12 deficiency and is usually when it gets pretty severe neurologic symptoms such as mood swings depression irritability is your film forgetful this is a general cognitive slowing this could be a sign of b12 deficiency also if you have any soreness or swelling of a tongue this is also another sign and one option you

Can consider just is to supplement with b12 whether it be just a multivitamin which most will include vitamin b12 but maybe just check the bottle or ask your pharmacist to make sure there’s also the tablet so just pad b12 in them you can usually buy those over-the-counter or the doctor could decide to give you an injection of b12 or he just could prescribe it for

You but as of anything talk with your doctor or pharmacist before you take anything every counter description that way we can prevent the side-effects and metformin from getting too serious so really that’s all i have guys i want to thank you for watching and like i said this is a brand new channel so if there’s any topics or drugs you would like to see covered

Please let me know i do work full-time so i will be able to upload daily videos but i would like to upload at least maybe once or twice a week especially if anything important comes out like maybe drug recalls or new black box warning things like that so again thanks for watching and have a great day

Transcribed from video
Metformin Overview – Metformin Side Effects, Uses, Black Box Warning By Pharmacy Update