In this video I have discussed various concepts related to Metformin in a simplified way.
Hi friends in this video we will talk about metformin what is metformin it is an oral anti-diabetic drug it belongs to the bio night class and it is the only drug available in this class how does it act it has a lot of actions but its primary action is to activate the enzyme emp dependent protein kinase also called a mpk so let’s look at the primary action metformin
Activates ampk in the liver therefore it blocks hepatic gluconeogenesis therefore it results in decreased glucose production by the liver it is a lot of other actions such as it causes increased glucose uptake increased insulin sensitivity increased fatty acid oxidation and decreased intestinal glucose absorption an important point to note is that unlike many
Other anti-diabetic drugs metformin does not cause the release of insulin and therefore it does not cause hypoglycemia let us have a look at the adverse effects metformin is generally well tolerated however the most common adverse effects are those of the gastrointestinal system these occur in 10 to 25 percent of patients and includes nausea vomiting diarrhea
Abdominal discomfort and metallic taste these are transient in nature and usually abate with time however they may be decreased by starting with low doses of metformin or taking metformin along with the meals the other adverse effect includes vitamin b12 deficiency it usually occurs on long-term therapy and is probably due to malabsorption of becoming b12 although
These are manageable adverse effects however one major concern is lactic acidosis although this is rare but it is a very serious adverse affect lactic acidosis occurs more commonly in patients with renal failure before moving to lactic acidosis it is worth noting that 1 metformin is not metabolized in the body and 2 metformin is excreted unchanged by the kidneys
So let us see what in renal failure in renal failure when the patient’s kidney is impaired the metformin excretion is decreased this results in increased in metformin levels in the blood we have already discussed that the primary action of metformin is to block hepatic local new genesis we also know that the main substrates for gluconeogenesis are lactate alanine
And blister all which are converted to glucose in the liver so once metformin level starts writing in the blood due to renal failure it impairs or hampers hepatic utilization of lactic acid this leads to an increased level of lactic acid in the blood this may increase the risk of lactic acidosis in the patient but risks apart metformin has many distinct advantages
Over other anti-diabetic drugs such as it is an insulin sparing drug which means that it has no direct effect on insulin secretion therefore it does not cause hypoglycemia it also does not cause weight in so it is preferred in obese diabetic patients due to this glaring advantages metformin is the first sign treatment for type 2 diabetes mellitus how is it used
In these patients it may be given either as a mono therapy which means that it can be used alone or it can be given in combination therapy where it can be combined with virtually every other drug used in type 2 diabetes mellitus hence it may be combined with sulfonylureas repa glenoid thiazolidinediones or insulin thanks for watching if you find this video useful
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Transcribed from video
METFORMIN – Pharmacology By Pharmacology Made Simple By Dr. Yogesh Gulati
