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/EricsMedicalLectures/



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