RECENTLY, there has been a lot of focus on Metformin, an old anti-diabetic drug now under consideration as a “wonder drug” due to its multiple beneficial effects, as highlighted by Senior Faculty Editor of Harvard Health Publishing.

Derived from a herb, Metformin was first discovered in Europe in 1918, but due to the side effect profile of a more potent and toxic molecule called Phenformin, it was shelved and later rediscovered in the 1950s. The FDA (Food and Drug Authority) only approved Metformin in 1955.

Today, Metformin is the most widely prescribed oral biguanide, due to efficacy, cost and availability. It is the first-line drug of choice for Type 2 Diabetes and Pre-diabetes, where it enhances the body’s response to naturally producing insulin, inevitably lowering blood sugar levels, both randomly and on a long-term basis, as evidenced in the RBS (random blood sugar) and HbA1C (glycosylated hemoglobin) results, respectively. If used in the pre-diabetic stage, the onset of full-blown diabetes is delayed, or may altogether prevent Diabetes. It is also safe in gestational diabetes (diabetes developed during pregnancy).

Additionally, Metformin is not exclusively used for just diabetes; it is used off-licensed for PCOS (polycystic ovarian syndrome) and infertility in women.

Various studies have shown additional benefits for Metformin users, especially in cardiovascular health, reducing the chances of heart attack and strokes. A particular study captured how breast, colon and prostate cancers were seemingly prevented in Type 2 diabetics who used Metformin over a ten-year period.

Though it is not recommended to use Metformin for weight control in non-diabetics, there is a boost in weight loss for diabetics, and for patients who gained weight caused by anti-psychotic medications.

Metformin is considered to slow the aging process, and to increase longevity due to its newly-found anti-oxidant effect, as well as enhancing the health of blood vessels. Age-related diseases are also minimised due to improving the body’s response to insulin.

Some research supports the fact that less incidents of dementia and stroke among Metformin users occur, whilst others have some concerns over long-term use of Metformin and memory loss. However, the clinician’s opinion that the benefits outweigh the risks continues to endorse the use of Metformin.

Noteworthy is that these findings were established exclusively for diabetics, since the studies were designed to target this particular group. So, parallels should not conclude similar benefits for non-diabetics.

Metformin is eliminated from the body via the kidneys. If, however, there is a reduced capacity of the kidney to pass out Metformin, such as if the GFR (glomerular filtration rate) is 45ml per minute per 1.73 square meter, then dose adjustments will be required. Below 30ml per minute per 1.73 square meter, Metformin should be discontinued. Likewise, Metformin is contraindicated in patients with serum creatinine levels that are greater than or equal to 1.4mg per milliliters for females and 1.5mg per milliliters for males.

The side effects of Metformin are generally rare, mild and transient such as nausea, vomiting, diarrhea, loss of appetite, and a metallic taste in the mouth. However, severe side effects may only occur if patients with kidney failure are not monitored, and Metformin excretion is impeded. This may cause the drug to build up in the body, resulting in lactic acidosis, which has similar symptoms to the side effects mentioned above, with the inclusion of muscle cramps, fast and shallow breathing, and tiredness or weakness.

In another study, it was estimated that 6.3 out of 100,000 patients per year may experience Metformin-induced lactic acidosis, of which 50 per cent mortality rate was associated.

Contrary to propaganda press, Metformin does not cause kidney disease, but its use may be restricted in persons with already decreased kidney function or on dialysis, since it is mostly excreted via this route. So, dose adjustments downwards will be required.

Some long-term users of Metformin have complained about nerve damage. Also, Vitamin B12 levels in the blood usually drop over years of using Metformin, which may be subsequently supplemented if the physician deems it appropriate.

It has been established that uncontrolled diabetes may cause memory loss, nerve damage, sexual dysfunction in men, and kidney degradation.

On the other hand, there are controversial claims that long-term use of Metformin may cause sexual dysfunction in men, due to interference of testosterone production. But the evidence is not conclusive, and hence should not deter men from using it, since Metformin is actually used as an adjunct in studies of diabetic men with erectile dysfunction. The answer of its benefit may lie in the time of commencing treatment, since addressing the problem early protects against the damage done from the disease.

In recent years, there were some batch recalls of the extended release (ER) versions of Metformin, which affords you less frequent dosing. Since 2020, some brands were found to contain NDMA (n-nitrosodimethylamine), a carcinogenic (cancer-causing) drug. However, it must be reiterated that patients were advised not to discontinue their treatment, since in doing so, you may cause other serious consequences. Safe options are currently available on the market.

This medication should not be crushed, and should be taken with meals, with a full glass of water to alleviate the side effects on the stomach and bowels.

So, in summary, Metformin, along with a controlled diet and exercise programme, not only controls blood glucose levels in Type 2 Diabetes, but also prevents kidney damage, blindness, nerve problems, sexual problems and loss of limbs. Inevitably, with controlled blood sugar levels, the chances of a heart attack and strokes are diminished.

For further discussion, contact the pharmacist of Medicine Express PHARMACY, located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic, kindly forward them to: medicine.express@gmail.com, or send them to 223 Camp Street, N/burg. Tel #225-5142.