It’s main use is in obese pt with NIDDM either alone or in
combination with a sulfonylureas.Metformin has an anorexic effect which helps
to reduce wt in the obese. Less used now a days .They causes sever lactic
acidosis in pt with renal disease, hepatic disease,cardiopulmonary
dysfunction,alcoholism.They also cause diarrhoea with vit
deficiency.
Mechanism of action:
[A]The activity of biguanide is not dependent on the
presence of functioning pancreatic β cells for their hypoglycemia action.
[B]They are appropriately termed ‘englycemic
agents’.Because they cause hypoglycemia in hyperglycemia condition.The effect
on normal blood glucose level is more or less zero.
They act by:
1) Direct stimulation of glycolysis in
tissue which increase glucose removal from blood.
2) Slowing of glucose absorption from
gut.
3)
Increasing insulin binding to insulin receptor.
4)
↓ Plasma glucogon level.
Indications of biguanides/Metformin:
1)
Type II.
2)
Obese patient.
3)
When Sulfonylurease fail.
Adverse effects Biguanide/Metformin:
·
Anorexia.
·
Nausea,vomting.
·
Diarrhoea.
·
Abdominal pain.
·
Lactic acidosis.
·
Erythema.
·
Hepatitis.
·
Pruritus and urticaria.
·
Derease Vitamin-B12 absorption.
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