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afya
Metformin
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> Biguanide for T2DM doesn't cause hypoglyc or weight gain also for PCOS and non-alcoholic fatty liver start low dose and titrate up slowly (>1/52 between increments) to avoid GI Sx ''Mechanism'' inc insulin sensitivity dec hepatic gluconeognesis ?dec GI absorption of CHO ''SE'' GI (nausea, diarrhoea, anorexia) - intolerable in 20% dec vit b12 absorption (rarely clinical problem) lactic acidosis - in liver or renal disease - rare ''CI'' CKD - review at Cr 130, eGFR 45 and stop at 150, 30 beware of lactic acidosis if tissue hypoxia - MI, sepsis, AKI, dehydration contrast nephropathy inc - iodine containing (IVP, angio) - stop on day and for 48hr post alcohol abuse sometimes used in pregnancy eg PCOS
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