NAME: Metformin (Glucophage)MOA: Decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilizationClinical: First-line treatment of T2DM, prevention of T2DM in individuals with pre-diabetesADME: onset is days with maximum effect in about 2 weeks, high Vd due to partitioning into liver, kidney, and GI tract, 90% excreted unchanged in urine, CONTRAINDICATED in renal failure (GFR < 70)AE: Gastrointestinal (most common, titrate to desired dose slowly, take with food, GI discomfort essens over several weeks, XR may reduce GI effects), malabsorption of vitamin B12 and folate, metallic taste, lactic acidosis with renal insufficiency (rare)Contraindications: Absolute contraindications: severe renal impairment (GFR < 30 ml/min/1.73 m2), known metformin hypersensitivity, acute or chronic metabolic acidosis, including diabetic ketoacidosis (treat DKA with insulin)Relative contraindications: 30 < GFR < 45 30 ml/min/1.73 m2, pause metformin for 48 hours following radiology with contrast, alcoholic patients, patients with severe hepatic impairmentInteractions: Alcohol, others. Check for drug interactions

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