Metformin/ja: Difference between revisions

'''メトホルミン'''（'''Metformin'''）は、'''グルコファージ（'''Glucophage'''）などの商品名で販売されており、特に[[overweight/ja|太りすぎ]]の[[diabetes mellitus type 2/ja|2型糖尿病]]の治療のための主要な[[first-line treatment/ja|第一選択]]医薬品である。また、[[polycystic ovary syndrome/ja|多嚢胞性卵巣症候群]]の治療にも用いられる。[[antipsychotic/ja|抗精神病薬]]を服用している人の[[metabolic syndrome/ja|メタボリックシンドローム]]のリスクを軽減するために、適応外の補助薬として使用されることもある。

[[Linagliptin]] combined with metformin hydrochloride is sold under the brand name Jentadueto. As of August 2021, linagliptin/metformin is available as a [[generic medicine]] in the US.

=====SGLT-2 inhibitors=====

There are combinations of metformin with the [[SGLT-2 inhibitor]]s [[Dapagliflozin/metformin|dapagliflozin]], [[Empagliflozin/metformin|empagliflozin]], and [[Canagliflozin/metformin|canagliflozin]].

===== Sulfonylureas =====

[[Sulfonylurea]]s act by increasing insulin release from the [[beta cell]]s in the [[pancreas]].

Metformin is available combined with the sulfonylureas [[glipizide]] (Metaglip) and [[glibenclamide]] (US: glyburide) (Glucovance). Generic formulations of metformin/glipizide and metformin/glibenclamide are available (the latter is more popular).

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===== Meglitinide =====

[[Meglitinide]]s are similar to sulfonylureas, as they bind to beta cells in the pancreas, but differ by the site of binding to the intended receptor and the drugs' affinities to the receptor. As a result, they have a shorter duration of action compared to sulfonylureas, and require higher blood glucose levels to begin to secrete insulin. Both meglitinides, known as nateglinide and repanglinide, is sold in formulations combined with metformin. A [[repaglinide]]/metformin combination is sold as Prandimet, or as its generic equivalent.

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===== Triple combination =====

The combination of metformin with [[pioglitazone]] and glibenclamide is available in India as Accuglim-MP, Adglim MP, and Alnamet-GP, along with the Philippines as Tri-Senza.

The combination of metformin with pioglitazone and [[lipoic acid]] is available in Turkey as Pional.

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=== Impurities ===

{{See also|Ranitidine#impurities}}

In December 2019, the US FDA announced that it learned that some metformin medicines manufactured outside the United States might contain a nitrosamine impurity called [[N-nitrosodimethylamine]] (NDMA), classified as a probable human carcinogen, at low levels. Health Canada announced that it was assessing NDMA levels in metformin.

In February 2020, [[Health Canada]] announced a recall of Apotex immediate-release metformin, followed in March by recalls of Ranbaxy metformin and in March by Jamp metformin.

In May 2020, the FDA asked five companies to voluntarily recall their [[sustained-release]] metformin products. The five companies were not named, but they were revealed to be Amneal Pharmaceuticals, Actavis Pharma, Apotex Corp, Lupin Pharma, and Marksans Pharma Limited in a letter sent to [[Valisure]], the pharmacy that had first alerted the FDA to this contaminant in metformin via a Citizen Petition.

In July 2020, Lupin Pharmaceuticals pulled all [[Lot number|lots]] (batches) of metformin after discovering unacceptably high levels of NDMA in tested samples.

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== Research ==

* [[Non-alcoholic fatty liver disease]]

* [[Premature puberty]]

* [[anti-cancer|Cancer]]

* [[Cardiovascular disease]] in people with diabetes

* [[Ageing|Aging]]

While metformin may reduce body weight in persons with [[fragile X syndrome]], whether it improves neurological or psychiatric symptoms is uncertain. Metformin has been studied in vivo (''[[Caenorhabditis elegans|C. elegans]]'' and [[Acheta domesticus|crickets]]) for effects on aging. A 2017 review found that people with diabetes who were taking metformin had lower all-cause mortality. They also had reduced cancer and cardiovascular disease compared with those on other therapies.

There is also some research suggesting that although metformin prevents diabetes, it does not reduce the risk of cancer and cardiovascular disease and thus does not extend lifespan in non-diabetic individuals. Furthermore, some studies suggest that long-term chronic use of metformin by healthy individuals may develop [[vitamin B12 deficiency]].