Metformin (Glucophage) - Uses, Dose, MOA, Brands, Side effects

Metformin (Glucophage) is an antidiabetic medicine that improves glycemic control by reducing hepatic glucose production and increasing insulin sensitivity.

It is used for the management of type 2 Diabetes Mellitus as an adjunct to diet and exercise. It is considered to be the preferred initial treatment if tolerated and no contraindications to treatment exist.

  • It is also used as an off-label treatment in adults in the following conditions:

    • Antipsychotic-induced weight gain

    • Prevention of Type 2 Diabetes Mellitus

    • Treatment of Gestational Diabetes Mellitus

    • Polycystic ovary syndrome (PCOS)

    • For the treatment of oligomenorrhea due to PCOS

    • For the prevention of ovarian hyperstimulation syndrome (OHSS) in females with PCOS.

Metformin Dose in the treatment of Antipsychotic-induced weight gain:

  • Immediate-release:

    • 750 mg - 2000 mg orally daily in 2 - 3 divided doses.
    • It should be initiated in a dose of 250 mg two times a day and gradually increased at a weekly interval to minimize gastrointestinal side effects.
  • Extended-release:

    • 1 - 2 gm orally once a day.
    • It may be initiated as 500 mg orally once a day and titrated upwards in 500 mg increments every 2 - 6 weeks if tolerated.

Metformin Dose in the prevention of type 2 Diabetes mellitus (as off-label use):

Note:

It is advised in selected patients with prediabetes. Individuals who may benefit from therapy include:

    • Those with a BMI of more than 35 kg/m²
    • Age less than 60 years
    • Women with a history of gestational diabetes mellitus in whom modification in diet and lifestyle interventions fail to improve glycemic indices
  • Immediate-release:

    • 850 mg orally once a day for one month, then increase to 850 mg two times a day.

Metformin Dose in the treatment of type 2 Diabetes mellitus:

  • Immediate-release tablets:

      • 500 mg orally once or twice a day or
      • 850 mg orally once a day
    • Dosage adjustments:

      • The dose should be gradually increased to minimize gastrointestinal adverse effects in increments of 500 or 850 mg every 7 days.
    • Usual maintenance dosage:

      • 1 g orally two times a day or
      • 850 mg orally two times a day.
    • Maximum:

      • The usual maximum dose is 2.55 g/day.
      • Doses of more than 2 gms should be administered in three divided doses.
  • Extended-release tablets:

      • 500 mg - 1 g orally once a day
  • Dosage adjustments:

    • The dose should be gradually increased in increments of 500 mg every week to minimize Gastrointestinal adverse effects.
  • Maximum dose:

    • 2 g/day.
    • The maximum dose may be given in two divided doses if glycemic control is not achieved.

Off label use as an alternative agent in the treatment of Gestational diabetes mellitus:

  • Immediate-release:

    • 500 mg orally once or two times a day
    • The dose may be increased gradually over one to two weeks to a maximum dose of 2.5 gm daily in 2 - 3 divided doses.
    • If target glycemic control is not achieved, insulin may be added to metformin.

Note: The preferred therapy in gestational diabetes mellitus is insulin as it does not cross the placenta.


Metformin Dose in the treatment of Polycystic ovary syndrome (PCOS):

Note: It is no longer recommended for anovulatory infertility in women with PCOS.


Off label use as an alternative treatment agent in patients with oligomenorrhea due to PCOS:

  • Immediate-release:

    • 1.5 - 2 g orally daily in 2 - 3 divided doses to minimize gastrointestinal adverse effects.
    • The dose should be initiated with 500 mg once or twice daily and gradually increased at weekly intervals by 500 mg.

Note: Until regular cycles are established, cyclic progestin therapy may be added for the first 6 months of metformin treatment.


Off label use in the prevention of Ovarian hyperstimulation syndrome due to in vitro fertilization or intracytoplasmic sperm injection in women with PCOS:

  • Immediate-release:

    • 1 - 2.55 g orally daily in 2 to 3 divided doses.

Metformin conversion recommendations:

  • Conversion from immediate-release to extended-release tablets:

    • Patients receiving immediate-release metformin may be switched to extended-release metformin once a day at the same total daily dose, up to 2 gm once a day.

Metformin Dose in Children:

Metformin Dose in the treatment of type 2 Diabetes mellitus:

Note:

  • A low initial starting dose is recommended by most experts to avoid gastrointestinal side effects.
  • The dose should be gradually titrated upwards at 1 - 2 weeks.

  • Immediate-release tablets or solution:

    • Children older than 10 years and Adolescents:
      • 500 - 1,000 mg orally once a day or 500 mg orally twice a day.
      • The dose may be increased the dose every 1 - 2 weeks as tolerated in 500 - 1,000 mg increments to a maximum dose of 1,000 mg twice a day or 850 mg orally thrice daily
  • Extended-release tablets:

    • Children older than 10 years and Adolescents:
      • 500 - 1,000 mg orally once a day for 7 - 14 days.
      • The dose may be increased in 500 - 1,000 mg increments every 1 - 2 weeks to a maximum daily dose of 2,000 mg/day.

Metformin Dose in the Treatment of Severe Obesity as an adjunct to lifestyle interventions:

The AACE has not recommended its use in the treatment of obesity. A modest reduction in weight ( about 3%) has been observed in studies.

  • Immediate-release tablets:

    • Children older than 6 years and Adolescents:
      • 500 mg orally once a day initially
      • The dose should be titrated at weekly intervals by 500 mg/day to the maximum dose of 1000 mg twice daily.
  • Extended-release tablets:

    • Metformin XR:
      • 500 mg orally once a day initially with the evening meal for 2 weeks.
      • The dose may be increased to 1,000 mg once a day for 2 weeks, and then 2,000 mg once a day.
      • The dose should be slowly titrated to reduce the gastrointestinal side effects.

Pregnancy Risk Factor: B

  • Metformin crosses over the placenta but there have been no adverse fetal outcomes when it is used to treat gestational diabetes mellitus.
  • Hyperglycemia can lead to adverse outcomes for fetal health. Glycated hemoglobin should be maintained as close as possible to the target without causing hypoglycemia.
  • Insulin has been the most popular treatment for patients suffering from gestational diabetes mellitus.

Metformin use during breastfeeding:

  • Breast milk contains Metformin.
  • Metformin can be used while breastfeeding. Women should encourage breastfeeding during therapy.
  • However, the manufacturer recommends that you weigh the benefits and risks of breastfeeding treatment.

Metformin Dose in Renal disease:

  • eGFR of more than 45 mL/minute/1.73 m²:

    • Dose adjustment is not required.
    • Renal functions should be monitored periodically.
    • Annual monitoring may be sufficient, however, for individuals with an eGFR of 45 - 60 ml/min/1.73m², more frequent monitoring should be done (every 3 - 6 months).
    • The dose should also not exceed in patients with an eGFR of 45 - 60 ml/min/1.73 m².
  • eGFR of 30 - 45 mL/minute/1.73 m² :

    • Patients with an existing impairment:
      • If there are no other risk factors, such as heart failure or dehydration, it may be used in low dosages.
      • You should start slowly and increase the dose gradually until you reach a maximum of 1 gm/day.
    • Therapy: eGFR should be between 30 and 45 mL/minute/1.73m2:

      • It is important to weigh the risks and benefits of therapy.
      • To achieve a maximum daily dose of 1 gm, the dose should be decreased by 50%
      • At least once every three months, it is important to monitor the function of your kidneys.
  • eGFR of less than 30 mL/minute/1.73 m² :

    • Its use is contraindicated.

Metformin Dose in Liver disease:

Due to the risk of lactic acidosis, metformin should be avoided in patients with moderate or severe liver disease. Lactic acidosis is more common in patients with concomitant renal or heart disease, as well as alcoholics. It may also be associated with survival benefits in mild hepatic dysfunction. 

Side effects of Metformin:

Common Side Effects of Metformin:

  • Gastrointestinal:

    • Diarrhea
    • Nausea
    • Vomiting
    • Flatulence
  • Infection:

    • Infection

Less Common Side Effects Of Metformin Include:

  • Cardiovascular:

    • Chest Discomfort
    • Flushing
    • Palpitations
  • Central Nervous System:

    • Headache
    • Chills
    • Dizziness
    • Taste Disorder
  • Dermatologic:

    • Diaphoresis
    • Nail Disease
    • Skin Rash
  • Endocrine & Metabolic:

    • Decreased Vitamin B Serum Concentrate
    • Hypoglycemia
  • Gastrointestinal:

    • Nausea
    • Dyspepsia
    • Abdominal Distress
    • Abdominal Pain
    • Abdominal Distention
    • Abnormal Stools
    • Constipation
    • Heartburn
  • Neuromuscular & Skeletal:

    • Weakness
    • Myalgia
  • Respiratory:

    • Rhinitis
    • Dyspnea
    • Flu-Like Symptoms
    • Upper Respiratory Tract Infection
  • Miscellaneous:

    • Accidental Injury

Contraindication to Metformin (Glucophage):

  • Allergic reactions to metformin or any component of the formulation.
  • Severe renal dysfunction with an eGFR of less than 30 mL/minute/1.73 m²
  • Acute or chronic metabolic acidosis including diabetic ketoacidosis.
  • Cardiogenic shock
  • Acute myocardial infarction
  • Sepsis
  • Type 1 Diabetes Mellitus or unstable insulin-dependent diabetes mellitus.
  • History of lactic acidosis
  • Excessive alcohol intake
  • Severe/ advanced liver disease
  • Diseases associated with hypoxemia
  • Stress conditions like severe infection, trauma, and surgery
  • Severe dehydration
  • Pregnancy
  • Breastfeeding

Warnings & Precautions

Lactic acidosis: [US Boxed Warning]:

  • Metformin-induced lactic acidosis can be life-threatening. It can cause death, hypothermia, hypotension, as well as cardiac bradyarrhythmias.
  • Non-specific symptoms of lactic acidosis include malaise, myalgias, and somnolence.
  • It is characterized by high blood lactate levels (more than 5 mmol/L), anion gaps metabolic acidosis, and increased lactate: pyruvate ratio. Plasma metformin levels are more than 5 mg/ml.
  • These patients are at high risk for developing lactic acidosis:
    • Patients with severe renal impairment
    • Use of other drugs, such as topiramate or Acetazolamide, in conjunction with certain drugs
    • Over 65
    • Radiocontrast study of patients
    • Major surgeries and diagnostic procedures are performed on patients undergoing major surgery.
    • Hypoxic states, such as heart failure, can be hypoxic.
    • Hepatic impairment
    • Alcohol intake that is excessive
    • Patients with lactic acidosis must stop treatment immediately. They may need hemodialysis.

Vitamin B - 12 concentrations:

  • Metformin's long-term use is linked to vitamin B-12 deficiency.
  • Patients with anemia or peripheral neuropathy should have their serum levels of vitamin A 12 levels monitored regularly.

Heart failure:

  • Patients suffering from unstable heart failure may be at high risk for lactic acidosis secondary hypoperfusion.
  • It can be used for patients with stable heart disease and is associated with reduced hospital admissions and mortality.

Hepatic impairment:

  • Metformin may be recommended for patients with mild to moderate liver dysfunction. However, individuals with advanced liver disease or unstable liver function may need to be careful.
  • Patients with advanced liver disease should avoid it.

Renal impairment:

  • Metformin is excreted through the kidneys.
  • Before initiating treatment, patients should have their renal function checked and again periodically thereafter.
  • Patients with a lower eGFR than 30 ml/min/1.73m2 should not use it.
  • Patients with an eGFR of 30 to 45 ml/min or less should have their dose reduced.
  • Patients suffering from acute renal dysfunction or dehydration should not use it.

Stress-related states:

  • Patients suffering from acute stress such as trauma, fever, infection, or surgery should not use insulin. Instead, they should be prescribed insulin.

Metformin: Drug Interaction

Risk Factor C (Monitor therapy)

Abemaciclib

May increase the serum concentration of MetFORMIN.

Alpha-Lipoic Acid

May enhance the hypoglycemic effect of Antidiabetic Agents.

Androgens

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Exceptions: Danazol.

Bictegravir

May increase the serum concentration of MetFORMIN.

Carbonic Anhydrase Inhibitors

May enhance the adverse/toxic effect of MetFORMIN. Specifically, the risk of developing lactic acidosis may be increased. Exceptions: Brinzolamide; Dorzolamide.

Cephalexin

May increase the serum concentration of MetFORMIN.

Dalfampridine

MetFORMIN may increase the serum concentration of Dalfampridine. Dalfampridine may increase the serum concentration of MetFORMIN.

Direct Acting Antiviral Agents (HCV)

May enhance the hypoglycemic effect of Antidiabetic Agents.

Dofetilide

MetFORMIN may increase the serum concentration of Dofetilide.

Glycopyrrolate (Systemic)

May increase the serum concentration of MetFORMIN.

Guanethidine

May enhance the hypoglycemic effect of Antidiabetic Agents.

Hyperglycemia-Associated Agents

May diminish the therapeutic effect of Antidiabetic Agents.

Hypoglycemia-Associated Agents

Antidiabetic Agents may enhance the hypoglycemic effect of Hypoglycemia-Associated Agents.

Isavuconazonium Sulfate

May increase the serum concentration of MetFORMIN.

LamoTRIgine

May increase the serum concentration of MetFORMIN. Management: The lamotrigine Canadian product monograph states that coadministration of these drugs is not recommended.

Maitake

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Monoamine Oxidase Inhibitors

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Ombitasvir, Paritaprevir, and Ritonavir

May enhance the adverse/toxic effect of MetFORMIN. Specifically, the risk for lactic acidosis may be increased.

Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir

May enhance the adverse/toxic effect of MetFORMIN. Specifically, the risk for lactic acidosis may be increased.

Ondansetron

May increase the serum concentration of MetFORMIN.

Pegvisomant

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Prothionamide

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Quinolones

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Quinolones may diminish the therapeutic effect of Blood Glucose Lowering Agents. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use.

Ritodrine

May diminish the therapeutic effect of Antidiabetic Agents.

Salicylates

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Selective Serotonin Reuptake Inhibitors

May enhance the hypoglycemic effect of Blood Glucose Lowering Agents.

Thiazide and Thiazide-Like Diuretics

May diminish the therapeutic effect of Antidiabetic Agents.

Topiramate

May enhance the adverse/toxic effect of MetFORMIN.

Trimethoprim

May increase the serum concentration of MetFORMIN.

Trospium

MetFORMIN may decrease the serum concentration of Trospium.

Vandetanib

May increase the serum concentration of MetFORMIN.

Verapamil

May diminish the therapeutic effect of MetFORMIN.

Risk Factor D (Consider therapy modification)

Cimetidine

May increase the serum concentration of MetFORMIN. Management: Consider alternatives to cimetidine in patients receiving metformin due to a potential for increased metformin concentrations and toxicity (including lactic acidosis).

Dolutegravir

May increase the serum concentration of MetFORMIN. Management: Limit the daily metformin dose to 1,000 mg when used with dolutegravir. Monitor for increased metformin effects/toxicities during concomitant use.

Iodinated Contrast Agents

May enhance the adverse/toxic effect of MetFORMIN. Renal dysfunction that may be caused by iodinated contrast agents may lead to metformin-associated lactic acidosis. Management: Management advice varies. Refer to the full drug interaction monograph content for details. Exceptions: Diatrizoate Meglumine; Diatrizoate Sodium; Ethiodized Oil.

Patiromer

May decrease the serum concentration of MetFORMIN. Management: Administer metformin at least 3 hours before or 3 hours after patiromer.

Ranolazine

May increase the serum concentration of MetFORMIN. Management: Limit the metformin dose to a maximum of 1700 mg/day when used together with ranolazine 1000 mg twice daily.

Tafenoquine

May increase the serum concentration of MATE1 Substrates. Management: Avoid use of MATE substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the MATE substrate and consider a reduced dose of the MATE substrate according to that substrate's labeling.

Tafenoquine

May increase the serum concentration of OCT2 Substrates. Management: Avoid use of OCT2 substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the OCT2 substrate and consider a reduced dose of the OCT2 substrate according to that substrate's labeling.

Risk Factor X (Avoid combination)

Alcohol (Ethyl)

May enhance the adverse/toxic effect of MetFORMIN. Specifically, alcohol may potentiate the risk of lactic acidosis

 

How to administer Metformin?

To reduce gastrointestinal side effects, it is taken orally along with food. Extended-release tablets must be taken whole. You should not chew, crush, or chew the extended-release tablets.

Mechanism of action of Metformin:

Metformin improves the glycemic control of patients with type 2 Diabetes Mellitus through the following mechanisms:

  • It reduces the production of hepatic glucose.
  • It decreases glucose absorption from the intestines.
  • Metformin increases insulin sensitivity by increasing glucose uptake in peripheral tissues.

The onset of action:

  • Metformin can take up to two weeks. The maximum effect can last up to 2 weeks. The drug is bound to proteins in very small quantities.

Bioavailability of Metformin:

  • It has a bioavailability of 50% to 60% when administered in the fasting state.

Metabolism:

  • It is not metabolized by the liver.
  • 90% of the drug is excreted in urine as unchanged in the urine.

The half-life of metformin:

  • It has an eliminating half-life between 4 and 9 hours, and blood for 17.6 hours. 

The time to reach peak serum concentration:

  • The time to achieve peak serum concentration for the immediate-release tablet is 2 - 3 hours, while the extended-release tablet takes 7 hours. This ranges from 4 – 8 hours.

International Brands of Metformin:

  • ACT MetFORMIN
  • APO-MetFORMIN
  • APO-MetFORMIN ER
  • Auro-Metformin
  • DOM-MetFORMIN
  • ECL-MetFORMIN
  • Glucophage
  • Glumetza
  • Glycon
  • JAMP-MetFORMIN
  • JAMP-MetFORMIN Blackberry
  • Mar-MetFORMIN
  • MetFORMIN FC
  • MINT-MetFORMIN
  • MYLAN-MetFORMIN
  • PHL-MetFORMIN
  • PMS-MetFORMIN
  • PRO-MetFORMIN
  • Q-MetFORMIN
  • RAN-MetFORMIN
  • RATIO-MetFORMIN
  • RIVA-MetFORMIN
  • SANDOZ MetFORMIN FC
  • Septa-MetFORMIN
  • TEVA-MetFORMIN
  • Adecco
  • Alexodiab
  • Amophage
  • Ansures
  • Bentic
  • Biguax
  • Dabex
  • Dainipron
  • Deson
  • DH-Metglu 850
  • DH-Metglu XR 1000
  • Diabemet
  • Diabetmin
  • Diabetmin Retard
  • Diabetmin XR
  • Diabetol
  • Diabex XR
  • Diafat
  • Diaformin
  • Diaformin XR
  • Diaformina LP
  • Dialon
  • Diamet
  • Dianben
  • Diaslim
  • Diformin
  • Diformin Retard
  • Dimefor
  • Dimet
  • Euform Retard
  • Fordica 500 XR
  • Formet
  • Formin
  • Formit
  • Fornidd
  • Glafornil
  • Glibudon
  • Glicenex
  • Glicophage
  • Glifage
  • Gliformin
  • Glikos
  • Glisulin XR
  • Gluciophage XR
  • Gluco
  • Glucodown
  • Glucofage
  • Glucofor
  • Glucoform
  • Glucogen
  • Glucoles
  • Glucomet
  • Glucomin
  • Glucomine
  • Glucon
  • Glucophage
  • Glucophage Forte
  • Glucophage Retard
  • Glucophage SR
  • Glucophage XR
  • Glucophage-Mite
  • Glucotika
  • Glucotin
  • Glufor
  • Glumet
  • Glumet DC
  • Glumet Forte
  • Glumet XR
  • Glumin XR
  • Glunor
  • Glupa
  • Glustress
  • Glutamet
  • Glutomin
  • Glycomet
  • Glycomin
  • Glyformin
  • Glymet
  • Guamet
  • Heskopaq
  • Humamet
  • Humamet XR
  • I-Max
  • Indform
  • Insufor
  • Insumed
  • Islotin
  • Lucomet
  • Maformin
  • Medfort
  • Mefarmil
  • Meglucon
  • Melbin
  • Merckformin
  • Mescorit
  • Metchek
  • Metdia
  • Metex XR
  • Metfar
  • Metfin
  • Metfogamma
  • Metfor
  • Metfor XR
  • Metforal
  • Metformax
  • Metgluco
  • Metgreen-SR
  • Metophage
  • Metta SR
  • Neoform
  • Normax
  • Omformin
  • Orabet
  • Panfor SR
  • Quexel
  • Risidon
  • Siamformet
  • Siofor
  • Stagid
  • Sukkarto SR
  • Thiabet
  • Walaphage
  • Xmet
  • Yaltormin

Metformin in Pakistan:

Metformin (Hcl) [Tabs 1 G]

D-Formin Mr Getz Pharma Pakistan (Pvt) Ltd.
Diabescot Xr Scotmann Pharmaceuticals
Diaform Pakheim Internanational Pharma
Glucoformin Everest Pharmaceuticals
Glucoformin Everest Pharmaceuticals
Glucophage Merck Private Ltd.
Metadox Caraway Pharmaceuticals
Meteor Asian Agencies
Metfor Valor Pharmaceuticals
Metform Gray`S Pharmaceuticals
Metformed Medicraft Pharmaceuticals (Pvt) Ltd.
Metformina Don Valley Pharmaceuticals (Pvt) Ltd.
Metwil-Xr Wilsons Pharmaceuticals
Neodipar Sanofi Aventis (Pakistan) Ltd.
Regain Xr Werrick Pharmaceuticals
Robustin Pulse Pharmaceuticals

Metformin (Hcl) [Tabs 100 Mg]

Metamide Multinational Buisness Link

Metformin (Hcl) [Tabs 250 Mg]

Biguanil Popular Chemical Works (Pvt) Ltd.
Diaform Pakheim Internanational Pharma
Diamet Nabiqasim Industries (Pvt) Ltd.
Diamet Nabiqasim Industries (Pvt) Ltd.
Glucophage Merck Private Ltd.
Metmin Maple Pharmaceuticals (Pvt) Ltd
Metmin Maple Pharmaceuticals (Pvt) Ltd
Neodipar Sanofi Aventis (Pakistan) Ltd.

Metformin (Hcl) [Tabs 500 Mg]

Aforal Derma Techno Pakistan
Ardiphage Ardin Pharmaceuticals
Baymet Bayer Health Care
Biguanil Popular Chemical Works (Pvt) Ltd.
Comet Reko Pharmacal (Pvt) Ltd.
D-Formin Mr Getz Pharma Pakistan (Pvt) Ltd.
Diabescot Xr Scotmann Pharmaceuticals
Diabimin Geofman Pharmaceuticals
Diabin Pharmedic (Pvt) Ltd.
Diaform Pakheim Internanational Pharma
Diamet Nabiqasim Industries (Pvt) Ltd.
Dianorm Bloom Pharmaceuticals (Pvt) Ltd.
Dianorm Bloom Pharmaceuticals (Pvt) Ltd.
Fynkomet Fynk Pharmaceuticals
Glucodal Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Glucoformin Everest Pharmaceuticals
Glucoformin Everest Pharmaceuticals
Glucomate Mediate Pharmaceuticals (Pvt) Ltd
Glucophage Merck Private Ltd.
Glucosic Alina Combine Pharmaceuticals (Pvt) Ltd.
Glucosic Alina Combine Pharmaceuticals (Pvt) Ltd.
Glumet Swiss Pharmaceuticals (Pvt) Ltd.
Glumin Medicaids Pakistan (Pvt) Ltd.
Glyform Wilshire Laboratories (Pvt) Ltd.
Glymax Multinational Buisness Link
Lotophage Lotus Pharmaceuticals (Pvt) Ltd
Lowmet Lowitt Pharmaceuticals (Pvt) Ltd
Mephage Standpharm Pakistan (Pvt) Ltd.
Metadox Caraway Pharmaceuticals
Metaglibe Lowitt Pharmaceuticals (Pvt) Ltd
Meteor Asian Agencies
Metfor Valor Pharmaceuticals
Metform Gray`S Pharmaceuticals
Metformed Medicraft Pharmaceuticals (Pvt) Ltd.
Metformina Don Valley Pharmaceuticals (Pvt) Ltd.
Metmin Maple Pharmaceuticals (Pvt) Ltd
Metphage Efroze Chemical Industries (Pvt) Ltd.
Metwil-Xr Wilsons Pharmaceuticals
Mfor Jawa Pharmaceuticals(Pvt) Ltd.
Minomet Zinta Pharmaceuticals Industries
Neodipar Sanofi Aventis (Pakistan) Ltd.
Neophage Abbott Laboratories (Pakistan) Limited.
Novinormin Novins International
Ormin Karachi Chemical Industries
Phage Medisure Laboratories Pakistan (Pvt.) Ltd.
Pharmin Pharmacare Laboratories (Pvt) Ltd.
Piofit Plus Schazoo Zaka
Regain Xr Werrick Pharmaceuticals
Robustin Pulse Pharmaceuticals
Sugamet Z-Jans Pharmaceutical (Pvt) Ltd.
Sunphage Helicon Pharmaceutek Pakistan (Pvt) Ltd.
Susmet Xr Hilton Pharma (Pvt) Limited
Tabrophage Tabros Pharma

Metformin (Hcl) [Tabs 750 Mg]

Glucophage Xr Merck Private Ltd.
Himet Xr Hilton Pharma (Pvt) Limited

Metformin (Hcl) [Tabs 850 Mg]

Biguanil Popular Chemical Works (Pvt) Ltd.
Comet Reko Pharmacal (Pvt) Ltd.
Diabescot Xr Scotmann Pharmaceuticals
Diabimin Geofman Pharmaceuticals
Diabin Pharmedic (Pvt) Ltd.
Glucoformin Everest Pharmaceuticals
Glucoformin Everest Pharmaceuticals
Glucophage Merck Private Ltd.
Lotophage Lotus Pharmaceuticals (Pvt) Ltd
Metadox Caraway Pharmaceuticals
Metadox Caraway Pharmaceuticals
Metfor Valor Pharmaceuticals
Metformina Don Valley Pharmaceuticals (Pvt) Ltd.
Metphage Efroze Chemical Industries (Pvt) Ltd.
Metwil-Xr Wilsons Pharmaceuticals
Neodipar Sanofi Aventis (Pakistan) Ltd.
Neophage Abbott Laboratories (Pakistan) Limited.
Novinormin Novins International
Piofit Plus Schazoo Zaka
Regain Xr Werrick Pharmaceuticals

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