Metgluco is the trade name of a drug containing metformin, a biguanide-class medication widely used for the treatment of type 2 diabetes mellitus, particularly in overweight patients, when diet and exercise alone do not provide adequate glycemic control.

Indications for Use:

1. Type 2 Diabetes Mellitus:
   • Especially in overweight patients when diet and exercise fail to achieve sufficient glycemic control.
2. Prevention of Type 2 Diabetes:
   • In patients with prediabetes and significant risk factors for developing diabetes.

Contraindications:

• Known hypersensitivity to metformin or any components of the drug.
• Acute or chronic metabolic acidosis, including diabetic ketoacidosis (with or without coma).
• Severe renal insufficiency (creatinine clearance <30 ml/min).
• Acute conditions that increase the risk of renal dysfunction, such as:
  • Dehydration, severe infections, or shock.
• Acute or chronic diseases leading to tissue hypoxia (e.g., cardiac or respiratory failure, recent myocardial infarction, shock).
• Liver failure, acute alcohol intoxication, or chronic alcoholism.
• Pregnancy and breastfeeding.

Side Effects:

1. Gastrointestinal:
   • Nausea, vomiting, diarrhea, abdominal pain, and loss of appetite.
   • These symptoms are most common at the beginning of treatment and usually resolve independently.
2. Metabolism:
   • Lactic Acidosis (very rare but serious; requires immediate discontinuation of treatment).
   • With prolonged use, reduced absorption of vitamin B₁₂ and a corresponding decrease in serum levels may occur.
3. Nervous System:
   • Taste disturbances.
4. Skin:
   • Very rare reactions, including erythema, pruritus (itching), and urticaria (hives).

Special Instructions:

1. Risk of Lactic Acidosis:
   • Lactic acidosis is a rare but life-threatening complication requiring immediate medical attention.
   • Risk factors include:
     • Uncontrolled diabetes, ketosis, prolonged fasting, excessive alcohol consumption, liver failure, and any condition associated with hypoxia.
2. Renal Function:
   • Renal function must be evaluated before initiating treatment and monitored regularly during therapy.
   • Metformin is contraindicated in patients with creatinine clearance <30 ml/min.
3. Surgical Interventions:
   • Discontinue metformin 48 hours before planned surgical procedures requiring general, spinal, or epidural anesthesia.
   • Therapy can be resumed no earlier than 48 hours post-surgery or when oral nutrition is re-established, provided renal function is normal.
4. Alcohol:
   • Alcohol consumption and ethanol-containing medications should be avoided due to an increased risk of lactic acidosis.
5. Consultation Required:
   • Prior to starting Metgluco, consult a physician to determine the appropriateness of treatment and the optimal dosage. Self-medication is not advised and may result in adverse outcomes.