title: Use of Metformin for Cardiometabolic Risks in Psychiatric Practice: Need-to-Know Safety Issues.
abstract: Metformin, a biguanide drug, is emerging as an important treatment option for the prevention or treatment of weight gain, type 2 diabetes mellitus, and the metabolic syndrome in psychiatric patients, especially those who require or receive antipsychotic drugs. Metformin treatment is commonly associated with gastrointestinal adverse effects; the risk of these is reduced by gradual dose uptitration, administration of the drug with meals, and use of a time-release formulation. Lactic acidosis, a potentially fatal complication of biguanide therapy, is very rare with metformin; the risk can be reduced by avoidance of its prescription in patients with impaired renal function, impaired liver function, cardiac failure, and certain other conditions. Long-term metformin use is associated with decreased vitamin B₁₂ levels, and even with biochemical B₁₂ deficiency; this complication can detected early by annual assessments of serum B₁₂ levels and prevented by annual intramuscular B₁₂ administration.
authors.affiliation: Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. candrade@psychiatrist.com.
authors.forename: Chittaranjan
authors.initials: C
authors.lastname: Andrade
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced / Q000517:prevention & control; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000188:drug therapy*; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D024821:Metabolic Syndrome / Q000139:chemically induced* / Q000188:drug therapy*; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014806:Vitamin B 12 Deficiency / Q000139:chemically induced / Q000517:prevention & control; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents; D008687:Metformin