Summary
Metformin is a medication used to control high blood sugar in people with type 2 diabetes. It helps to lower glucose production in the liver and absorption in the intestines. However, it is a prescription medication and cannot be purchased over the counter.
What is Metformin?
Metformin is a widely used oral medication to reduce elevated blood sugar in people with type 2 diabetes. It is considered the first-line treatment for type 2 diabetes and between 2008 and 2012 was the 8th most prescribed medication in the United States [1, 2, 3]. It can be in immediate or extended release tablets [4, 5].
How Does Metformin Work?
Metformin reduces the production and release of sugar from the liver by blocking a biological process called gluconeogenesis. It can also increase insulin sensitivity of cells, which makes the cells more likely to take in glucose in the presence of some insulin in the blood [2, 6].
The cellular-level effect of Metformin is complex, but can be summarised as follows:
How does Metformin work at a cellular level?
Metformin works at a cellular level by interfering with several processes. It perturbs the cytosolic and mitochondrial NAD/NADH ratio and the ATP/AMP ratio within cells, affecting enzymatic activities and metabolic and signaling pathways dependent on redox- and energy balance [11]. It also increases insulin-stimulated glucose transport by potentiating insulin-induced translocation of glucose transporters from the intracellular pool to the plasma membrane [12]. Furthermore, metformin interferes with mitochondrial respiration, leading to an activation of the AMPK tumor-suppressive pathway [13].
In addition to its effects on reducing blood sugar, metformin has been found to have several non-glycaemic effects. These include benefits in:
- weight stabilisation
- cardiovascular protection
- polycystic ovarian syndrome
- renoprotection (protection of the kidneys) [1].
Metformin also increases plasma concentrations of the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1), which may contribute to its glucose-lowering effect in patients with type 2 diabetes [7]. This is similar to how peptides for weight loss work, including dulaglutide and semaglutide and may explain the link between metformin and weight stabilisation.
Can You Buy Metformin Over The Counter?
Metformin is a prescription drug, which means you cannot buy it over the counter.
Brand names Of Metformin
None of the Metformin formulations (immediate and extended release) can be brought over the counter.
The immediate-release tablet is available only as a generic drug, while the extended-release tablet is available as the brand-name drugs Fortamet and Glumetza. Both forms are also available as generic drugs, which usually cost less than brand-name versions [8].
It is important to note that the use of metformin should always be under the supervision of a healthcare provider due to potential side effects and the need for regular monitoring of liver and kidney function [9, 10].