| Name | Metformin - Compounded & Branded (e.g., Glucophage®) |
| Uses | Adjunct for weight management, longevity support, insulin sensitivity improvement, and metabolic regulation. |
| Route Of Administration | Oral (tablet or extended-release formulation). |
| Frequency Of Use | Once or twice daily, depending on formulation and tolerance. |
| Concentration(s) | Compounded: 250 mg, 500 mg, 850 mg, 1,000 mg; Branded: 500 mg, 850 mg, 1,000 mg. |
| Maximum Dosage (Day, Wk) | Max 2,000 mg per day, divided into two doses for tolerability. |
| Contraindications | Severe renal impairment (eGFR <30 mL/min/1.73m²), metabolic acidosis, active liver disease, alcohol use disorder, hypersensitivity to metformin. |
| Possible Side Effects | Common: gastrointestinal upset (nausea, diarrhea, bloating). Rare: lactic acidosis, vitamin B12 deficiency, hypoglycemia (when combined with other agents). |
| Compatibility With Other Treatments/Drugs | Avoid with contrast dye (hold 48 hours before/after imaging studies). Use caution with insulin or sulfonylureas to prevent hypoglycemia. |
| Allergies | Assess for hypersensitivity to metformin or tablet excipients. |
| Administration Time | With meals to improve gastrointestinal tolerance; extended-release formulation taken once daily, preferably in the evening. |
| Dosing/Settings | Start with 250-500 mg once daily; titrate every 1-2 weeks based on tolerance, up to 2,000 mg daily. |
| Test Spot Requirement | Not applicable for metformin. |
| Pre-Treatment Guidelines | Assess kidney function (eGFR), liver enzymes, B12 levels, and metabolic markers prior to initiation. |
| Provider Clearance Guidelines | NP, PA, MD, or DO must approve; confirm kidney and liver function before prescribing. |
| Pre-Treatment Screening Workflow | 1. Confirm no renal or hepatic contraindications. 2. Assess gastrointestinal tolerance history. 3. Review concurrent medications for interactions. |
| What To Do If Adverse Reaction Occurs | For GI upset: reduce dose, take with meals, or switch to extended-release. For lactic acidosis signs: discontinue immediately, initiate emergency care. |
| Clinic Implementation Guidelines | Store at room temperature; educate patients on titration schedule and potential GI side effects. |
| Photographic Documentation Protocol | Not required for metformin therapy. |
| Post-Treatment Care | Monitor B12 levels periodically, assess weight and metabolic response, follow-up every 3-6 months. |
| Additional Documentation Requirements | Signed informed consent, treatment logs, renal function monitoring, adverse event documentation if applicable. |