Increases activity of AMPK (AMP-activated protein kinase), usually activated by high AMP:ATP ratio, as seen in starvation or energy deprived states.
In such condition, liver decreases gluconeogenesis in favour of glycolysis.
1.2 Minor actions
1.2.1 Increasing peripheral insulin sensitivity
2.1 5 hour half life
2.2 Taken with or after meals
3.1 Obese patient with T2DM
Has a mild anorexic effect, so can help to reduce weight.
3.2.1 General anaesthesia or iodine
containing contrast medium
Iodinated contrast media increase the risk of renal failure.
18.104.22.168 Suspend on the morning of surgery and restart
when renal function returns to baseline. Suspend
prior to any test, restart at least 48 hours after the
test if renal function has returned to baseline.
3.2.2 Renal failure
22.214.171.124 Review dose if eGFR <45
and stop if eGFR <30.
3.2.3 Those at risk of tissue hypoxia or sudden deterioration in renal
function. Dehydration, severe infection, shock, sepsis, acute heart
failure, resp failure, or hepatic impairment or recent MI.
4 Adverse reactions
4.1 Minor -
4.1.1 Nausea, Diarrhoea and metallic taste
4.1.2 Reduces with time or
4.1.3 Prolonged use - B12
deficiency due to
4.1.4 Ketonuria with normal
blood sugars. Reduces with
the dose, and not severe
4.2 Lactic acidosis,
0.03 per 1000 patient years
4.2.1 Background of renal or liver
failure, cardiogenic and septic shock