메트포르민

항고혈당제 / 비구아나이드계

**메트포르민(Metformin)**은 인체 의학에서 제2형 당뇨병 관리에 널리 사용되는 비구아나이드계 경구용 항고혈당제입니다. 수의학에서 이 약물의 사용은 논란이 많으며 일반적으로 효능이 제한적인 것으로 간주됩니다. * **고양이**: 인슐린 비의존성 당뇨병(NIDDM)의 보조 치료제로 연구되었습니다. 그러나 임상적 성공은 매우 제한적이며, 위장관 독성으로 인해 내약성이 떨어지는 경우가 많습니다. 일부 수의 내분비학자들은 고양이에게 이 약을 사용하지 말 것을 강력히 권고합니다. * **말**: 말 대사 증후군(EMS) 및 인슐린 조절 장애 관리를 위해 연구되었습니다. 불행히도 메트포르민은 말에서 경구 생체이용률이 극히 낮고(~4-7%) 반감기가 매우 짧아 전신적 효능이 의심스럽습니다. > **임상 요점**: 설포닐우레아(예: 글리피지드)나 인슐린과 달리 메트포르민은 췌장의 인슐린 분비를 자극하지 않으므로 단독으로 사용할 때 저혈당을 유발하는 경우가 드뭅니다.

작용 기전: Metformin acts primarily as an **insulin sensitizer** and inhibitor of hepatic glucose output. Its actions are multifaceted: * **AMPK Activation**: Metformin activates **AMP-activated protein kinase (AMPK)** in hepatocytes → **decreases hepatic gluconeogenesis** (glucose production). * **Peripheral Sensitization**: Increases insulin's ability to transport glucose across cell membranes in skeletal muscle → **increases peripheral glucose uptake**. * **Intestinal Absorption**: May decrease the intestinal absorption of dietary glucose. * **Advanced Glycosylation**: Inhibits the formation of advanced glycosylation end-products. Because it does not stimulate insulin production or release from pancreatic beta cells, it does not directly induce hypoglycemia.

동물 종별 용량

Cats

Non-insulin dependent diabetes mellitus (NIDDM) · 50 mg (total dose) per cat PO twice daily · PO · q12h · May be efficacious only in cats with detectable concentrations of insulin at time of treatment.
Early NIDDM · 2 mg/kg PO q12h · PO · q12h
General Use Warning · Not recommended · PO · Author states 'metformin has been shown toxic to cats and should not be used. It is also ineffective.'

Birds

General · 100-500 mg/L of drinking water · PO · Continuous

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Hypersensitivity to metformin
Renal dysfunction
Metabolic acidosis
Concurrent use of parenteral iodinated contrast agents (temporary contraindication)

이상반응

Lethargy
Inappetence
Vomiting
Diarrhea
Weight loss
Lactic acidosis (rare but severe)

약물 상호작용

ACE Inhibitors · May increase risk for hypoglycemia
Cimetidine · Can cause a 60% increase in peak metformin plasma levels and a 40% increase in AUC
Corticosteroids · May reduce hypoglycemic efficacy
Diuretics, Thiazide · May reduce hypoglycemic efficacy
Furosemide · Can increase the AUC and plasma levels of metformin by 22%; metformin can decrease the peak plasma concentrations and AUC of furosemide
Iodinated Contrast Agents (Parenteral) · May cause acute renal failure and lactic acidosis if used within 48 hours of a metformin dose
Isoniazid · May reduce hypoglycemic efficacy
Sympathomimetic Agents · May reduce hypoglycemic efficacy

모니터링

Fasting blood glucose
Appetite and attitude
Body condition
PU/PD resolution
Serum fructosamine and/or glycosylated hemoglobin levels
Renal function (baseline and annually)
Adverse effects (especially GI signs)

과용량

**Overdose & Toxicity Profile:** * **Small Animals**: Hypoglycemia is **not commonly seen** in overdoses of metformin alone. However, the drug has a narrow margin of safety regarding gastrointestinal upset. * **Clinical Signs**: Vomiting and diarrhea are the most common findings in dogs and cats following accidental ingestion. * **Human Data**: Massive overdoses (e.g., 100 grams) caused hypoglycemia only 10% of the time, but **lactic acidosis** occurred. Lactic acidosis has been seen in human overdoses of 7 to 20 grams. It is unknown at what exact dose acidosis may occur in domestic animals. > **Management**: Treatment is largely supportive and symptomatic, focusing on managing GI distress and monitoring acid-base status and renal function.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.