METFORMIN HYDROCHLORIDE - Generic Drug Details

What are the generic sources for metformin hydrochloride and what is the scope of patent protection?

Metformin hydrochloride is the generic ingredient in twenty-one branded drugs marketed by Sun Pharm, Annora Pharma, Bionpharma, Saptalis Pharms, Vistapharm Llc, Ranbaxy, Andrx Labs Llc, Emd Serono Inc, Santarus Inc, Actavis Elizabeth, Actavis Labs Fl Inc, Ajanta Pharma Ltd, Alignscience Pharma, Alkem Labs Ltd, Amneal Pharms Ny, Apotex, Aurobindo Pharma, Aurobindo Pharma Ltd, Barr, Cspc Ouyi, Glenmark Pharms Ltd, Granules, Harman Finochem, Impax Labs, Inventia, Ivax Sub Teva Pharms, Laurus, Lupin Ltd, Macleods Pharms Ltd, Marksans Pharma, Medicap Labs, Micro Labs, Mpp Pharma, Mylan Pharms Inc, Nostrum Pharms Llc, Novast Labs, Pharmobedient, Prinston Inc, Qingdao Baheal Pharm, Ranbaxy Labs Ltd, Regcon Holdings, Rk Pharma, Sandoz, Sciegen Pharms, Sun Pharm Inds (in), Sun Pharm Industries, Teva, Torrent, Torrent Pharms Ltd, Twi Pharms, Unichem, Utopic Pharms, Watson Labs Inc, Yichang Humanwell, Zydus Lifesciences, Aarxion Anda Hlding, Alkem, Aurobindo, Chartwell, Dr Reddys Labs Inc, Epic Pharma Llc, Granules India, Heritage Pharma, Indicus Pharma, Ipca Labs Ltd, Mylan, Provident Pharm, Senores Pharms, Sun Pharm Inds Inc, Sunshine, Torrent Pharms, Watson Labs, Watson Labs Florida, Zydus Hlthcare, Zydus Pharms Usa, Takeda Pharms Usa, Chartwell Rx, Teva Pharms Usa, Novo Nordisk Inc, Sb Pharmco, Astrazeneca Ab, Dr Reddys Labs Sa, Msd Sub Merck, and Ph Health, and is included in one hundred and thirty-two NDAs. There are seven patents protecting this compound and two Paragraph IV challenges. Additional information is available in the individual branded drug profile pages.

Metformin hydrochloride has twenty-nine patent family members in eight countries.

There are forty-three drug master file entries for metformin hydrochloride. Eighty-two suppliers are listed for this compound. There are twelve tentative approvals for this compound.

Summary for METFORMIN HYDROCHLORIDE

International Patents:	29
US Patents:	7
Tradenames:	21
Applicants:	84
NDAs:	132
Drug Master File Entries:	43
Finished Product Suppliers / Packagers:	82
Raw Ingredient (Bulk) Api Vendors:	164
Clinical Trials:	2,859
Patent Litigation and PTAB cases:	See patent lawsuits and PTAB cases for METFORMIN HYDROCHLORIDE
What excipients (inactive ingredients) are in METFORMIN HYDROCHLORIDE?	METFORMIN HYDROCHLORIDE excipients list
DailyMed Link:	METFORMIN HYDROCHLORIDE at DailyMed

Recent Clinical Trials for METFORMIN HYDROCHLORIDE

Identify potential brand extensions & 505(b)(2) entrants

Sponsor	Phase
Eurofarma Laboratorios S.A.	PHASE3
Sultan Qaboos University	PHASE4
Aspargo Labs, Inc	PHASE1

See all METFORMIN HYDROCHLORIDE clinical trials

Generic filers with tentative approvals for METFORMIN HYDROCHLORIDE

Applicant	Application No.	Strength	Dosage Form
		500MG	TABLET, EXTENDED RELEASE;ORAL
		50MG/500MG;50MG/1000MG	TABLET;ORAL
		10MG; 1GM	TABLET, EXTENDED RELEASE; ORAL

The 'tentative' approval signifies that the product meets all FDA standards for marketing, and, but for the patents / regulatory protections, it would approved.

Pharmacology for METFORMIN HYDROCHLORIDE

Drug Class

Biguanide

Medical Subject Heading (MeSH) Categories for METFORMIN HYDROCHLORIDE

Hypoglycemic Agents

Anatomical Therapeutic Chemical (ATC) Classes for METFORMIN HYDROCHLORIDE

A10BA	Biguanides
A10B	BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS
A10	DRUGS USED IN DIABETES
A	Alimentary tract and metabolism

Paragraph IV (Patent) Challenges for METFORMIN HYDROCHLORIDE

Tradename	Dosage	Ingredient	Strength	NDA	ANDAs Submitted	Submissiondate
RIOMET	Oral Solution	metformin hydrochloride	500 mg/5 mL	021591	1	2018-02-02
GLUMETZA	Extended-release Tablets	metformin hydrochloride	500 mg and 1000 mg	021748	1	2009-07-27
FORTAMET	Extended-release Tablets	metformin hydrochloride	500 mg and 1000 mg	021574	1	2008-10-14

US Patents and Regulatory Information for METFORMIN HYDROCHLORIDE

Applicant	Tradename	Generic Name	Dosage	NDA	Approval Date	TE	Type	RLD	RS	Patent No.	Patent Expiration	Product	Substance	Delist Req.	Exclusivity Expiration
Heritage Pharma	METFORMIN HYDROCHLORIDE	metformin hydrochloride	TABLET;ORAL	075978-003	Nov 5, 2002		DISCN	No	No
Aurobindo	METFORMIN HYDROCHLORIDE	metformin hydrochloride	TABLET;ORAL	077095-003	Jan 14, 2005	AB	RX	No	No
Lupin Ltd	METFORMIN HYDROCHLORIDE	metformin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	090692-002	Jun 29, 2011	AB2	RX	No	Yes
Sunshine	METFORMIN HYDROCHLORIDE	metformin hydrochloride	TABLET;ORAL	208999-002	Oct 12, 2018		DISCN	No	No
Dr Reddys Labs Sa	SAXAGLIPTIN AND METFORMIN HYDROCHLORIDE	metformin hydrochloride; saxagliptin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	207678-001	Aug 9, 2023	AB	RX	No	No
Alkem	METFORMIN HYDROCHLORIDE	metformin hydrochloride	TABLET;ORAL	091184-003	Nov 1, 2010	AB	RX	No	No

Expired US Patents for METFORMIN HYDROCHLORIDE

Applicant	Tradename	Generic Name	Dosage	NDA	Approval Date	Patent No.	Patent Expiration
Santarus Inc	GLUMETZA	metformin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	021748-001	Jun 3, 2005	6,723,340
Andrx Labs Llc	FORTAMET	metformin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	021574-001	Apr 27, 2004	6,495,162
Emd Serono Inc	GLUCOPHAGE XR	metformin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	021202-001	Oct 13, 2000	6,475,521
Santarus Inc	GLUMETZA	metformin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	021748-002	Jun 3, 2005	8,323,692
Ranbaxy	RIOMET	metformin hydrochloride	SOLUTION;ORAL	021591-001	Sep 11, 2003	6,890,957
Andrx Labs Llc	FORTAMET	metformin hydrochloride	TABLET, EXTENDED RELEASE;ORAL	021574-002	Apr 27, 2004	6,866,866

International Patents for METFORMIN HYDROCHLORIDE

Country	Patent Number	Title	Estimated Expiration
Brazil	112017001968
European Patent Office	3445349
European Patent Office	3288518
World Intellectual Property Organization (WIPO)	2016178131
Japan	2017514903	徐放性懸濁組成物
World Intellectual Property Organization (WIPO)	2017182852

Supplementary Protection Certificates for METFORMIN HYDROCHLORIDE

Patent Number	Supplementary Protection Certificate	SPC Country	SPC Expiration	SPC Description
1412357	77 5006-2008	Slovakia		PRODUCT NAME: SITAGLIPTIN A METFORMIN; NAT. REG.NO/DATE: EU/1/08/455/001-014, EU/1/08/456/001-014, EU/1/08/457/001-014 20080716; FIRST REG.:CH 58450 01-03 20080408
2498758	301040	Netherlands		PRODUCT NAME: METFORMINE OF EEN FARMACEUTISCH AANVAARDBAAR ZOUT DAARVAN; SAXAGLIPTINE OF EEN FARMACEUTISCH AANVAARDBAAR ZOUT DAARVAN; DAPAGLIFLOZINE OF EEN FARMACEUTISCH AANVAARDBAAR SOLVAAT DAARVAN; REGISTRATION NO/DATE: EU/1/19/1401 20191113
2498758	132020000000034	Italy		PRODUCT NAME: METFORMINA O UN SUO SALE FARMACEUTICAMENTE ACCETTABILE; SAXAGLIPTIN O UN SUO SALE FARMACEUTICAMENTE ACCETTABILE; DAPAGLIFLOZIN O UN SUO SOLVATO FARMACEUTICAMENTE ACCETTABILE.(QTRILMET); AUTHORISATION NUMBER(S) AND DATE(S): EU/1/19/1401, 20191113
1506211	92496	Luxembourg		PRODUCT NAME: COMBINAISON DE DAPAGLIFLOZINE OU D UN SEL PHARMACEUTIQUEMENT ACCEPTABLE DE CELLE-CI ET DE METFORMINE OU D UN SEL PHARMACEUTIQUEMENT ACCEPTABLE DE CELLE-CI,TELLE QUE PROTEGEE PAR LE BREVET DE BASE EP1506211 B1
1506211	PA2014026	Lithuania		PRODUCT NAME: DAPAGLIFOZINUM + METFORMINUM; REGISTRATION NO/DATE: EU/1/13/900 20140116
1412357	122008000046	Germany		PRODUCT NAME: SITAGLIPTIN, GEGEBENENFALLS IN FORM EINES PHARMAZEUTISCH ANNEHMBAREN SALZES, INSBESONDERE SITAGLIPTINPHOSPHAT- MONOHYDRAT, IN KOMBINATION MIT METFORMIN, GEGEBENENFALLS IN FORM EINES PHARMAZEUTISCH ANNEHMBAREN SALZES, INSBESONDERE DES HYDROCHLORIDS; NAT. REGISTRATION NO/DATE: EU/1/08/455/001-014 20080716 FIRST REGISTRATION: CH/LI 58450 01 58450 02 58450 03 20080408

Metformin Hydrochloride: Market Dynamics and Financial Trajectory

Last updated: February 19, 2026

Executive Summary

Metformin hydrochloride, a first-line therapy for type 2 diabetes, maintains a dominant market position due to its established efficacy, safety profile, and low cost. The global metformin hydrochloride market is projected for steady, albeit moderate, growth, driven by the rising prevalence of diabetes, increasing healthcare access in emerging economies, and continued physician preference. Key market segments include oral formulations, with immediate-release (IR) and extended-release (ER) versions representing the primary product types. Competitive pressures stem from generic manufacturers and the development of novel diabetes medications, though metformin's entrenched status limits the impact of these challenges. Financial projections indicate consistent revenue generation, with growth primarily influenced by volume expansion rather than significant price appreciation.

What is the current market size and projected growth for Metformin Hydrochloride?

The global market for metformin hydrochloride is substantial and exhibits consistent growth. In 2023, the market was valued at an estimated $2.1 billion USD. Projections indicate a compound annual growth rate (CAGR) of 4.2% through 2030, potentially reaching approximately $2.8 billion USD by the end of the forecast period. This growth is underpinned by several factors.

The prevalence of type 2 diabetes is a primary driver. The World Health Organization (WHO) reported that in 2021, approximately 422 million people worldwide had diabetes, a figure that has been steadily increasing. Metformin remains the cornerstone of treatment for a significant proportion of these patients due to its accessibility and affordability. [1]

Emerging markets represent a key growth avenue. Increased healthcare expenditure, improved diagnostic capabilities, and greater patient access to essential medicines in regions like Asia-Pacific and Latin America are expanding the user base for metformin. For instance, in India, the diabetes population is projected to reach 134.3 million by 2045, creating a vast market for cost-effective treatments. [2]

Physician and patient preference for metformin hydrochloride, attributed to its decades-long track record of efficacy and safety, also contributes to market stability. Its minimal risk of hypoglycemia, weight neutrality, and cardioprotective potential further solidify its position. [3]

What are the primary therapeutic applications and formulations of Metformin Hydrochloride?

Metformin hydrochloride’s primary therapeutic application is the management of type 2 diabetes mellitus. It is indicated as a first-line, monotherapy, or in combination with other oral antidiabetic agents or insulin. Its mechanism of action involves reducing hepatic glucose production, decreasing intestinal glucose absorption, and improving insulin sensitivity in peripheral tissues. [4]

The market is segmented by product formulation:

• Immediate-Release (IR) Metformin Hydrochloride: This is the most common and widely prescribed form. It requires multiple daily doses, typically taken with meals to minimize gastrointestinal side effects.
• Extended-Release (ER) Metformin Hydrochloride: Also known as sustained-release (SR) or controlled-release (CR), this formulation allows for once-daily dosing. It is designed to release the drug slowly over an extended period, improving patient compliance and often reducing gastrointestinal tolerability issues.

Beyond these primary oral formulations, combination therapies are also prevalent. Metformin is frequently co-formulated with other antidiabetic agents such as sulfonylureas (e.g., glipizide, glyburide), dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., sitagliptin, saxagliptin), and sodium-glucose cotransporter-2 (SGLT2) inhibitors (e.g., empagliflozin, dapagliflozin). These combination products offer enhanced glycemic control and further improve patient adherence.

Who are the key market players and what is the competitive landscape?

The metformin hydrochloride market is characterized by a highly fragmented and competitive landscape, dominated by generic manufacturers. The patent exclusivity for the original metformin molecule expired decades ago, leading to widespread generic availability.

Key global manufacturers and suppliers include:

• Bristol Myers Squibb: While historically involved, its primary focus has shifted to newer diabetes therapies.
• Takeda Pharmaceutical Company: Also historically significant, Takeda’s presence is more focused on branded combination products.
• Major Generic Manufacturers: Companies such as Mylan N.V. (now Viatris), Teva Pharmaceutical Industries Ltd., Sun Pharmaceutical Industries Ltd., Dr. Reddy's Laboratories Ltd., and Cipla Ltd. are significant suppliers of both IR and ER metformin hydrochloride generics. These companies leverage extensive manufacturing capabilities and global distribution networks.

The competitive dynamics are primarily driven by:

• Pricing: As a commoditized generic drug, price competition is intense. Manufacturers differentiate through cost-effective production and efficient supply chains.
• Product Quality and Compliance: Adherence to stringent regulatory standards (e.g., FDA, EMA) is critical for market access. Consistency in product quality and manufacturing practices is paramount.
• Distribution Networks: Establishing robust distribution channels to reach diverse healthcare settings and patient populations, particularly in emerging markets, is a competitive advantage.
• Formulation Innovation: While core molecule patents have expired, companies can still innovate in formulation, such as developing novel ER or combination products with improved pharmacokinetic profiles or patient convenience.

The market also faces competition from newer classes of antidiabetic drugs, including GLP-1 receptor agonists and SGLT2 inhibitors, which offer additional benefits such as weight loss and cardiovascular protection. However, metformin’s cost-effectiveness and established role as a first-line therapy ensure its continued market relevance.

What are the key drivers and restraints impacting the Metformin Hydrochloride market?

Market Drivers:

• Rising Global Diabetes Prevalence: The World Health Organization (WHO) estimates that diabetes cases will continue to rise globally, with type 2 diabetes accounting for the vast majority. This demographic trend directly fuels demand for metformin hydrochloride. [1]
• Cost-Effectiveness and Affordability: Metformin hydrochloride is one of the most affordable antidiabetic medications available, making it accessible to a broad patient population, especially in low- and middle-income countries. Its cost per daily dose is significantly lower than many newer therapies.
• Established Safety and Efficacy Profile: With over six decades of clinical use, metformin hydrochloride has a well-documented safety and efficacy record. Physicians and patients trust its long-term performance and predictable outcomes. [3]
• Government Initiatives and Healthcare Policies: Many governments promote the use of essential medicines like metformin as part of national diabetes management programs, further bolstering its market share.
• Increasing Access to Healthcare: Improved healthcare infrastructure and expanded access to medical professionals in developing nations are driving greater diagnosis and treatment of diabetes, increasing the patient pool for metformin.

Market Restraints:

• Development of Novel Diabetes Therapies: The emergence of innovative drug classes, such as GLP-1 receptor agonists and SGLT2 inhibitors, which offer additional benefits beyond glycemic control (e.g., cardiovascular risk reduction, weight loss), poses a competitive threat.
• Gastrointestinal Side Effects: While generally well-tolerated, gastrointestinal adverse events (e.g., nausea, diarrhea) remain a common reason for patient non-adherence or discontinuation.
• Renal Impairment Contraindication: Metformin hydrochloride is contraindicated in patients with severe renal impairment due to the risk of lactic acidosis. This limits its use in a segment of the diabetic population. [5]
• Stringent Regulatory Requirements: While a driver for quality, navigating evolving regulatory landscapes and post-market surveillance can be resource-intensive for manufacturers.
• Price Pressures in Generic Markets: Intense competition among generic manufacturers leads to significant price erosion, limiting revenue growth opportunities solely from price increases.

What is the financial trajectory and revenue potential of Metformin Hydrochloride?

The financial trajectory for metformin hydrochloride is characterized by stable, volume-driven revenue generation. Due to its status as a mature, off-patent generic drug, significant price appreciation is not anticipated. Growth is primarily a function of increasing diabetes prevalence globally and expanding market penetration, particularly in emerging economies.

Revenue Streams:

• Generic Sales: The overwhelming majority of revenue is derived from the sale of generic metformin hydrochloride (both IR and ER formulations).
• Combination Product Sales: Metformin is a key component in numerous fixed-dose combination (FDC) products with other antidiabetic agents. Revenue from these FDCs contributes to the overall financial performance associated with metformin.

Key Financial Indicators:

• Volume Growth: Driven by the expanding diabetic population and healthcare access, the volume of metformin hydrochloride dispensed globally is expected to continue its upward trend. This is the primary engine of revenue growth.
• Price Stability/Moderate Decline: While volume increases, price per unit may see marginal declines or remain relatively stable due to intense generic competition and formulary pressures in developed markets. In emerging markets, initial pricing might be higher before commoditization occurs.
• Profit Margins: Profit margins for generic metformin are typically lower compared to patented pharmaceuticals due to the competitive landscape. Manufacturers rely on high-volume sales and efficient manufacturing processes to achieve profitability. Economies of scale are critical.
• Investment Focus: Investment in R&D for metformin hydrochloride itself is minimal. Investment by pharmaceutical companies is largely focused on optimizing manufacturing processes, expanding production capacity, and developing new combination formulations or delivery systems.

Projected Revenue Contribution:

While individual generic manufacturers may see fluctuating revenues based on market share and supply agreements, the aggregate global market value is projected to grow at a CAGR of 4.2% from 2023 to 2030. This indicates a steady and reliable, though not explosive, financial contribution from metformin hydrochloride over the coming years. Companies that can secure large-scale supply contracts, optimize their cost structures, and maintain high-quality production will be best positioned to capitalize on this stable revenue stream. The total market value, as previously stated, is expected to grow from approximately $2.1 billion in 2023 to around $2.8 billion by 2030.

What are the regulatory considerations and patent landscape?

The regulatory landscape for metformin hydrochloride is mature, with well-established guidelines from major health authorities. Given that the original compound patent has long expired, there are no active substance patents for metformin hydrochloride itself.

Regulatory Approvals:

• Food and Drug Administration (FDA) (USA): Metformin hydrochloride products are approved through the Abbreviated New Drug Application (ANDA) process, which requires demonstrating bioequivalence to an innovator product. Manufacturers must adhere to Current Good Manufacturing Practices (cGMP).
• European Medicines Agency (EMA) (Europe): Similar to the FDA, the EMA oversees the approval of generic metformin hydrochloride. Marketing authorization applications are reviewed, and compliance with EU GMP standards is mandatory.
• Other National Regulatory Bodies: Each country has its own regulatory framework for drug approval, but generally, the principles of demonstrating quality, safety, and efficacy (through bioequivalence for generics) apply.

Patent Landscape:

• No Active Substance Patents: The core patent for metformin hydrochloride expired decades ago. This has allowed for widespread generic manufacturing and competition.
• Formulation and Combination Patents: While the molecule is off-patent, manufacturers can still seek patent protection for novel formulations (e.g., new extended-release technologies, different particle sizes for improved dissolution) or for new fixed-dose combination products that combine metformin with other active pharmaceutical ingredients. These patents, if granted, can provide a limited period of market exclusivity for specific innovative products.
• Intellectual Property in Manufacturing: Companies may also have proprietary processes or technologies related to manufacturing efficiency or purity, which can be protected as trade secrets or through process patents, offering a competitive advantage.

Key Regulatory Considerations for Market Participants:

• cGMP Compliance: Continuous adherence to stringent manufacturing standards is non-negotiable. Regulatory bodies conduct regular inspections to ensure compliance.
• Quality Control and Assurance: Robust quality control systems are essential to guarantee product consistency, purity, and stability.
• Pharmacovigilance: Manufacturers are required to monitor and report adverse drug reactions, contributing to ongoing safety surveillance.
• Bioequivalence Studies: For generic products, demonstrating bioequivalence to the reference listed drug is a critical regulatory hurdle for market approval.
• Impurity Profiling: Regulatory agencies, including the FDA and EMA, have increased scrutiny on nitrosamine impurities in metformin products. Manufacturers must ensure their products meet strict impurity limits. In 2019, the FDA identified N-nitrosodimethylamine (NDMA) in some metformin products, leading to recalls and ongoing monitoring requirements. [6]

The lack of patent protection for the active substance means that competitive advantage is primarily derived from manufacturing efficiency, cost leadership, robust supply chain management, and adherence to the highest quality and regulatory standards.

Key Takeaways

• Metformin hydrochloride’s market is stable and projected for moderate growth (4.2% CAGR) driven by rising diabetes prevalence and its cost-effectiveness.
• The market is dominated by generic manufacturers, leading to intense price competition and emphasis on operational efficiency.
• Key growth drivers include increasing diabetes incidence globally, especially in emerging markets, and the drug’s established safety and efficacy.
• Restraints include competition from novel diabetes drugs and gastrointestinal side effects that impact patient compliance.
• No active substance patents exist, but innovation in formulations and combination products can offer limited market exclusivity.
• Regulatory compliance, particularly cGMP standards and impurity control (e.g., nitrosamines), is paramount for market access and sustained operations.
• Financial trajectory is characterized by volume-driven revenue, with low price appreciation potential.

Frequently Asked Questions

1. What is the estimated market value of Metformin Hydrochloride in 2024? The market value is estimated to be around $2.19 billion USD in 2024, reflecting continued growth from the 2023 valuation.
2. Which geographical region is expected to exhibit the highest growth rate for Metformin Hydrochloride? The Asia-Pacific region is projected to experience the highest growth rate due to the significant and increasing burden of diabetes, coupled with improving healthcare infrastructure and access.
3. Are there any significant upcoming patent expiries that could impact Metformin Hydrochloride’s market? As the original substance patents for metformin hydrochloride have long expired, there are no significant upcoming patent expiries for the core molecule that would alter its generic status. However, patents on specific novel formulations or combination products could expire, potentially increasing competition for those niche segments.
4. What is the primary concern for regulatory bodies regarding Metformin Hydrochloride manufacturing? The primary current concern for regulatory bodies is the control of nitrosamine impurities, such as NDMA, in metformin hydrochloride products to ensure patient safety.
5. How do GLP-1 receptor agonists and SGLT2 inhibitors impact the market for Metformin Hydrochloride? These newer drug classes impact the market by offering alternative or adjunctive therapies with additional benefits like weight loss and cardiovascular protection. While they may displace metformin in some treatment pathways, metformin's cost-effectiveness ensures its continued role as a first-line therapy for a vast number of patients.

Citations

[1] World Health Organization. (2021). Global report on diabetes. Geneva: World Health Organization. [2] International Diabetes Federation. (2021). IDF Diabetes Atlas 10th edition 2021. Brussels: International Diabetes Federation. [3] American Diabetes Association. (2023). Standards of Medical Care in Diabetes—2023. Diabetes Care, 46(Supplement_1), S1–S291. [4] Krentz, A. J., & Bailey, C. J. (2005). Metformin. Diabetes Care, 28(4), 983–995. [5] National Institute for Health and Care Excellence. (2022). Type 2 diabetes in adults: management. NICE guideline [NG28]. [6] U.S. Food and Drug Administration. (2023, December 1). Ongoing Actions Related to Metformin. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/ongoing-actions-related-metformin