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It is an appetite suppressant that works by affecting the central nervous system to decrease appetite and increase feelings of fullness. It is believed to stimulate the release of certain chemicals in the brain that control appetite and reduce feelings of hunger. This leads to a decrease in food intake and ultimately weight loss.

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Experts estimate that about one third of insurance companies cover all FDA-approved weight loss medications, another third cover some drugs in some cases, while the remaining third do not cover any pharmaceutical therapy for obesity 3. Weight loss significantly improves health outcomes for the vast majority of patients, but insurance companies may not see those savings for years to come. So, profit-driven insurance companies, especially those with high patient turnover, are often hesitant to cover preventative treatments like weight loss medications. The US Preventative Task Force repeatedly fails to recommend pharmaceuticals as an advisable treatment for obesity in the primary care setting 5.

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It can be used with sulfonylureas. Adverse effects of metformin are few, mainly gastrointestinal upsets and a rare but potentially fatal lactic acidosis, which is why other drugs in this class are unavailable. Metformin should never be prescribed for patients with renal disease or severe pulmonary or cardiac disease. Metformin is contraindicated with concurrent use of iodine containing contrast agents.

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The following case study is of a patient who might be seen in a podiatry clinic and who might be a suitable case for supplementary prescribing under a clinical management plan. You may need to refer to Chapter and the use of clinical management plans. She sees the practice nurse in between who does the breathing test with her but has to get the doctor to sign the repeat prescription.