# Metabolic Syndrome - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ADA Standards of Care 2024 for the indication, with the dose from GLUCOPHAGE 500 mg film-coated tablets / GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 (eMC product 987): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." and "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses." The SmPC's indication is type 2 diabetes, so use in metabolic syndrome without diabetes is off-label and rests on the ADA standards, which are not held in this corpus. · IDF Consensus Worldwide Definition of the Metabolic Syndrome 2006 · ADA Standards of Care 2024 · ATORVASTATIN CALCIUM US prescribing information, Dosage and Administration (DailyMed SetID e74278b6-31fc-48d4-97b7-ba500e9e15fb) - Verified date: 2026-08 ## Verified against - ADA Standards of Care 2024 for the indication, with the dose from GLUCOPHAGE 500 mg film-coated tablets / GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 (eMC product 987): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." and "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses." The SmPC's indication is type 2 diabetes, so use in metabolic syndrome without diabetes is off-label and rests on the ADA standards, which are not held in this corpus. - ADA Standards of Care 2024 - ATORVASTATIN CALCIUM US prescribing information, Dosage and Administration (DailyMed SetID e74278b6-31fc-48d4-97b7-ba500e9e15fb) ## Treatment metadata - Metformin — 500 mg — oral.solid - Atorvastatin — 20 mg — oral.solid ## Complete treatment card ```text METABOLIC SYNDROME Sources: ADA Standards of Care 2024 for the indication, with the dose from GLUCOPHAGE 500 mg film- coated tablets / GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 (eMC product 987): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." and "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses." The SmPC's indication is type 2 diabetes, so use in metabolic syndrome without diabetes is off-label and rests on the ADA standards, which are not held in this corpus. · IDF Consensus Worldwide Definition of the Metabolic Syndrome 2006 · ADA Standards of Care 2024 · ATORVASTATIN CALCIUM US prescribing information, Dosage and Administration (DailyMed SetID e74278b6-31fc-48d4-97b7-ba500e9e15fb) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Polyuria, polydipsia, and polyphagia point toward diabetes as a feature of the syndrome [excess thirst · polyuria] - A family history of early coronary artery disease should prompt a work-up for metabolic syndrome - Smoking history matters, since it affects cardiovascular risk in this syndrome SIGNS - what you find (3) - Waist circumference should be measured in every patient evaluated - Acanthosis nigricans is a sign of insulin resistance - Xanthomas point to dyslipidaemia TESTS (7) - Fasting glucose and HbA1c screen for insulin resistance and diabetes - A lipid panel checks for raised triglycerides, low HDL, and raised LDL - A basic metabolic panel screens for kidney dysfunction - Selected patients may also get a uric acid level, thyroid studies, CRP, and a liver panel - ASCVD risk should be estimated in every patient to guide primary prevention - A coronary calcium score can be considered in asymptomatic patients at significant ASCVD risk or with early family history of it - Symptomatic patients may need cardiac stress testing such as an ECG stress test, stress echo, or myocardial perfusion imaging IF NOT THIS - what else fits (3) - Hypothyroidism causes hypertension, dyslipidaemia, and obesity, making it a close mimic of the syndrome - Secondary causes such as renal parenchymal or renovascular disease, endocrine disorders, or aortic coarctation are considered - Other differentials include polycystic ovary syndrome, phaeochromocytoma, Cushing syndrome, and acromegaly Source StatPearls "Metabolic Syndrome" - disease-level clinical article Status traced to the source above 1. METFORMIN [1st line] Adult 500 mg once or twice daily with meals to start, titrate to 850-1000 mg twice daily (DPP trial dose 850 mg BID) - long-term Peds 10 years and over: 500 mg daily initially, max 2000 mg daily, under specialist guidance (For children >= 10 years: 500 mg daily, max 2000 mg daily under specialist guidance) Source ADA Standards of Care 2024 for the indication, with the dose from GLUCOPHAGE 500 mg film-coated tablets / GLUCOPHAGE 850 mg film-coated tablets SmPC section 4.2 (eMC product 987): "The usual starting dose is 500 mg or 850 mg metformin hydrochloride 2 or 3 times daily given during or after meals." and "The maximum recommended dose of metformin hydrochloride is 3 g daily, taken as 3 divided doses." The SmPC's indication is type 2 diabetes, so use in metabolic syndrome without diabetes is off-label and rests on the ADA standards, which are not held in this corpus. Why Biguanide that improves insulin sensitivity and lowers hepatic glucose output, targeting the insulin-resistance core of metabolic syndrome alongside diet and exercise. Caution Lifestyle modification (diet and exercise) is essential foundation. Check renal function prior to initiation. Gastrointestinal side effects are common; titrate the dose gradually. Egypt METFORMIN-EL NASR 500MG 200 TAB. EL NASR 26.00 EGP (0.13/unit) DIAPHAGE 500MG 20 TAB. PHAROPHARMA 4.00 EGP (0.20/unit) AMOPHAGE 500MG 30 TAB. AMOUN 10.50 EGP (0.35/unit) CIDOPHAGE 500 MG 10 TAB. CID 11.00 EGP (1.10/unit) GLUCOPHAGE 500 MG 50 F.C.TABS. MINA PHARM > ... 60.00 EGP (1.20/unit) KELVAMET MR 500 MG 30 TABS. BIOMED 54.00 EGP (1.80/unit) ANDOGLYCEMIC XR 500MG 30 EXT. REL. TABS. ANDALOUS PHARMA 24.00 EGP METIANORMIN 500 MG 30 EXT. REL. F.C.TABS. WADI ELNEEL BENTA 54.00 EGP 2. ATORVASTATIN [add-on - not a substitute] Adult 10-20 mg once daily - long-term Peds Specialist consultation required for paediatric dyslipidaemia Source ATORVASTATIN CALCIUM US prescribing information, Dosage and Administration (DailyMed SetID e74278b6-31fc-48d4-97b7-ba500e9e15fb) Why Statin added to metformin and lifestyle change, not a replacement for either; lowers LDL and corrects the atherogenic dyslipidaemia (high triglycerides, low HDL) typical of metabolic syndrome. Caution Advise patient to report unexplained muscle pain or weakness. Target atherogenic dyslipidaemia (high triglycerides, low HDL). Monitor baseline liver function tests. Egypt ANTICHOL 20 MG 10 F.C. TAB. JEDCO INT. CO... 14.40 EGP (1.44/unit) LIRIMAR 20 MG 10 CAPS. RIVA PHARMA S... 15.00 EGP (1.50/unit) LIPOVAST 20MG 7 F.C.TAB. MISR 11.50 EGP (1.64/unit) SIGMALIP 20 MG 10 F.C.TAB. SIGMA 24.00 EGP (2.40/unit) LIPOSEDRA 20 MG 30 F.C.TABS. DELTA PHARMA ... 111.00 EGP (3.70/unit) ATOR 20 MG 10 F.C.TABS. EIPICO 79.00 EGP (7.90/unit) ATCOLIPOX 20 MG 30 CHEW. TABS. ATCO PHARMA 72.00 EGP HIPOLIXAVAST 20 MG 30 CHEW. TABS. EGPI 127.50 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)