chronic

Metabolic Syndrome

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 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 against3 documents

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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Metabolic Syndrome" - disease-level clinical article

Presentation findings are traced to the source above.

METFORMIN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

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

Paediatric dose

(For children >= 10 years: 500 mg daily, max 2000 mg daily under specialist guidance)

Dose by age
10 years and over:	500 mg daily initially, max 2000 mg daily, under specialist guidance

Dose source

Why

Biguanide that improves insulin sensitivity and lowers hepatic glucose output, targeting the insulin-resistance core of metabolic syndrome alongside diet and exercise.

Cautions

Lifestyle modification (diet and exercise) is essential foundation.
Check renal function prior to initiation.
Gastrointestinal side effects are common; titrate the dose gradually.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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 > MERCK SANTE-FRANCE	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

ATORVASTATIN

add-on - not a substitute

Strength20 mg

Formoral.solid

Adult dose and duration

10-20 mg once daily - long-term

Paediatric dose

Specialist consultation required for paediatric dyslipidaemia

Dose 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.

Cautions

Advise patient to report unexplained muscle pain or weakness.
Target atherogenic dyslipidaemia (high triglycerides, low HDL).
Monitor baseline liver function tests.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ANTICHOL 20 MG 10 F.C. TAB.	JEDCO INT. CO. FOR PHARMACEUTICALS	14.40 EGP (1.44/unit)
LIRIMAR 20 MG 10 CAPS.	RIVA PHARMA S.A.E.	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 > SUECAL 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.