Metformin Transport Rates Between Plasma and Red Blood Cells in Humans

BACKGROUND: Metformin has been used for the treatment of type 2 diabetes for over 60 years; however, its mechanism of pharmacological action is not fully clear. Different hypotheses exist regarding metformin distribution and redistribution mechanisms between plasma and erythrocytes/red blood cells (RBCs). OBJECTIVE: We aimed to test the hypothesis that the metformin distribution between plasma and RBC occurs via concentration difference-driven passive transport and estimated transport rate coefficient values based on metformin concentration time series in plasma and RBCs from in vivo studies. METHODS: An ordinary differential equation (ODE) system with two compartments was used to describe diffusion-based passive transport between plasma and RBCs. Metformin concentration time series in plasma and RBCs of 35 individuals were used for metformin transport parametrization. Plasma concentration has been approximated by biexponential decline. RESULTS: A single passive transport coefficient, k = 0.044 ± 0.014 (h(–1)), can be applied, describing the uptake and release transport rate versus the linear equation v = k × (M(pl) − M(RBC)), where M(pl) is the metformin concentration in plasma and M(RBC) is the metformin concentration in RBCs. CONCLUSIONS: Our research suggests that passive transport can explain metformin distribution dynamics between plasma and RBCs because transport speed is proportional to the metformin concentration difference and independent of the transport direction. Concentration difference-driven passive transport can explain the mechanism of faster metformin distribution to RBCs the first few hours after administration, and faster release and domination of the redistribution transport rate after metformin concentration in plasma becomes smaller than in RBCs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40262-021-01058-2.