Metformin HCL/Progesterone/Azelaic Acid Cream Compounded

Description

Clinical content written by Julia Ossman, 2027 PharmD Candidate, Philadelphia College of Pharmacy

Metformin HCl / Progesterone / Azelaic Acid Cream

This compounded topical cream combines metformin HCl, progesterone, and azelaic acid to help manage the dermatologic effects of polycystic ovary syndrome (PCOS) and acne vulgaris. Together, these medications work to reduce breakouts and other skin changes linked to these conditions.

Pronunciation: MET-for-min HCl / proe-JESS-te-rone / aye-ZAY-lay-ik ASS-id

Active Ingredients & How They Work

Metformin — Drug class: biguanide. Typically used orally as a first-line agent for type 2 diabetes, metformin enhances insulin sensitivity by reducing gluconeogenesis and activating AMP-activated protein kinase (AMPK), which inhibits gluconeogenic gene transcription.

Progesterone — Drug class: progestogen. Commonly used to prevent endometrial hyperplasia in patients taking conjugated estrogen and for secondary amenorrhea. It acts on two main receptor types — nuclear (PR-A and PR-B) and non-nuclear — each driving different transcriptional activity.

Azelaic Acid — Drug class: dicarboxylic acid. Used for acne and rosacea, it works through antibacterial, keratolytic, depigmenting, antioxidant, and anti-inflammatory mechanisms that kill bacteria and reduce redness and swelling.

Possible Side Effects

Common side effects may include burning, redness, itching, and dryness at the application site.

⚠️ Low blood sugar: Tell your doctor if you notice dizziness, headache, shakiness, irregular heartbeat, or hunger.

🚨 Allergic reaction: Seek immediate medical help if you experience swelling of the face, trouble breathing, rash, hives, or itching.

Drug Interactions

Do not use this medication with alcohol. Let your prescriber know about all medications you are taking, as they may interact with this cream.

Warning: Do not use this medication if you have active or a history of breast cancer, blood clots (e.g., pulmonary embolism), or arterial thromboembolic disease (e.g., stroke).

Administration & Dosing

Apply this medication topically exactly as prescribed. Contact your healthcare provider for specific dosing instructions.

Pregnancy, Breastfeeding & Pediatrics

This medication may be recommended against use in pregnant or breastfeeding patients, and careful monitoring may be required. It may or may not be recommended for pediatric patients depending on indication and patient history. Consult your provider to learn more.

⚠️ Disclaimer: This information is generalized and not intended as specific medical advice. If you have questions about the use of your prescription, please contact your prescriber.

References

– Afshar, K., Adibfard, S., Nikbakht, M.H., Rastegarnasab, F., Pourmahdi-Boroujeni, M. and Abtahi-Naeini, B. (2024). A Systematic Review on Clinical Evidence for Topical Metformin: Old Medication With New Application. Health Science Reports, 7: e70281. https://doi.org/10.1002/hsr2.70281

– U.S. Food and Drug Administration. PROMETRIUM (progesterone, USP) capsules 100 mg; capsules 200 mg [package insert]. Silver Spring (MD): U.S. Food and Drug Administration; 2026 Feb. Package insert

– National Library of Medicine (US). Azelaic acid topical [Internet]. Bethesda (MD): National Library of Medicine (US); revised 2016 Dec 15. medlineplus.gov

– Feng X, Shang J, Gu Z, Gong J, Chen Y, Liu Y. Azelaic Acid: Mechanisms of Action and Clinical Applications. Clin Cosmet Investig Dermatol. 2024 Oct 22;17:2359-2371. doi: 10.2147/CCID.S485237. PMID: 39464747; PMCID: PMC11512533.

– U.S. Food and Drug Administration. Finacea (azelaic acid) gel, 15% [package insert]. Silver Spring (MD): U.S. Food and Drug Administration; 2010. Package insert

– U.S. Food and Drug Administration. GLUCOPHAGE (metformin hydrochloride) tablets; GLUCOPHAGE XR (metformin hydrochloride) extended-release tablets [package insert]. Silver Spring (MD): U.S. Food and Drug Administration; 2018. Package insert

– Kolatorova L, Vitku J, Suchopar J, Hill M, Parizek A. Progesterone: A Steroid with Wide Range of Effects in Physiology as Well as Human Medicine. Int J Mol Sci. 2022 Jul 20;23(14):7989. doi: 10.3390/ijms23147989. PMID: 35887338; PMCID: PMC9322133.