Repurposing metformin: A potential off-label indication for ischaemic stroke?

The term 'clinical cemetery' is frequently used to characterize ischaemic stroke, one of the leading causes of mortality and long-term morbidity globally. Over the past two decades, a number of novel therapies have been investigated for ischaemic stroke. However, aside from mechanical thrombectomy, the only FDA-approved prescription for treating ischaemic stroke is tissue plasminogen activator, which has a limited therapeutic period. Although post-stroke rehabilitation therapies are helpful in improving functional recovery, their benefits cannot be yielded promptly. Nowadays, drug repurposing might be an appealing approach to expanding therapeutic options for ischaemic stroke. During the last decade, metformin has been extensively researched as a potential repurposing medicine for ischaemic stroke, with a focus on both preventive and therapeutic approaches. With regard to the idea of repurposing metformin in ischaemic stroke, this review aims to compile the available data from pre-clinical and clinical trials, address and clarify any discrepancies, and offer solutions.