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This is a combination of two distinct drugs with different mechanisms of action. 9-cis retinoic acid (alitretinoin) is a naturally occurring endogenous retinoid that binds to and activates both retinoic acid receptors (RAR) and retinoid X receptors (RXR), enhancing gene transcription. It affects gene expression that inhibits cell proliferation, induces cell differentiation, and triggers apoptosis. Metformin is an antidiabetic agent that reduces glucose production in the liver, increases insulin sensitivity, and improves blood sugar control in type 2 diabetes.
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