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L-citrulline + metformin is a combination therapy that targets the nitric oxide (NO) pathway to potentially improve muscle function in patients with muscular dystrophies, particularly Duchenne muscular dystrophy (DMD). L-citrulline is an amino acid and precursor to L-arginine, which is the substrate for neuronal nitric oxide synthase (nNOS). Metformin is a biguanide antidiabetic drug that activates nNOS in human skeletal muscle. The combined actions are expected to help improve muscle function and slow down disease progression by enhancing nitric oxide synthesis and improving blood flow to muscles.
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