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Metformin And Contrast Media
Department of Diagnostic Sciences, Faculty of Health Sciences, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark*e-mail: [emailprotected] Department of Diagnostic Imaging, Northern General Hospital, Sheffield, England Department of Radiology, Karolinska Universitets Sjukhus, Huddinge, Sweden General Adult Radiology Service, Hpital de Bictre, Le Kremlin-Bictre Cedex, France Radiology Service, Hpital Europen Georges Pompidou, Paris, France# Department of Radiology, University Hospital Vienna, Vienna, Austria** Radiology, Klinikum Karlsruhe, Academic Teaching Hospital, University of Freiburg, Karlsruhe, Germany S.C. Radiologia Ospedale Maggiore, Tieste, Italy Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands Department of Diagnostic Radiology, St. Bartholomews Hospital, London, England We read with interest the article in the January 2010 issue of Radiology by Dr Goergen and colleagues ( 1 ), which evaluated current guidelines for using contrast medium in diabetic patients who are receiving metformin. The European Society of Urogenital Radiology (ESUR) guideline on this topic evaluated by Dr Goergen and colleagues was published in 1999 ( 2 ) and is not the current guideline, which was published in Contrast Media: Safety Issues and ESUR Guidelines in February 2009 ( 3 ) and also online ( 4 ). We note that book chapters were not included in the authors search. The current ESUR guideline indicates that patients with an estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m2 can continue to take metformin normally after receiving contrast medium, a recommendation similar to that made by Dr Goergen and colleagues following their literature review. We agree with them that there is insufficient evidence in th Continue reading >>
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Metformin Deemed Safe For Most Medical Imaging
Radiologists previously thought the drug might up risk of kidney problems in procedures that involved injecting contrast. In 2015, the American College of Radiology (ACR) changed their guidelines for how radiologists should handle patients using metformin. Metformin is an oral drug which lowers blood sugar levels by decreasing the amount of sugar produced in the liver and increasing the sensitivity of muscle cells to insulin. Metformin is then eliminated by the kidneys. However, metformin use had been thought in the past to predispose patients with Type 2 diabetes, especially those with underlying kidney problems, to increased risk of kidney failure or serious cases of lactic acidosis. Because of this potential risk, the ACR and the Food and Drug Administration (FDA) issued strict guidelines in 2013 about the use of metformin when contrast is used in medical imaging. These guidelines came about because such contrast can damage the kidneys in some cases, a condition called contrast-induced nephropathy. The 2013 guidelines recommended that metformin be stopped 48 hours post-procedure, and that it should not be taken again until doctors see the kidney is not injured. In 2015, these restrictions were removed from the guidelines, according to a Medscape article. This is partly because most radiologists simply weren’t following the 2013 guidelines, and partly because the rate of contrast-induced nephropathy in metformin users has been found to be incredibly low. Also, researchers now believe that metformin is not the source for most of the kidney problems. New studies seem to show that kidney injury and lactic acidosis probably come as a result of preexisting medical conditions along with metformin buildup in the kidneys, not from just metformin use alone. The 2015 guidelin Continue reading >>
Metformin And Iodinated Contrast: Lactic Acidosis Warning
Metformin and Iodinated Contrast: Lactic Acidosis Warning Have you wondered about the liquid given before a CT scan1 or X-ray procedure is done? Did someone give you an information sheet talking about the possible adverse drug effects? Any adverse drug effects if you are diabetic? Jay Harold will discuss an important warning from the Food and Drug Administration (FDA) about a diabetic medication (metformin) andIodinated contrast agents. A CT Scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create 3-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. A CT scan may be used to help diagnose disease, plan treatment, or find out how well treatment is working. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography. Iodinated contrast agents have been in use since the 1950s to facilitate radiographic imaging modalities. Physicians in almost all specialties will either administer these agents or care for patients who have received these drugs2. By far the most successful and widely applied contrast agents in use today are the iodinated contrast agents (ICAs), first introduced into clinical practice in the 1950s. It is estimated that approximately 75 million doses of ICAs are given worldwide each year. Metformin3 is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount Continue reading >>
Metformin
CT scan is a sophisticated imaging tool utilizing x-rays and powerful computers to generate cross-sectional images of the body. CT scans are used to diagnosis wide range of diseases from head to toe. Spiral CT was introduced in the 1990's, which enable much faster and accurate scanning capabilities. Main Street Radiology installed the first 16-detector spiral CT in Queens, with the ability to scan up to 16 times faster than a traditional spiral CT. About the Procedure Depending on the type of scan requested by the referring physician, a patient may receive oral and/or intravenous (IV) contrast. Oral contrast is used to outline the stomach and intestines during the exam, and is given as a flavored drink approximately one hour prior to the actual scan. IV contrast is an iodine-based liquid injected into the vein during the scan to highlight organs of the body. The patient lies on a table that automatically moves the patient's body through a "donut" shaped tube, where a thin beam of x-rays is generated to produce high-resolution cross-sectional images of the body. The actual scanning time is usually less than 30 seconds with a 16-detector spiral CT. The patient may be asked to hold his/her breath during the scan, so that body part being imaged does not move during the scan acquisition. Preparation for Procedure To prepare for a CT scan, we ask that you follow the following guidelines: Please do not wear any item that is metal – including watches, hair pins, hearing aids, eyeglasses and jewelry. Please also do not wear any clothing that does not contain metal buttons, snaps or zippers. If you are, or think you may be pregnant please let us know as a CT scan is not generally performed on pregnant women. CT Scan with Contrast Refrain from eating AND drinking 4 hours prior t Continue reading >>
Systematic Review Of Current Guidelines, And Their Evidence Base, On Risk Of Lactic Acidosis After Administration Of Contrast Medium For Patients Receiving Metformin
Systematic Review of Current Guidelines, and Their Evidence Base, on Risk of Lactic Acidosis after Administration of Contrast Medium for Patients Receiving Metformin 1From the Department of Diagnostic Imaging, Southern Health, 246 Clayton Rd, Clayton, VIC 3168, Australia (S.K.G., G.C.); and Centre for Clinical Effectiveness, Monash Institute of Health Services Research, Monash University, Clayton, Victoria, Australia (G.R., C.H.). From the 2008 RSNA Annual Meeting. Address correspondence to S.K.G. (e-mail: [emailprotected] ). To systematically review evidence about the relationship between metformin administration and the use of iodinated contrast medium and risk of lactic acidosis (LA) and to assess the quality of five current guidelines for use of contrast medium in patients who are taking metformin. A search strategy was developed by using search termsrelated to metformin, contrast media, and LA. Searches were conducted in MEDLINE (Ovid), all Evidence-based Medicine Reviews (Ovid), EMBASE, and Cochrane library databases and were augmented with searches for evidence-based guidelines on radiology and evidence-based medicine Web sites by using the Google Internet search engine. Guidelines were appraised by two independent reviewers by using the Appraisal of Guidelines Research and Evaluation Collaboration Instrument. Other studies were appraised by using structured appraisal checklists. Five guidelines were identified and five empirical studies met inclusion criteria. All guidelines had poor scores on some Appraisal of Guidelines for Research and Evaluation (AGREE) Collaboration criteria; poorer scores tended to occur in relation to objective assessment of rigor of guideline development, editorial independence, and applicability of the guideline to clinical practice. L Continue reading >>
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Metformin And Contrast Media: Where Is The Conflict?
Abstract Intravascular administration of iodinated contrast media to patients who are receiving metformin, an oral antidiabetic agent, can result in lactic acidosis. However, this rare complication occurs only if the contrast medium causes renal failure, and the patient continues to take metformin in the presence of renal failure. Because metformin is excreted primarily by the kidneys, continued intake of metformin after the onset of renal failure results in a toxic accumulation of this drug and subsequent lactic acidosis. To avoid this complication, metformin must be withheld after the administration of the contrast agent for 48 hours, during which the contrast-induced renal failure becomes clinically apparent. If renal function is normal at 48 hours, the metformin can be restarted. There is no scientific justification for withholding metformin for 48 hours before administration of the contrast medium, as currently recommended in the package insert. The authors review the pharmacology of metformin and present a departmental policy for managing patients with diabetes who receive metformin and who require intravascular administration of iodinated contrast media. Continue reading >>
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Metformin (oral Route)
Precautions Drug information provided by: Micromedex It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take this medicine. Blood and urine tests may be needed to check for unwanted effects. This medicine may interact with the dye used for an X-ray or CT scan. Your doctor should advise you to stop taking it before you have any medical exams or diagnostic tests that might cause less urine output than usual. You may be advised to start taking the medicine again 48 hours after the exams or tests if your kidney function is tested and found to be normal. Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests. It is very important to carefully follow any instructions from your health care team about: Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team. Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems. Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur with lifestyle changes, such as changes in exercise or diet. Counseling on birth control and pregnancy may be needed because of the problems that can occur in pregnancy for patients with diabetes. Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would norm Continue reading >>
The Best Guideline On When To Stop Metformin
The Best Guideline on When To Stop Metformin The Australian RANZCR guideline on metformin in diabetics getting iodinated contrast is the most clinically relevant among all international guidelines on this topic. It states that metformin does not need to be withheld in patients with an eGFR over 30. Metformin, a biguanide, is commonly prescribed for type 2 diabetics, as it inhibits gluconeogenesis, and enhances peripheral glucose uptake. Many hospitals currently withhold metformin from type 2 diabetics for 48 hours after applying intravenous iodinated contrast. The reason is metformin-associated lactic acidosis (MALA): Metformin increases anaerobic metabolism. This together with low insulin levels increases lactate production. Reduced gluconeogenesis from lactate further increases lactate levels. While MALA is a rare event, it is potentially life-threatening. Gastrointestinal symptoms predominate in MALA, patients may show evidence of severe acidosis and renal dysfunction. Withholding metformin for 48 hours has become controversial, said Arlene Weir, Galway University Hospital, Ireland. MALA is likely associated with predecessors of metformin. In addition, the data this recommendation is based on, is weak. Weir reviewed the current guidelines and the English literature on the indications and rationale for withholding metformin. She included five guidelines: The Royal College of Radiologists (RCR), the American College of Radiologists (ACR), the European Society of Urogenital Radiology (ESUR), the Royal Australian and New Zealand College of Radiologists (RANZCR), and the Canadian Association of Radiologists (CAR). All these guidelines have undergone reviews during the last couple of years; CAR being the oldest with 2012 as its publication date, and ACR and RANZCR being t Continue reading >>
No Metformin After Ct Scan
Metformin and Contrast Medium - Diabetes Home Page Metformin and Contrast Medium. ... An Overview of Metformin and Contrast Medium Metformin ... Certain computed tomography (CT) scans ; PDF Holding Metformin for CT scans - GI Consultants Holding Metformin for CT scans ... Notification to Resume Metformin After having your CT scan, drink a lot of fluids for the next 48 hours to flush out the contrast from Metformin and your CT Scan | UW Medicine Metformin and your CT Scan ... Metformin and Your Scan. ... your healthcare provider wants you to stop taking any medicine that contains metformin after your ... Metformin And Ct Scans With Contrast - HealthTap ... Dr. Daniel on metformin and ct scans with contrast: You likely will be fine ... Doctor insights on: Metformin And Ct Scans With Contrast Share Share Metformin After A Ct Scan (Metformin:Glucophage ... metformin after a ct scan 850 mg preis can and amaryl be taken together estradiol testosterone suppression metformin after a ct scan sitagliptin and hydrochloride ... CT Scan Patient Instructions - VCU Radiology Department of Radiology at Virginia Commonwealth University ... CT Scan View patient ... CT Angiography. Metformin ... CT | Main Street Radiology | Bayside NY The following meds contain Metformin and can't be taken for 6 hours before CT and 48 hours after CT without contrast: Glucophage; Fortamet; ... Your CT Scan: If you ... Landmark Medical Center | Cat Scan WHAT TO EXPECT AFTER THE CAT SCAN There are no side ... Special Instructions for Diabetic Patients on Metformin. If you had a CT scan with IV ... Metformin and IV Contrast Media for CT Scan - Prezi Metformin and IV Contrast Media for CT Scan. ... check for order to discontinue Metformin for 48 hours after CT. If you do not have an order to hold the Metformi Continue reading >>
Metformin And Intravenous Contrast
Go to: Metformin is excreted by the kidneys Metformin is used in type 2 diabetes mellitus to decrease the amount of glucose produced by the liver and to increase the body’s response to insulin. In patients with renal failure (acute or chronic), the renal clearance of metformin is decreased, and there is an associated risk of lactic acidosis, which has a mortality rate of up to 50%.1 Some patients who receive intravenous contrast may experience a deterioration of renal function (contrast-induced nephropathy). Although the points in this article discuss the use of intravenous contrast, the same principles apply to intra-arterial contrast. Go to: Use of metformin is not a contraindication to intravenous contrast administration Metformin in isolation is not considered a risk factor for contrast-induced nephropathy,2 but particular attention must be paid to patients taking metformin who are scheduled to undergo contrast-enhanced examination (e.g., enhanced computed tomography [CT], angiography, venography).3 Many physicians are particularly cautious in the case of elderly patients aged greater than 80 years. Go to: For most patients, metformin should be stopped at the time of contrast administration There is some controversy about when to stop and restart metformin for patients scheduled to undergo intravenous contrast-enhanced examinations.4 The guidelines from the Canadian Association of Radiologists2 state that patients taking metformin who have an estimated glomerular filtration rate (eGFR) of less than 60 mL/min should stop taking metformin at the time of contrast administration. The European Society of Urogenital Radiology advocates stopping metformin 48 hours before CT for patients with an eGFR of less than 45 mL/min.5 Go to: Restarting metformin depends on renal fu Continue reading >>
Should You Stop Metformin After Iv Contrast?
Metformin has been known to be associated with increased incidence of lactic acidosis. Metformin is renally excreted. Increased Metformin concentration leads to increased risk of lactic acidosis. IV contrast causes nephropathy leading to increased blood levels of Metformin. Metformin + IV contrast = lactic acidosis = bad This was the reasoning to having patients stop Metformin for 48 hours post IV contrast administration since 1999 as recommended by the NICE (National Institute for Health and Care Excellence ) and ESUR (European Society of Urogenital Radiology) guidelines. Patients were to have their Cr checked after 48 hours and only restarted if it was unchanged. So does this mean you should instruct every patient on Metformin for diabetes to stop taking their Metformin for 48 hours? Maybe not anymore!! According to the updated 2009 NICE and 2011 ESUR guidelines, patients with a GFR > 45 can now take their Metformin without interruption after getting IV contrast for their CT scan. So why the Maybe? These NICE and ESUR guidelines are from the UK so they are not universally accepted in the US. It’s often forgotten to tell the patient to stop taking their Metformin after getting IV contrast but at least now you have some guidelines to make you feel better when you do forget. As always, make sure your attending agrees with your plan. Continue reading >>
Intravenous Contrast In Patients With Diabetes On Metformin: New Common Sense Guidelines
Abstract Abbreviations: ACR = American College of Radiology AKI = acute kidney injury CT = computed tomography Cr = creatinine DM = diabetes mellitus eGFR = estimated glomerular filtration rate FDA = Food and Drug Administration FDG = fluorodeoxyglucose IV = intravenous Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free Arti D. Shah, MD1; Cody McHargue, BA2; Judy Yee, MD2; Robert J. Rushakoff, MD1 a repeat creatinine (Cr) was not required. These specic Historically, given metformin’s renal excretion, with a Cr ≥1.5 mg/dL, in females with a Cr ≥1.4 mg/dL eGFR cutoff of 30 mL/min/1.73 m2 below which metfor- min is contraindicated and a dose reduction at 45 mL/ Given concerns about metformin-induced lactic mulation but rather are due to associated hypoxic condi- 30% had an eGFR <60 mL/min/1.73 m2. There was no to baseline within 2 weeks (6). More recently, Gómez- ated (5). No patients with an eGFR >60 mL/min/1.73 m2 patients with a precontrast eGFR <60 mL/min/1.73 m2. an angiotensin-converting enzyme inhibitor or angioten- or following the intravenous administration of iodinated contrast media, nor is there an obligatory need to reassess the patient’s renal min/1.73 m2), or are undergoing arterial catheter studies that might result in emboli (atheromatous or other) to the renal arteries, metformin should be temporarily discontinued at the time of or prior to the procedure, withheld for 48 hours subsequent to the Continue reading >>
In Brief: New Recommendations For Use Of Metformin In Renal Impairment
The FDA has required labeling changes that replace serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) as the parameter used to determine the appropriateness of treatment with the biguanide metformin (Glucophage, and others) in patients with renal impairment. These changes will allow more patients with mild to moderate renal impairment to receive metformin, which is generally the first drug prescribed for treatment of type 2 diabetes. Metformin was previously contraindicated in women with a SCr level ≥1.4 mg/dL and in men with a SCr level ≥1.5 mg/dL, but use of SCr as a surrogate indicator tends to underestimate renal function in certain populations (e.g., younger patients, men, black patients, patients with greater muscle mass). The calculation of eGFR takes into account age, race, and sex, as well as SCr level, providing a more accurate assessment of kidney function. A literature review summarized in an FDA Drug Safety Communication concluded that, based on eGFR, metformin is safe to use in patients with mild renal impairment and in some patients with moderate renal impairment.1 The eGFR should be calculated before patients begin treatment with metformin and at least annually thereafter. Metformin is now contraindicated in patients with an eGFR <30 mL/min/1.73 m2, and starting treatment with the drug in patients with an eGFR between 30 and 45 mL/min/1.73 m2 is not recommended. If the eGFR falls below 45 mL/min/1.73 m2 in a patient already taking metformin, the benefits and risks of continuing treatment should be assessed. Metformin should be not be administered for 48 hours after an iodinated contrast imaging procedure in patients with an eGFR <60 mL/min/1.73 m2 or a history of liver disease, alcoholism, or heart failure, or in those receiving Continue reading >>
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For Diabetic Patients On Glucophage Or Glucovance
For Diabetic Patients on Glucophage or Glucovance How to take diabetes medicine that contain Metformin* after receiving a contrast injection for a CT Scan *The diabetes medications that contain Metformin include: Stop taking Metformin and contact your doctor within 48 hours before restarting. Show this sheet to your doctor. If you do not suffer from any of the above conditions: Category 1: Normal renal function and none of the above co-morbidities: Metformin nood not be discontinued. Category 2: Normal renal function but above co-morbidities: May restart Metformin after 48 hours if clinically stable. Category 3: Renal dysfunction: May restart Metformin only after cautious follow up of renal function. When you express interest in a specific study, the information from your profile will be sent to the doctor conducting that study. If you're eligible to participate, you may be contacted by a nurse or study coordinator. If you select a health category rather than a specific study, doctors who have active studies in that area may contact you to ask if you would like to participate. In both cases, you will be contacted by the preferred method (email or phone) that you specified in your profile. Continue reading >>
