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Life Threatening Considerations For Metformin

Life Threatening Lactic Acidosis

Life Threatening Lactic Acidosis

M Lemyze, specialist registrar in critical care medicine 1 , J F Baudry, specialist registrar in critical care medicine 2 , F Collet, specialist registrar in critical care medicine 2 , N Guinard, specialist registrar in critical care medicine 2 1Department of Critical Care Medicine, Schaffner Hospital, 62300 Lens, France 2Department of Critical Care Medicine, Broussais Hospital, 35400 Saint Malo, France Correspondence to: M Lemyze malcolmlemyze{at}yahoo.fr An 83 year old woman with diabetes presented to the emergency department with progressive shortness of breath and a two week history of diarrhoea. Her drugs included aspirin, 75 mg four times a day; a combination of irbesartan with hydrochlorothiazide, 300/25 mg four times a day; and metformin, 1000 mg three times a day. She had no previously known renal insufficiency, but on arrival she was oliguric, disoriented, and confused. Her respiratory rate was 32 breaths/min, blood pressure was 76/46 mm Hg, heart rate was 125 beats/min, and rectal temperature reached 36.8C. She had cool and clammy extremities and a persistent skinfoldadditional evidence of severe dehydration. Arterial blood gases showed a profound lactic acidosis, with pH 6.72, partial pressure of carbon dioxide (PCO2) 14 mm Hg, partial pressure of oxygen (PO2) 106 mm Hg, bicarbonate 12 mmol/l, and a high lactate concentration of 17.4 mmol/l. Laboratory results showed a normal blood glucose concentration of 9 mmol/l, a serum urea of 22 mmol/l, a serum creatinine of 779 mol/l, an increased serum potassium concentration of 6.8 mmol/l, and a decreased prothrombin activity of 43% (prothrombin time of 21 seconds). Chest and abdominal examination, chest radiography, urine dipstick, plasma C reactive protein (<5 mg/l), and procalcitonin (<0.5 g/l) concentrations sh Continue reading >>

Fatal Metformin Overdose Presenting With Progressive Hyperglycemia

Fatal Metformin Overdose Presenting With Progressive Hyperglycemia

Go to: CASE REPORT A 29-year-old man ingested metformin in a suicide attempt. The patient consumed the entire remaining contents of his father’s prescription metformin bottle that originally contained 100 tablets of 850 mg each. The father stated that the bottle had contained at least three-quarters of its original contents, putting the ingested dose between 64 and 85 grams. The patient also consumed ethanol, but denied any other co-ingestants. The parents discovered the overdose around 6:30 a.m., about 5 ½ hours post-ingestion, when the patient began complaining of vomiting, diarrhea, thirst, abdominal pain and bilateral leg pain. Paramedics were called, who found the patient to be agitated with a fingerstick glucose level of 180 mg/dL. The patient had a history of psychosis and depression, including prior suicide attempts by drug ingestion. He was not taking any prescribed medications, having discontinued olanzapine and sertraline several months earlier. The patient had no personal history of diabetes, despite the family history of type II diabetes in his father, who was taking no other anti-diabetic medications than metformin. The patient admitted to daily ethanol and tobacco use, but denied any current or past use of illicit drugs. He had no surgical history or known allergies. Vital signs on arrival to the Emergency Department (ED) were temperature of 35.2°C (rectal), pulse of 113 beats/min, blood pressure of 129/59 mmHg, respirations at 28 breaths/min with 100% saturation via pulse oximetry on room air. The patient was awake and oriented x4, but agitated and slightly confused (GCS=14). Pupils were equal and reactive at 4mm and the oral mucous membranes were dry. Other than tachycardia, the heart and lung exams were unremarkable. The abdomen was mildly tender t Continue reading >>

Metformin

Metformin

Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have kidney disease. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. Also, tell your doctor if you plan to have any x-ray procedure in which dye is injected, especially if you drink or have ever drunk large amounts of alcohol or have or have had liver disease or heart failure. You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Your doctor will tell you exactly when you should stop taking metformin and when you should start taking it again. If you experience any of the following symptoms, stop taking metformin and call your doctor immediately: extreme tiredness, weakness, or discomfort; nausea; vomiting; stomach pain; decreased appetite; deep and rapid breathing or shortness of breath; dizzi Continue reading >>

Segluromet (ertugliflozin/metformin) Dosing, Indications, Interactions, Adverse Effects, And More

Segluromet (ertugliflozin/metformin) Dosing, Indications, Interactions, Adverse Effects, And More

Indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are not adequately controlled on a regimen containing ertugliflozin or metformin, or in patients who are already treated with both ertugliflozin and metformin Individualize starting dose based on patients current regimen, while not exceeding daily dose of ertugliflozin 15 mg and metformin 2000 mg Patients on metformin: Switch to tablets containing 2.5 mg ertugliflozin, with a similar total daily dose of metformin Patients on ertugliflozin: Switch to tablets containing 500 mg metformin, with a similar total daily dose of ertugliflozin Patients already on ertugliflozin and metformin: Switch to tablets containing same total daily dose of ertugliflozin and a similar daily dose of metformin To reduce GI adverse effects, gradually escalate dose for those initiating metformin Adjust dose based on effectiveness and tolerability Concomitant use with insulin and insulin secretagogues may increase the risk of hypoglycemia; lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used in combination with ertugliflozin Discontinue at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR <60 mL/min/1.73 m, history of liver disease, alcoholism, heart failure, or in patients who will be administered intra-arterial iodinated contrast Reevaluate eGFR 48 hr after the imaging procedure; restart drug if renal function is stable eGFR &g;e60 mL/min/1.73 m: No dosage adjustment necessary End-stage renal disease or dialysis: Contraindicated Initiation of ertugliflozin not recommended Continued use not recommended with persistent eGFR 30-60 mL/min/1.73 m Metformin has been associated with some cases Continue reading >>

Canagliflozin | Davis's Drug Guide

Canagliflozin | Davis's Drug Guide

sodium-glucose co-transporter 2 (SGLT2) inhibitors Adjunct to diet and exercise in the management of type 2 diabetes mellitus. May be used with other antidiabetic agents. Inhibits proximal renal tubular sodium-glucose co-transporter 2 (SGLT2), which determines reabsorption of glucose from the tubular lumen. Inhibits reabsorption of glucose, lowers renal threshold for glucose, and increases excretion of glucose in urine. Absorption: Well absorbed (65%) following oral administration. Distribution: Extensive tissue distribution. Metabolism and Excretion: Mostly metabolized by UDP-glucuronyl transferases (UGT) to inactive metabolites, minimal metabolism by CYP3A4 (7%). 50% excreted in feces as parent drug and metabolites, 33% as metabolites in urine, <1% excreted in urine as unchanged drug. Severe renal impairment (eGFR <45 mL/min/1.73 m2 ), end-stage renal disease or on dialysis; Lactation: Avoid use, discontinue breast feeding or discontinue canagliflozin. eGFR <60 mL/min/1.73 m2 (monitor frequently) ( risk of adverse reactions related to intravascular volume); History of pancreatitis, pancreatic surgery, reduced caloric intake due to illness or surgery, or alcohol abuse ( risk of ketoacidosis); Hypovolemia, chronic kidney disease, HF, or concurrent use of diuretics, NSAIDs, ACE inhibitors, or ARBs ( risk of acute kidney injury); Previous amputation, peripheral vascular disease, or neuropathy ( risk of limb amputation); Geri: risk of adverse reactions related to intravascular volume; Hypotension (correct prior to treatment, especially if eGFR 3060 mL/min, age >75 yr, or concurrent use of loop diuretics, ACE inhibitors, or ARBs; OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; Pedi: Safety and effectiveness not established. GU: U Continue reading >>

Taking Metformin? Here’s Everything You Need To Know

Taking Metformin? Here’s Everything You Need To Know

Metformin is often the first drug prescribed to people who have been diagnosed with type 2 diabetes. Taken orally, metformin helps to control your blood sugar levels. Metformin is often used in combination with other drugs to treat diabetes. Without the proper long-term management of diabetes, it can cause serious health complications. One of the best ways to accomplish this is through the proper use of medications such as metformin and making appropriate lifestyle changes. If you’d like to learn about some of the other medications used to treat type 2 diabetes, please click here. How Metformin Works for Type 2 Diabetics Metformin is prescribed for type 2 diabetes because it can help control blood sugar spikes. So, how does this diabetes drug do this? . The drug reduces the amount of glucose (sugar) your liver produces and how much your body absorbs. Thus, metformin will increase the effect that insulin has on your body. In addition to increasing the body’s insulin sensitivity, patients often report a drop in their cholesterol levels. Metformin can impact your appetite, which results in fewer calories consumed and weight loss. Losing excess weight will also improve your body’s sensitivity to insulin. Please note that metformin should not be solely relied on to treat high blood sugar levels. Diet and exercise are crucial to proper management of your diabetes. This combined with a stable dosage of metformin can be very effective. What are the Side Effects Associated with Metformin? As with any drug, metformin does come with the risk of side effects. These can range from mild to severe. Less severe side effects usually subside within a few days to a couple weeks. If your side effects persist or get worse, alert your healthcare provider imediately. Metformin can cause Continue reading >>

Synjardy (empagliflozin And Metformin Hydrochloride Tablets): Side Effects, Interactions, Warning, Dosage & Uses

Synjardy (empagliflozin And Metformin Hydrochloride Tablets): Side Effects, Interactions, Warning, Dosage & Uses

(empagliflozin and metformin hydrochloride) Tablets Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia,hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is oftensubtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress,somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevatedblood lactate levels (>5 mmol/Liter), anion gap acidosis (without evidence of ketonuria or ketonemia),an increased lactate/pyruvate ratio; and metformin plasma levels generally >5 mcg/mL [see WARNINGS AND PRECAUTIONS ]. Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use ofcertain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater,having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acutecongestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage metformin-associated lactic acidosis in these high risk groupsare provided in the full prescribing information [see DOSAGE AND ADMINISTRATION , CONTRAINDICATIONS , WARNINGS AND PRECAUTIONS , DRUG INTERACTIONS and Use In Specific Populations ]. If metformin-associated lactic acidosis is suspected, immediately discontinue SYNJARDY and institutegeneral supportive measures in a hospital setting. Prompt hemodialysis is recommended [see WARNINGS AND PRECAUTIONS ]. SYNJARDY tablets contain two oral antihyperglycemic drugs used in the management of type 2 diabetes :empagliflozin and metformin hydrochloride. Empagliflozin is an orally-active inhibitor of the sodium-glucose co-transporter 2 (SGLT2). The chemical name of Continue reading >>

Metformin, Oral Tablet

Metformin, Oral Tablet

Metformin oral tablet is available as both a generic and brand-name drug. Brand names: Glucophage, Glucophage XR, Fortamet, and Glumetza. Metformin is also available as an oral solution but only in the brand-name drug Riomet. Metformin is used to treat high blood sugar levels caused by type 2 diabetes. FDA warning: Lactic acidosis warning This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects. Lactic acidosis is a rare but serious side effect of this drug. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital. Lactic acidosis is fatal in about half of people who develop it. You should stop taking this drug and call your doctor right away or go to the emergency room if you have signs of lactic acidosis. Symptoms include tiredness, weakness, unusual muscle pain, trouble breathing, unusual sleepiness, stomach pains, nausea (or vomiting), dizziness (or lightheadedness), and slow or irregular heart rate. Alcohol use warning: You shouldn’t drink alcohol while taking this drug. Alcohol can affect your blood sugar levels unpredictably and increase your risk of lactic acidosis. Kidney problems warning: If you have moderate to severe kidney problems, you have a higher risk of lactic acidosis. You shouldn’t take this drug. Liver problems warning: Liver disease is a risk factor for lactic acidosis. You shouldn’t take this drug if you have liver problems. Metformin oral tablet is a prescription drug that’s available as the brand name drugs Glucophage, Glucophage XR, Fortamet, and Glumetza. Glucophage is an immediate-release tablet. All of the other brands are extended-r Continue reading >>

Glyburide | Davis's Drug Guide

Glyburide | Davis's Drug Guide

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. PO: Control of blood sugar in type 2 diabetes mellitus when diet therapy fails. Requires some pancreatic function. Lowers blood sugar by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production. Lowering of blood sugar in diabetic patients. Absorption: Well absorbed following oral administration; micronized forms have better absorption. Distribution: Reaches high concentrations in bile and crosses the placenta. Metabolism and Excretion: Mostly metabolized by the liver (primarily by CYP2C9). Hypersensitivity to sulfonamides (cross-sensitivity may occur) Glucose 6-phosphate dehydrogenase deficiency ( risk of hemolytic anemia); Geri: sensitivity; dose reduction may be required Severe renal disease ( risk of hypoglycemia) Infection, stress, or changes in diet may alter requirements for control of blood sugar Impaired thyroid, pituitary, or adrenal function Malnutrition, high fever, prolonged nausea, or vomiting OB: Lactation: Safety not established; insulin recommended during pregnancy. CNS: dizziness, drowsiness, headache, weakness GI: constipation, cramps, diarrhea, drug-induced hepatitis, dyspepsia, appetite, nausea, vomiting Derm: ERYTHEMA MULTIFORME, photosensitivity, exfoliative dermatitis, rash Hemat: APLASTIC ANEMIA, agranulocytosis, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia risk of elevated liver enzymes when used with bosentan (avoid concurrent use). Ingestion of alcohol may result in disulfiram-like reaction. Effectiveness may be by concurrent use of diuretics , corticosteroids , phenothiazines , oral contraceptives , es Continue reading >>

Glucophage (metformin) Is The First Choice Medicine To Control Your Blood Sugar And Lower The Risk Of Death From Diabetes, Although A Few People May Not Tolerate The Stomach Side Effects.

Glucophage (metformin) Is The First Choice Medicine To Control Your Blood Sugar And Lower The Risk Of Death From Diabetes, Although A Few People May Not Tolerate The Stomach Side Effects.

Our bottom line Glucophage (metformin) is the first choice medicine to control your blood sugar and lower the risk of death from diabetes, although a few people may not tolerate the stomach side effects. Improves sugar control and lowers A1c levels as much as 2%. One of the few diabetes medicines that lowers the risk of death from diabetes-related complications. Rarely causes low blood sugar. Often causes stomach upset, like diarrhea, nausea, gas, or stomach cramping. Usually not a good choice for people with kidney problems. Your doctor will tell you if Glucophage (metformin) is right for you to take. Excessive or chronic alcohol use can increase the risk of a dangerous side effect. Glucophage (metformin) is an anti-diabetic drug. It lowers the amount of sugar your body makes or absorbs, and allows your body use the existing insulin better. Sign up and get Pill Talk, the latest in health & medicine news from Iodine What to expect when you take Glucophage (metformin) for Type 2 diabetes Effectiveness Source: FDA product label and Iodine pharmacists Where we got our data » Higher risk if: › Kidney problems › Liver problems › Congestive heart failure › Using contrast dye for procedures › Surgery › Alcohol use Glucophage (metformin) can cause this rare life-threatening condition. Your doctor will check your kidneys and liver before you start. Symptoms include deep and rapid breathing, nausea, vomiting, and stomach pain. This is a medical emergency and you should get help right away. You're more likely to get this if you already have kidney problems. Glucophage (metformin) should be stopped 48 hours before and after surgery or any imaging procedure needing contrast dye. This is a black box warning. The FDA requires this warning when there is a significant risk Continue reading >>

Metformin Hcl

Metformin Hcl

Uses Metformin is used with a proper diet and exercise program and possibly with other medications to control high blood sugar. It is used in patients with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. Metformin works by helping to restore your body's proper response to the insulin you naturally produce. It also decreases the amount of sugar that your liver makes and that your stomach/intestines absorb. How to use Metformin HCL Read the Patient Information Leaflet if available from your pharmacist before you start taking metformin and each time you get a refill. If you have any questions, consult your doctor or pharmacist. Take this medication by mouth as directed by your doctor, usually 1-3 times a day with meals. Drink plenty of fluids while taking this medication unless otherwise directed by your doctor. The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects (such as upset stomach), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly in order to get the most benefit from it. Remember to use it at the same times each day. If you are already taking another diabetes drug (such as chlorpropamide), follow your doctor's directions carefully for stopping/continuing the old drug and starting metformin. Check your blood sugar regularly a Continue reading >>

Metformin (glucophage): Drug Whys

Metformin (glucophage): Drug Whys

Generic name: Metformin (multiple manufacturers) Common U.S. brand names: Glucophage (Bristol-Myers Squibb, USA) Popularity: Sixteenth most commonly prescribed drug between 2002-2006 (U.S.) Class: Antidiabetic Treatment Uses — For treatment of Type 2 diabetes mellitus (DM) when drug therapy is necessary. Metformin is the first drug of choice for Type 2 diabetics. In obese patients, unlike some other antidiabetic agents, it is not associated with weight gain and actually promotes weight loss. May afford better glycemic control when used as an adjunct to insulin therapy in Type 1 DM. Beneficial for preventing development of gestational diabetes in women with insulin resistance or polycystic ovary syndrome (PCOS). In combination with carbohydrate-modified diet, metformin has been used to help nondiabetic, hyperinsulinemic, obese women and adolescents achieve and sustain long-term weight loss. In combination with other agents, metformin reduces a variety of symptoms in adolescents with hyperinsulinemic hypersecretion of ovarian androgens. In PCOS, metformin has increased return of normal menses and ovulation in obese women and is being studied for treatment of infertility. Metformin is not effective for prevention of DM in high-risk patients, in prevention of fibrosis (progressive damage) in non-alcoholic fatty liver, or in reducing fat deposits in HIV patients taking protease inhibitors. In maturity onset diabetes of the young (MODY) — an inherited genetic mutation — metformin performs significantly worse at controlling disease than gliclazide (a different type of antidiabetic agent). Diabetes is relatively common: 20.8 million Americans — 7 percent of the total population — have it. Treatment for diabetes is evolving rapidly and will continue to progress with th Continue reading >>

Metformin Presentation

Metformin Presentation

Metformin - a biguanide antidiabetic Drug perscribed to help manage Type II NIDDM However, this is only after lifestyle changes in diet and execise have failed. It has also been used for Gestational Diabetes, polycystic ovary syndrom, and for the prevention of Type II NIDDM Metformin's MOA includes 3 things: it decreases Hepatic production, lowers intestinal absorption of glucose and improves insulin sensitivity at the target site. If taken corectly, this drug has few adverse side effects that include GI issues; however lactic acidosis can occur if used with alcohol. Since this drug is used is used to manage blood sugar levels a patient on this drug should know the symptoms of hypo and hyperglycemia, because if left uncontrolled, it can become life threatening. So that is what my visual aid is on (put visual aid up). And as you can see symptoms of hyperglycemia are exterme thirst/hunger, frequent urination, weakness and blured vision. You can also see here what could happen if left uncontrolled Some syptoms of hypoglycemia are shakiness, sweating, sudden changes in behavior or mood, pale skin, and quite a few others. Here you can also see what could hapen if hypoglycemia is left uncontrolled as well. Metformin's effect on dental treatment is altered taste; however, all diabetic patients should be scheduled in the morning for dental treatments, to avoid the chance of stress induced hypoglycemia, and you should stress the importance of a good breakfast 2 hours prior. other Special considerations for the diabetic patient include having a quick glucose source available such as orange juice, ask them what there latest test results were. Also remember that it takes longer for these patients to heal and infection adm more likely. Metformin, an anti-diabetic drug, used for typ Continue reading >>

Metformin And Iodinated Contrast: Lactic Acidosis Warning

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, The Diabetes Drug Developed From French Lilac

Metformin, The Diabetes Drug Developed From French Lilac

Metformin, the diabetes drug developed from French lilac Metformin is the most widely used drug to treat type 2 diabetes globally. More snippets from the article by Merlin Thomas, Adjunct Professor of Preventive Medicine, Baker IDI Heart & Diabetes Institute, which I hope will be at least of interest for those with a diabetes II co-morbidity with their CLL, : theconversation.com/weekly-... 'Metformin was originally developed from natural compounds found in the plant Galega officinalis, known as French lilac or goats rue. Synthetic biguanides were developed in the 1920s in Germany, but their use was limited due to side effects. During the 1940s, however, French physician Jean Sterne examined a new biguanide called dimethylbiguanide or metformin. At the time, it was being studied for the treatment of influenza, but Sterne recognised it had glucose-lowering properties. He proposed calling it glucophage, meaning glucose eater, a name with which it is still commercially associated today. Metformin has been used to treat diabetes since the late 1950s. It is now on the World Health Organisations List of Essential Medicines needed for a basic health care system. Metformin is associated with a rare but life-threatening condition known as lactic acidosis, where the body builds up too much lactic acid. This can be caused by factors such as heart, liver or kidney failure. There is still controversy over whether metformin is the cause of lactic acidosis or whether it exacerbates the condition. Metformin competes for clearance by the kidneys with drugs including digoxin (for heart rhythm problems) trimethoprim and vancomycin (antibiotics), ranitidine and cimetidine (for heartburn), nifedipine and furosemide (for blood pressure) which all have the potential to modestly increase metfo Continue reading >>

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