Metformin-induced Lactic Acidosis: No One Left Behind
Abstract Metformin is a safe drug when correctly used in properly selected patients. In real life, however, associated lactic acidosis has been repeatedly, although rarely, reported. The term metformin-induced lactic acidosis refers to cases that cannot be explained by any major risk factor other than drug accumulation, usually due to renal failure. Treatment consists of vital function support and drug removal, mainly achieved by renal replacement therapy. Despite dramatic clinical presentation, the prognosis of metformin-induced lactic acidosis is usually surprisingly good. In the previous issue of Critical Care, Friesecke and colleagues demonstrate that the survival rate of patients with severe lactic acidosis due to metformin accumulation can be strikingly higher than expected based on the initial clinical evaluation [1]. Metformin is nowadays the first-line drug of choice for the treatment of adults with type 2 diabetes [2]. This drug is the sixth most frequently prescribed in the USA (> 50 million prescriptions in 2009) and is taken by almost 1.5% of the Italian population [3, 4]. Metformin is a safe drug when correctly used in properly selected patients. In particular, no cases of lactic acidosis (a relatively common side effect of other biguanide compounds) were reported in 347 trials with 70,490 patient-years of metformin use [5]. Real life can differ from research settings, however, and lactic acidosis has been repeatedly, although rarely, observed in patients treated with metformin. The number of inquiries to the Swedish Poison Information Centre for metformin intoxication has increased 10 times during the past decade, with 25 cases of severe lactic acidosis reported in 2007 and 2008 [6]. According to the American Association of Poison Control Centers, metform Continue reading >>
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A Pediatric Suicide Attempt By Ingestion Of Metformin, Glimepiride Andsulpiride: A Case Report And Literature Review
Received date: March 01, 2016; Accepted date: July 04, 2016; Published date: July 11, 2016 Citation: Tarek G, Kais G, Ramzi G (2016) A Pediatric Suicide Attempt by Ingestion of Metformin, Glimepiride and Sulpiride: A Case Report and Literature Review. J Clin Toxicol 6:310. doi:10.4172/2161-0495.1000310 Copyright: 2016 Tarek G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A case of a pediatric patient poisoning after ingestion of metformin , glimepiride and sulpiride, he was presented to the emergency service with symptoms and signs of hypoglycemia. Using a risk assessment based approach, the management of glimepiride and metformin overdose is discussed. Glimepiride overdose invariably results in profound hypoglycemia that requires resuscitation with IV dextrose and the use of octreotide as an antidote. Metformin overdose rarely causes problems. The acute sulpiride poisoning is poorly reported in the medical literature. Pediatric; Suicide attempt; Poisoning; Metformin; Glimepiride; Sulpiride Children suffering from physical, mental or psychological problems are being increasingly evaluated and treated in pediatric clinical [ 1 ]. Pediatric emergency departments frequently admit that a lot of children have attempted to commit suicide. Cases vary depending on both the child's age and some risk factors [ 2 ]. The main profile is a female between 12 and 14 years of age that attempted suicide at home using medication especially benzodiazepines. Among those under 10 years, there is a significant predominance of males using non pharmacological methods [ 3 ]. Understanding how childr Continue reading >>
Metformin Makes Headline News
Metformin is the first-line drug of choice in the treatment of type II diabetes. It was first approved in Europe in 1958.1 Americans had to wait until 1994 to legally obtain metformin.1 The holdup in approving metformin goes beyond the FDA. It is an indictment of a political/legal system that will forever cause needless suffering and death unless substantively changed. When Life Extension® informed Americans about drugs like metformin in the 1980s, the FDA did everything in its power to incarcerate me and shut down our Foundation.2 FDA propaganda at the time was that consumers needed to be "protected" against "unproven" therapies. As history has since proven, the result of the FDA's embargo has been unparalleled human carnage. So called "consumer protection" translated into ailing Americans being denied access to therapies that the FDA now claims are essential to saving lives. Today's major problem is not drugs available in other countries that Americans can't access. Instead, it is a political/legal system that suffocates medical innovation. Headline news stories earlier this year touted the anti-cancer effects of metformin, data that Foundation members were alerted to long ago.3 The problem is that it is illegal for metformin manufacturers to promote this drug to cancer patients or oncologists. It's also illegal to promote metformin to healthy people who want to reduce their risk of cancer, diabetes, vascular occlusion, and obesity. This fatal departure from reality continues unabated, as our dysfunctional political/legal system denies information about metformin that could spare countless numbers of lives. Type II diabetics suffer sharply higher rates of cancer4-7and vascular disease.8-11 The anti-diabetic drug metformin has been shown in numerous scientific studies Continue reading >>
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 >>
Metformin Causes Cell Death, Increases Risk For Alzheimer's Disease
The blockbuster drug, metformin, is considered effective, safe and cost-effective for priority conditions and a basic healthcare system. It is the most widely used medication for type 2 diabetes. While this drug was discovered nearly 100 years ago and considered safe and essential to medicine, recent research may turn this belief upside down. It should make you stop and think about that seemingly harmless drug and the subtle memory and cognitive changes that are attributed to normal aging. [Jump to: Nutritional Options] Metformin, a generic type 2 diabetes drug, and its brand name equivalents - Fortamet, Glucophage, Glucophage XR, Glumetza, and Riomet has at least three known adverse consequences. One is the well-known issue that metformin interferes with and depletes vitamin B12 and folate and raises homocysteine levels. This finding alone is enough to make this drug worrisome for anyone with methylation concerns, seniors, digestive concerns, or gastric bypass patients as these are commonly related with vitamin B12 and folate deficiency. The second concern is the build-up of lactic acid. Lactic acid can make muscles hurt, markedly increase fatigue and rarely be deadly. It reflects an insult to normal metabolism and aerobic energy production. The third recently discovered issue is piercing its way through medical research and raises serious concerns about metformin. Metformin Causes Mitochondrial Dysfunction and Nerve Cell Death Research published in the journal Aging, August 2016 is the latest article in a progression of cellular and animal studies that demonstrates increased risk of Alzheimer’s with chronic use of metformin. Metformin induces mitochondrial dysfunction and cell death in the brain by affecting several proteins, including beta-amyloid protein. These is Continue reading >>
Diabetes Drug, Metformin, Lowers Risk Of Heart Disease Deaths Better Than Sulfonylureas, New Analysis Shows
Study confirms metformin should be first-line therapy for treatment of #diabetes.- Click to Tweet #Diabetes drug metformin found more effective at lowering risk of heart disease deaths than sulfonylureas.- Click to Tweet Metformin outperforms other #diabetes drugs; doesn’t cause weight gain like other drugs, study confirms. - Click to Tweet A new analysis of 204 studies involving more than 1.4 million people suggests that metformin, the most frequently prescribed stand-alone drug for type 2 diabetes, reduces the relative risk of a patient dying from heart disease by about 30 to 40 percent compared to its closest competitor drug, sulfonylurea. The study, designed to assess the comparative — not absolute or individual — benefits and risks of more than a dozen FDA-approved drugs for lowering blood sugar in type 2 diabetes, is described in the April 19 issue of the Annals of Internal Medicine. Diabetes now affects almost 10 percent of the U.S. population and poses a growing public health threat, and most people will eventually need drug treatment, the researchers say. “Metformin looks like a clear winner,” says Nisa Maruthur, M.D., M.H.S., assistant professor of medicine at the Johns Hopkins University School of Medicine. “This is likely the biggest bit of evidence to guide treatment of type 2 diabetes for the next two to three years.” Maruthur, the lead author on the meta-analysis, notes that cardiovascular fatalities — heart attacks and strokes — are major risks for people with uncontrolled blood sugar, but it has never been clear if one diabetes drug is better than another at lowering these fatalities. Other diabetes-related complications include blindness, kidney failure and limb amputations. This review, Maruthur says, provides a much-needed update to Continue reading >>
Will You Have Sudden Death With Metformin - From Fda Reports - Ehealthme
A study for a 64 year old man who takes Vitamin D3, Lantus, Novalgin, Synthroid, Mirapex, Magnesium, Methotrexate, Metformin, Azulfidine En-tabs NOTE: The study is based on active ingredients and brand name. Other drugs that have the same active ingredients (e.g. generic drugs) are NOT considered. WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health. DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only, and has not been supported by scientific studies or clinical trials unless otherwise stated. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk. You may report adverse side effects to the FDA at or 1-800-FDA-1088 (1-800-332-1088). If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. Continue reading >>
Common Diabetes Drugs Associated With Increased Risk Of Death
Follow all of ScienceDaily's latest research news and top science headlines ! Common diabetes drugs associated with increased risk of death Compared to another popular drug, three widely used diabetes medications are associated with a greater risk of death, a large new analysis finds. Compared to another popular drug, three widely used diabetes medications are associated with a greater risk of death, a large new analysis finds. The results were presented June 25 at The Endocrine Society's 94th Annual Meeting in Houston. The drugs, glipizide, glyburide, and glimepiride, are known as sulfonylureas, which help decrease blood-sugar levels among type 2 diabetes patients by stimulating the pancreas to produce insulin. In the past, these medications were considered comparable to one another in terms of effectiveness and safety. Recently, however, research has shown some sulfonylureas may be safer than others. These findings led to this latest research, which compared them to another type of blood-sugar-reducing drug known as metformin. All four medications are available under low-cost, generic labels. "We have clearly demonstrated that metformin is associated with a substantial reduction in mortality risk, and, thus, should be the preferred first-line agent, if one has a choice between metformin and a sulfonylurea," said study lead author Kevin M. Pantalone, D.O., an endocrinologist at Summa Western Reserve Hospital in Cuyahoga Falls, OH, who conducted this study in conjunction with a team of researchers from Cleveland Clinic in Cleveland, OH. In the United States, nearly 26 million people, or 8 percent of the population, have diabetes, according to the Centers for Disease Control and Prevention. Many of these patients also have other underlying medical conditions, including Continue reading >>
Side Effects Of Metformin Are More Serious Than You Think
The Side Effects of Metformin can range from not so serious, to deadly, are the risks of Metformin and Glucophage side effects worth it? This page will give you information that might be able to help you decide that for yourself. Also known as Glucophage, this is an antidiabetic medicine most often used in those with Type 2 Diabetes who are also overweight. It’s also used extensively in women with Polycystic Ovarian Syndrome, a condition known as PCOS, which is often accompanied by higher blood sugar readings which often benefit from the blood sugar lowering effects of Metformin. While at first glance it seems that Side Effects of Metformin are rare, a closer look and a little math show that there are some serious problems that can occur when taking this drug, and others that can and should be prevented easily, but are usually not due to a medical community that simply does not use nutritional supplements in the prevention of even well-known, easily preventable Glucophage side effects. Vitamin B12 Deficiency Vitamin B12 and Folic Acid Deficiency are well-known and well-studied side effects of Metformin. Despite the fact that there have been many studies confirming this problem over and over again in the medical literature, just like the Side Effects of Nitrous Oxide, few doctors warn their patients of this or recommend that they take simple, cheap over the counter Vitamin B12 Supplements in order to avoid this potentially devastating nutritional deficiency. In addition, the long term use of the ‘antacid’ drugs known as H2 receptor antagonist or proton pump inhibitors like Famotidine or Omeprazole, some of the most widely prescribed drugs, can increase this risk, as is mentioned in the Omeprazole Side Effects page. The Vitamin B12 Deficiency Symptoms range anywhere Continue reading >>
Metformin
Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>
Fatal Metformin Intoxication With Markedly Elevated Blood And Liver Concentrations
Since being approved by the United States Food and Drug Administration in 1995, metformin, a member of the biguanide class of oral hypoglycemics, has become one of the most popular medications prescribed in the United States (1). Because of its widespread use, it is not surprising that over 7,500 cases of metformin exposures were reported to United States poison control centers in 2010 (2). Despite this large number of exposures, only five reported fatalities occurred where metformin was detected during postmortem analysis. Upon reviewing the literature, the highest reported postmortem metformin concentrations in central blood and the liver are 77.3 mg/L (3) and 146 mg/kg (4), respectively. This study reports the highest peripheral blood and liver metformin concentrations on record. The decedent was a 57-year-old woman who had a medical history of hypertension, hypercholesterolemia, diabetes mellitus, depression and anxiety. Her regular medications included mirtazapine, atorvastatin, metformin, glipizide, pioglitazone/glimepiride, trazodone, losartan, clonazepam, ubidecarenone, aspirin and vitamins. One evening while visiting relatives, the decedent developed persistent vomiting and diarrhea. When questioned, she admitted to ingesting some of her medication with drain cleaner. Emergency medical services were immediately contacted and the patient was transported to a hospital by paramedics. Upon arrival, she complained of oral irritation, but refused to give further information to staff. Initial vital signs were: blood pressure, 116/85 mm/Hg; heart rate, 120 beats per min; respiratory rate, 19; temperature, 99.0°F; oxygen saturation, 99% on room air. An admission urine toxicology screen was negative for opiates, methadone, barbiturates, phencyclidine, amphetamines, benz Continue reading >>
Commonly Used Diabetes Drugs Increase The Risk Of Death
Autism is 4 times more likely if mum is obese and type 2 diabetic Commonly used diabetes drugs increase the risk of death According to detailed research, 3 commonly used drugs for type 2 diabetes actually raise the risk of death. Researchers decided to compare three drugs: glipizide, glyburide, and glimepiride with metformin. Glipizide, glyburide and glimepiride are in a class of medication called sulfonylureas. They help to lower blood sugar levels in type 2 diabetics by stimulating the pancreas to produce insulin. In the past these drugs were all considered to be safe and effective. Fortunately some researchers decided to compare them with metformin. Here is an interesting statement from study lead author Kevin M. Pantalone, D.O., an endocrinologist at Summa Western Reserve Hospital in Cuyahoga Falls, OH: We have clearly demonstrated that metformin is associated with a substantial reduction in mortality risk, and, thus, should be the preferred first-line agent, if one has a choice between metformin and a sulfonylurea. In the United States almost 26 million people have diabetes. The vast majority of them have type 2 diabetes. A large percentage of type 2 diabetics have coronary heart disease and are taking one or more medications for their heart. This is worrying because sulfonylureas can actually worsen a heart condition. In the study, glimepiride is the only drug studied that did not increase the risk of death compared to metformin. Worringly, glipizide was associated with a 41 percent higher risk, and for glyburide the figure was 38 percent. It is important to remember that all medications have risks and benefits; however some drugs are significantly safer than others. Metformin is an old drug and is really one of the safest available. The brand new drugs on the ma Continue reading >>
Metformin Feels Like Death In A Pill..
Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Well let's just say I was prepared for the stomach problems as most of you have talked about. However it has been absolutely horrid! I started my 2000mg of metformin yesterday, 1000 in the am and the rest at dinner. All I can say is oh my god! To think I felt sick before I was on meds, this just is horrible! Non stop bathroom trips, throwing up all night and this morning. My blood sugar is higher than before, probably because I can not stay hydrated. Called my dr and asked if I could start the normal dose and she won't let me lower it because my bs is too high, and made an appointment for tomorrow to check my sugar and go from there. I really do not know what to do at this point. I am missing so much work in the past week. At this point I would rather just deal with the high sugar symptoms! Sorry to hear you're having so much problems with the metformin...i'm surprised your doctor didn't start you off at the 500 mg twice daily dose the progressively increase it ---though he/she probably started you out higher as your blood sugars were so high at diagnosis. If you are taking the regular strength as opposed to the extended release pills, you might consider cutting the pills in half and spacing out your doses...say 1/2 at breakfast, 1/2 at lunch, 1/2 at dinner and 1/2 at bedtime...you'd still be getting the same TOTAL dose, just spaced differently. This might help with the symptoms, then when/if your body adjusts to the medicine, you can start just taking 2 WHOLE pills/day as directed. I did this for awhile when I was on the metformin, to stabilize my blood sugar readings. I never took more than Continue reading >>
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 And Fatal Lactic Acidosis
Publications Published: July 1998 Information on this subject has been updated. Read the most recent information. Dr P Pillans,former Medical Assessor, Centre for Adverse Reactions Monitoring (CARM), Dunedin Metformin is a useful anti-hyperglycaemic agent but significant mortality is associated with drug-induced lactic acidosis. Significant renal and hepatic disease, alcoholism and conditions associated with hypoxia (eg. cardiac and pulmonary disease, surgery) are contraindications to the use of metformin. Other risk factors for metformin-induced lactic acidosis are sepsis, dehydration, high dosages and increasing age. Metformin remains a major reported cause of drug-associated mortality in New Zealand. Of the 12 cases of lactic acidosis associated with metformin reported to CARM since 1977, 2 occurred in the last year and 8 cases had a fatal outcome. Metformin useful but small risk of potentially fatal lactic acidosis Metformin is a useful therapeutic agent for obese non-insulin dependent diabetics and those whose glycaemia cannot be controlled by sulphonylurea monotherapy. Lactic acidosis is an uncommon but potentially fatal adverse effect. The reported frequency of lactic acidosis is 0.06 per 1000 patient-years, mostly in patients with predisposing factors.1 Examples of metformin-induced lactic acidosis cases reported to CARM include: A 69-year-old man, with renal and cardiac disease, was prescribed metformin due to failing glycaemic control on glibenclamide monotherapy. He was well for six weeks, then developed lactic acidosis and died within 3 days. Post-surgical lactic acidosis caused the death of a 70-year-old man whose metformin was not withdrawn at the time of surgery. A 56-year-old woman, with no predisposing disease, died from lactic acidosis following major Continue reading >>
