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Metformin Contraindications

Metformin Contraindications & Benefits From Fenugreek

Metformin Contraindications & Benefits From Fenugreek

Metformin Contraindications & Benefits from Fenugreek Metformin is the first-line medication for type-2 diabetes to control blood sugar levels. It is also used in the treatment of polycystic ovary syndrome (PCOS). It is an insulin sensitizer which means that it works to make the cells in the body more receptive to insulin. When the cells are insulin sensitive, they are able to take more glucose from the blood to be used for energy. ( ) It lowers the blood sugar levels in type-2 diabetic patients by decreasing the amount of glucose released into the blood stream by the liver. Thus, it lowers the glucose production by liver. In type-2 diabetic patients, the glucose production by liver is 3-times more than a normal individual. Metformin reduces this by one-third. (Kirpichnikov D et al.: Metformin: an update. Ann Intern Med.2002; 137(1):25-33) Metformin is generally well tolerated but it has some side effects such as: Long-term consumption or higher doses of metformin is associated with increased incidence of vitamin B12 deficiency ( ). Metformin is a widely used anti-diabetic drug. Deterioration of sleep is an important unwanted side effect of metformin. ( ) Lactic acidosis: Most serious side effect caused by metformin is lactic acidosis. Lactic acidosis happens when there is not enough oxygen in the body and too much lactic acid builds up in the blood. Dehydration and drinking large amounts of alcohol can bring on lactic acidosis. Metformin also worsens this state of lactic acidosis. Its symptoms include: Minor side effects including diarrhea, nausea and abdominal pain. Metformin does not signal the pancreas to release insulin due to which there is a little risk of low blood sugar (hypoglycemia) when taking this drug. Are you on Metformin for a long time, then answering Continue reading >>

Metformin In The Diabetic Elderly Patient: An Old, Safe And Effective Treatment

Metformin In The Diabetic Elderly Patient: An Old, Safe And Effective Treatment

Over-65 diabetics represent about half of the patients visiting general practitioners. Although diabetes pathogenesis in geriatric and young age are similar, treatment gold standards and clinical conditions are extremely variable, requiring a more individualised approach.1 In this context, a recent review points out that there is no clear evidence for the optimal glycaemic target in the elderly patient and that patient’s preferences and pharmacologic burden must be taken into consideration, within the therapeutic choices, together with the possible risks and benefits associated to single treatments.2 This study also suggests a HbA1c value between 7.5% and 9.0% as optimal glycaemic target in the elderly patient. Steps for the individualised treatment of diabetes in the elderly patient:2 Estimate desired benefits upon the life expectancy Estimate the risks potentially associated with intensive glycaemic control (age, polypharmacy, disease duration, social support) Identify the desired glycaemic target Minimise the risk of polypharmacy Consider patient preferences Adapted by bibliographic reference 2 Particularly in the elderly patient, the onset of hypoglycaemia is often associated with severe consequences and is facilitated by several factors, such as polypharmacy and the risk of subsequent interactions, the mistakes caused by the reduced ability of handling medicines, the inability of evaluating the relation between ingested carbohydrates and the therapy, the scarce symptomatology of neuropathies and the reduced adrenergic reaction.3 Hypoglycaemia absolute risk increases with age, therefore in elderly diabetics it is often preferable to avoid intensive hypoglycaemic treatments that increase the risk of hypoglycaemia4 whilst low hypoglycaemia risk treatments should be Continue reading >>

Ema Approval For Metformin In Patients With Renal Impairment

Ema Approval For Metformin In Patients With Renal Impairment

The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has issued a positive opinion recommending extension of the label for all metformin-containing products to included patients with stable moderate renal failure (chronic kidney disease stage 3). The maximum daily metformin dose will be 2000 mg/day in CKD stage 3a (GFR = 45-59 ml/min) and 1000 mg/day in CKD stage 3b (GFR = 30-44 ml/min), allowing a large additional group of type 2 diabetes patients with reduced kidney function to benefit from the treatment. The product information for these medicines will be updated to revise the current contraindication and give information about doses, monitoring and precautions in patients with reduced kidney function. Following a routine evaluation of the safety of metformin medicines, it was found that based on scientific evidence and clinical guidelines, patients with moderate renal failure may stand to benefit from treatment with metformin, and that the contraindication may therefore no longer be justified. Based on this evidence, the EMA issued an Article 31 referral requesting a cumulative review of the benefit and risk in this patient group across all companies selling metformin companies in the European Union. The EMA reviewed the data submitted by all companies, and as a result, the CHMP has issued a positive opinion on lifting the contraindication for treatment of type 2 diabetes patients with renal impairment CKD stage 3. More information EMA summary on metformin in moderate renal failure Continue reading >>

Review Article Metformin In Heart Failure Patients

Review Article Metformin In Heart Failure Patients

Summary The use of metformin was considered a contraindication in heart failure patients because of the potential risk of lactic acidosis; however, more recent evidence has shown that this should no longer be the case. We reviewed the current literature and the recent guideline to correct the misconception. Continue reading >>

Metformin Use Being Limited?

Metformin Use Being Limited?

Current black box warning may be overstating the kidney risk. Metformin—the blockbuster drug utilized as the primary agent to treat patients with type 2 diabetes—may potentially be hindered in usage due to its current prescribing grounds. Despite its establishment as the first-line therapy for type 2 diabetes, about one-half of the patients currently in the United States do not take it. A major proponent of this is its current labeling, which expresses unjustifiable concerns about its use for treatment in those with mild to moderate renal insufficiency. The current label carries a contraindication against use of metformin when serum creatinine levels exceed 1.4mg/dL in women or 1.5mg/dL in men. Over the past few years, clinicians throughout the country have come to an overwhelming consensus that the US Food and Drug Administration (FDA) labeling for metformin could be more lenient and also that it can be expressed in the more precise estimated glomerular filtration rates (eGFRs), rather than serum creatinine. The FDA’s initial rationale behind the label was due to resilient evidence that phenformin caused lactic acidosis (another biguanide which has been removed from the US market). Metformin is cleared from the body via the kidneys and for patients with significant renal failure, there were increasing concerns that metformin could potentially build up to relatively high levels that could leave patients to have lactic acidosis. There is now an overwhelming two decades’ worth of research and evidence showing no serious increased risks for lactic acidosis in patients with mild-to-moderately impaired renal function. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have furthermore supported the removal of restric Continue reading >>

Metformin

Metformin

Postmarketing cases of Metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of Metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood 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 PRECAUTIONS). Risk factors for Metformin-associated lactic acidosis include renal impairment, concomitant use of certain 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., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Steps to reduce the risk of and manage Metformin-associated lactic acidosis in these high risk groups are provided (see DOSAGE AND ADMINISTRATION, CONTRAINDICATIONS, and PRECAUTIONS). If Metformin-associated lactic acidosis is suspected, immediately discontinue Metformin and institute general supportive measures in a hospital setting. Prompt hemodialysis is recommended (see PRECAUTIONS). Table 1: Select Mean (±S.D.) Metformin Pharmacokinetic Parameters Following Single or Multiple Oral Doses of Metformin Hydrochloride Tablets Subject Groups: Metformin hydrochloride tablets dose* (number of subjects) Cmax† (mcg/mL) Tmax‡ (hrs) Renal Clearance (mL/min) * All doses given fasting except the first 18 doses of the multiple dose studies † Peak plasma concentration ‡ Time to peak plasma concentration § Co Continue reading >>

Safe Prescribing Of Metformin In Diabetes

Safe Prescribing Of Metformin In Diabetes

Metformin is the first-line pharmacological therapy for type 2 diabetes. It is the only glucose-lowering oral drug that has been shown to reduce mortality in patients with diabetes. The most common adverse effect is gastrointestinal upset. Starting at a low dose and increasing it slowly reduces this risk. Taking metformin with food also helps. Numerous contraindications to the use of metformin are listed in the product information, including reduced renal function. Strict adherence to these recommendations may deny a valuable drug to many patients. Introduction Metformin lowers both fasting and postprandial blood glucose. It reduces hepatic glucose output 1 and increases peripheral glucose uptake, and may delay intestinal glucose absorption. Its use is not associated with weight gain and hypoglycaemia is extremely rare when metformin is used on its own. It lowers triglyceride concentrations and has small but beneficial effects on total and high-density lipoprotein cholesterol. In the UK Prospective Diabetes Study metformin reduced diabetes-related and all-cause mortality, and reduced the risk of myocardial infarction in obese patients with type 2 diabetes when used as first-line therapy. It also reduced the risk of microvascular complications, but was no more effective than insulin or sulfonylureas. 2 A retrospective cohort study from the USA found a lower rate of hospitalisations for myocardial infarction and stroke and a reduced death rate when metformin was used first-line in type 2 diabetes in comparison with a sulfonylurea. 3 Metformin is effective when used with other glucose-lowering drugs. A standard-release (3000 mg/day maximum dose) and an extended-release preparation of metformin (2000 mg/day maximum dose) are available. The extended-release preparation can b Continue reading >>

They Are Available As Monotherapy Or Combination Therapies, With The Latter Involving Two (or, Less Commonly, Three) Antidiabetic Drugs And/or

They Are Available As Monotherapy Or Combination Therapies, With The Latter Involving Two (or, Less Commonly, Three) Antidiabetic Drugs And/or

Antidiabetic drugs (with the exception of insulin) are all pharmacological agents that have been approved for hypoglycemic treatment in type 2 diabetes mellitus (DM). If lifestyle modifications (weight loss, dietary modification, and exercise) do not sufficiently reduce A1C levels (target level: ∼ 7%), pharmacological treatment with antidiabetic drugs should be initiated. These drugs may be classified according to their mechanism of action as insulinotropic or non-insulinotropic. They are available as monotherapy or combination therapies, with the latter involving two (or, less commonly, three) antidiabetic drugs and/or insulin. The exact treatment algorithms are reviewed in the treatment section of diabetes mellitus. The drug of choice for all type 2 diabetic patients is metformin. This drug has beneficial effects on glucose metabolism and promotes weight loss or at least weight stabilization. In addition, numerous studies have demonstrated that metformin can reduce mortality and the risk of complications. If metformin is contraindicated, not tolerated, or does not sufficiently control blood glucose levels, another class of antidiabetic drug may be administered. Most antidiabetic drugs are not recommended or should be used with caution in patients with moderate or severe renal failure or other significant comorbidities. Oral antidiabetic drugs are not recommended during pregnancy or breastfeeding. Continue reading >>

Can You Drink Alcohol While Taking Metformin?

Can You Drink Alcohol While Taking Metformin?

Metformin is a medication that helps manage type 2 diabetes and occasionally prediabetes. In general, drinking alcohol while taking metformin is not helpful and not recommended by doctors. The side effects of metformin can be life-threatening with excessive alcohol consumption. Metformin and alcohol both put stress on the liver, so intensifying the harmful effects and increasing the risk of liver complications. How does metformin and alcohol affect the body? Metformin is a popular, effective, and inexpensive management medication, prescribed for the treatment of type 2 diabetes. In 2014, some 14.4 million people in the United States were prescribed metformin. Metformin is also being used more and more frequently in prediabetes cases. Metformin use in overweight people with type 1 diabetes may also reduce insulin requirements and increase metabolic control. The drug works by improving insulin sensitivity, promoting the uptake of glucose into tissues and lowering sugar levels in the bloodstream. By increasing how effectively the existing glucose is used, metformin reduces the amount of glucose the liver produces and the intestines absorb. Alcohol also affects blood sugars significantly. Alcohol digestion puts stress on the liver, an organ dedicated to the removal of poisons from the body. When the liver is forced to process high amounts of alcohol, it becomes overworked and releases less glucose. Long-term alcohol use can also make cells less sensitive to insulin. This means that less glucose is absorbed from the blood and levels in the bloodstream increase. Over time, alcohol consumption damages the liver, especially when it is consumed in excess. It reduces the liver's ability to produce and regulate glucose. Conditions like alcoholic hepatitis and cirrhosis of the live Continue reading >>

Tips From Other Journals - American Family Physician

Tips From Other Journals - American Family Physician

Am Fam Physician.1998Feb1;57(3):536-537. In 1995, biguanide metformin was approved by the U.S. Food and Drug Administration for use in the treatment of type 2 diabetes. Use of biguanide phenformin in the 1970s led to its subsequent withdrawal from the market in many countries because of a high incidence of lactic acidosis in patients with renal impairment, hepatic dysfunction or cardiac disease. Sulkin and associates studied the prevalence of conditions currently regarded as contraindications or cautions to the use of metformin in patients receiving this agent. The authors identified the following potential contraindications or cautions to metformin therapy: (1) renal impairment, defined as a plasma creatinine level greater than 1.4 mg per dL (120 mol per L) or dipstick-positive proteinuria, (2) cardiac failure, (3) chronic hepatic dysfunction, (4) significant chronic pulmonary disease, (5) coronary artery disease, (6) peripheral vascular disease, and (7) miscellaneous conditions (intercurrent illnesses, acute trauma or major surgical procedures, and metastatic malignancy). The authors reviewed the medical records of 89 patients receiving metformin to identify the prevalence of potential contraindications to the use of the drug. These patients were seen at a university hospital diabetes clinic in the United Kingdom. The authors found that over one half of the patients had conditions regarded as cautions or contraindications to the use of metformin, eight of the patients had two conditions, five patients had three conditions and one patient had four conditions. The most common conditions were peripheral vascular disease (22 patients), ischemic heart disease (20 patients) and proteinuria (14 patients). Two of the patients had a significant degree of renal impairment. The Continue reading >>

Should Fda Change Metformin's Black Box Warning?

Should Fda Change Metformin's Black Box Warning?

Diabetes experts are building a case to lift restrictions on using metformin in patients with moderate chronic kidney disease. Two groups of researchers who have separately filed citizens petitions with the FDA have published studies in JAMA journals in the past few weeks showing a lack of evidence for metformin-associated lactic acidosis -- a severe complication that prompted the FDA to warn against the drug's use in CKD patients when it came on the market 20 years ago. Silvio Inzucchi, MD, and Kasia Lipska, MD, MHS, of Yale, published a review in the Dec. 24/31 issue of JAMA concluding that most observational data -- there are no randomized controlled trials -- confirm the "overall safety profile" of metformin in mild-to-moderate CKD patients. And James Flory, MD, of Weill Cornell, and Sean Hennessy, PharmD, PhD, of the University of Pennsylvania, reported in a research letter in the Jan. 5 issue of the Archives of Internal Medicine, that nearly 1 million patients who have diabetes and CKD could be taking metformin but aren't. Both groups have asked the FDA to lift its black box warning that limits prescribing in CKD patients based on serum creatinine levels (1.5 mg/dL or above for men, 1.4 mg/dL for women), and asks the agency to use eGFR cutoffs instead -- typically, at 30 mL/min, where several professional societies and other international regulators draw the line. How the Black Box Came to Be When the FDA approved metformin in 1994, it slapped on the black box warning about lactic acidosis because of a similar problem with another biguanide, phenformin. This cousin to metformin was withdrawn from the market in 1977 because of an increased risk of lactic acidosis. Since metformin is also renally cleared, the agency was concerned that metabolism of the drug could co Continue reading >>

Fda Issues Guidance For Metformin Use In Renal Impairment

Fda Issues Guidance For Metformin Use In Renal Impairment

Chris Tanski received his PharmD from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences and is now working as a clinical staff pharmacist for Pinnacle Health in Harrisburg, Pennsylvania. He entered the field of hospital pharmacy directly from school, and he was one of the first to pilot a decentralized pharmacist role in the hospital. His other notable work contributions include working on palliative projects and transition of care for COPD patients. Chris was an editor and contributor to a film theory blog, a sketch comedy writer throughout pharmacy school, and he has a significant amount of experience writing drug information papers on neurology and infectious disease topics for both school and work. The FDA has issued new guidance for the use of the first-line diabetes drug metformin in patients with renal impairment. Metformin was approved by the FDA in 1994 for the management of type 2 diabetes. Since its approval, its labeling has warned of a contraindication in elevated serum creatinine (>1.5 mg/dL for males, >1.4 mg/dL for females) due to a risk of lactic acidosis secondary to metformin accumulation.1 Other risk factors for lactic acidosis include contrast dye exposure within 48 hours, chronic or excessive alcohol intake, dehydration, sepsis, acute congestive heart failure, and age. This absolute contraindication was based on clinical trials of an older biguanide called phenformin, which showed a greater risk of lactic acidosis associated with significant mortality and was subsequently pulled off the market in 1977.2 Although phenformin is no longer available in the United States, it’s still available in European and South American markets. Notably, the incidence of lactic acidosis associated with metformin is as low as 0.03 cases per 10 Continue reading >>

Metformin Contraindications

Metformin Contraindications

The biguanide metformin (dimethylbiguanide) was initially introduced for use in the treatment of type 2 diabetes mellitus in the late 1950s. Today this drug is considered to be the first-choice agent and the “gold standard” for most people with type 2 diabetes. It has been estimated that the annual number of people receiving prescriptions for metformin worldwide is more than 120 million. The efficacy and benefits of metformin treatment in type 2 diabetes have been confirmed by large-scale studies and recognized by many consensus statements. Still, a large list of contraindications may increase the incidence of serious adverse effects, which precludes many patients from taking metformin. Intolerance and contraindications to metformin Three particular contraindications to the use of metformin have been suggested. They include renal impairment with elevated serum creatine levels (i.e. more than 136 mmol/l in men and 124 mmol/l in women) or abnormal creatinine clearance, congestive heart failure requiring pharmacologic treatment and advanced age (more than 80 years of age). Renal impairment represents a contraindication to metformin usage due to the increased risk of lactic acidosis (a form of metabolic acidosis due to the inadequate clearance of lactic acid from the blood). Although lactic acidosis linked to metformin is a rare condition, with an estimated prevalence of one to five cases per 100 000 population, it has a reported mortality of 30-50%. However, recent studies have suggested that metformin can be used safely, unless the estimated glomerulal filtration rate (the volume of fluid that is filtered from the capillaries of the glomeruli into the kidney tubules per unit time) falls below 30 ml/min, with a dose reduction advised at 45 ml/min. Congestive heart fail Continue reading >>

Metformin For Weight Loss, Side Effects, Contraindications

Metformin For Weight Loss, Side Effects, Contraindications

Nearly more than 35% of American adults are obese which means every one-third of American is obese or overweight. According to statistics, it shows that the annual medical cost for persons who are obese is $1,429 higher than that of the persons with normal body weight. Metformin, sold under various brand names like Glumetza , Glucophage, Fortamet is a drug of group Biguanides. It is an oral hypo-glycemic drug introduced in late 50s. It is used as first line of treatment in diabetes mellitus type 2 as well as in pre-diabetic condition. But recent studies has shown that it also helps non-diabetics persons in weight loss. Obesity or overweight is a condition when the weight of a person is greater that of which is considered as healthy for a given height. You might be wondering whether your weight is normal or not? Well let me explain you the simple way to find. It is calculated by using BMI (Body Mass Index). If a persons BMI is between 25 to 29.9 then the person is over weight and the person with BMI higher than 30 is considered as obese. Since obesity has been linked with a lot of new world diseases like different heart diseases and stroke, diabetes, gall diseases, hypertension and many more. And due to the growing numbers of individuals with increased body weight, now obesity is growing as a serious problem in our modern society. Obesity or overweight can be due to various reasons. Your body is producing excess insulin. Which means your blood glucose level is always getting low and as a result of which insulin activates your hunger receptors in the brain. So, you might be feeding yourself a lot. Insulin also causes liver to convert the excess glucose into fat, which is stored under the skin in the subcutaneous tissue. Taking high amount of sugars in your diet like cake Continue reading >>

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

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