Metformin, Heart Failure, And Lactic Acidosis: Is Metformin Absolutely Contraindicated?
Many patients with type 2 diabetes are denied treatment with metformin because of “contraindications” such as cardiac failure, which may not be absolute contraindications Summary points Treatment with metformin is not associated with an increased risk of lactic acidosis among patients with type 2 diabetes mellitus who have no cardiac, renal, or liver failure Despite increasing disregard of contraindications to metformin by physicians, the incidence of lactic acidosis has not increased, so metformin may be safe even in patients with “contraindications” The vast majority of case reports relating metformin to lactic acidosis report at least one other disease/illness that could result in lactic acidosis Use of metformin in patients with heart failure might be associated with lower mortality and morbidity, with no increase in hospital admissions and no documented increased risk of lactic acidosis Further studies are needed to assess the risk of lactic acidosis in patients with type 2 diabetes and traditional contraindications to metformin Metformin first became available in the United Kingdom in 1957 but was first prescribed in the United States only in 1995.w1 The mechanism of action has been extensively reviewed.w2 w3 The UK prospective diabetes study showed that metformin was associated with a lower mortality from cardiovascular disease than sulphonylureas or insulin in obese patients with type 2 diabetes mellitus.1 It was also associated with reduced all cause mortality, which was not seen in patients with equally well controlled blood glucose treated with sulphonylureas or insulin.1 Despite the evidence base for the benefits of metformin, concerns remain about its side effects and especially the perceived risk of lactic acidosis in the presence of renal, hepatic Continue reading >>
Metformin And Alcohol
The combination of Metformin and alcohol is generally recommended to be avoided. This drug can lead to some rather uncomfortable side effects even without imbibing alcohol, especially within the first few weeks of the initial medical treatment program. Metformin side effects with alcohol consumption in vast quantities will only increase in their levels of discomfort when simultaneously drinking beer, wine or hard liquor. The occasional alcoholic beverage is considered to be generally safe, although the preference is to abstain from all use of alcohol until the treatment program has run its course. This combination of Metformin and alcohol can also lead to some potentially severe consequences, one of which is a resulting possible side effect of lactic acidosis. This can be fatal if not treated in time. This condition can occur when the blood does not have enough oxygen, which is required to transport the glucose throughout the body. The glucose then transforms into lactic acid. Although this is a naturally produced chemical agent within the body, increased levels can result in potentially fatal toxic effects. This resulting lactic acidosis and Metformin side effects with alcohol consumption will first appear in the form of breathing difficulties, fluctuations in heartbeat, nausea and vomiting. The patient should inform the prescribing physician immediately if any of these warning signs occur. Metformin works in relationship to the liver and its ability to regulate insulin production levels. Additionally, alcohol has a severe detrimental effect on the liver, especially when ingested in vast quantities over long periods of time. A common result of alcoholism is irreversible liver damage. Therefore, the combination of Metformin and alcohol can only exacerbate this possibili Continue reading >>
Metformin's Contraindications Should Be Contraindicated
Metformin has been used for over 40 years for patients with type 2 diabetes mellitus.1 With over 40 million patient-years of use as of 1999,1 there is now evidence that the drug decreases the risk of morbidity and death when used to treat type 2 diabetes.2 However, concern remains over the possible side effect of lactic acidosis, a condition with a mortality of up to 50%.3 Because of this concern, contraindications to the use of metformin have been suggested. In particular, the following 3 are listed in the Compendium of Pharmaceuticals and Specialties:4 These specific contraindications cause consternation for clinicians who may wish to prescribe metformin but do not want to put their patients at risk of lactic acidosis or expose themselves to potential legal problems. However, we believe the evidence shows that the benefits of metformin use in patients with contraindications outweigh the risks. In 2002 Calabrese and associates5 reported that 62% of 204 hospital patients taking metformin had at least 1 contraindication or precautionary condition (renal impairment, congestive heart failure, age ≥ 80 years, exposure to contrast media, hepatic disease, excessive alcohol intake, surgery).5 In particular, 14% of the patients taking metformin had an elevated creatinine level and 10% were older than 80. These findings led Calabrese and associates to state that “many patients are treated with metformin despite having clinical conditions that place them at risk for developing lactic acidosis. To minimize this risk, it is essential that prescribers develop a better understanding of the prescribing guidelines for metformin.” Interestingly, despite the presence of these risks, lactic acidosis did not develop in any of the patients in their study. Although these authors' inten Continue reading >>
Can You Drink Alcohol While On Metformin?
Home Q & A Questions Can you drink alcohol while... Can you drink alcohol while on metformin? If you're diabetic then you have to be careful of the drinks you have, because of sugar. The interaction checker says Ask your doctor before using ethanol together with metFORMIN. Taking this combination may cause a condition called lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain. Use alcohol cautiously. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safey take this combination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor. Having one drink for women (12 oz beer, 5 oz glass of wine and 0.5-1 oz hard liquor means one drink) or two drinks (same measurements except for hard alcohol can be only 1 1/2 oz liquor between two drinks) for men is usually permissible but you must consider the drink as a sugar/carb in your diet. Alcohol becomes pure glucose in your body, just like eating a high carb/sugar dessert. If you have alcohol, have it with a meal or snack (be sure to adjust for the alcohol's added carbs so you will need to reduce carbs somewhere else in the diet). One effect of alcohol is that it shuts off your liver from releasing stored glucose from your liver into your blood stream which increases the likelihood of experiencing low blood sugar. Many of the symptoms of low blood sugar resemble intoxication (like dizziness, slurred speech, blurred vision, muscle weakness and a shaky feeling). If you are on insulin or pills, the medication Continue reading >>
Metformin Overview
Metformin is a prescription medication used to treat type 2 diabetes. Metformin belongs to a group of drugs called biguanides, which work by helping your body respond better to the insulin it makes naturally, decreasing the amount of sugar your liver makes, and decreasing the amount of sugar your intestines absorb. This medication comes in tablet, extended-release tablet, and liquid forms. It is taken up to 3 times daily, depending on which form you are taking. Swallow extended-release tablets whole. Common side effects of metformin include diarrhea, nausea, and upset stomach. Metformin is a prescription medication used to treat type 2 diabetes. This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. Metformin may be found in some form under the following brand names: Serious side effects have been reported including: Lactic Acidosis. In rare cases, metformin can cause a serious side effect called lactic acidosis. This is caused by a buildup of lactic acid in your blood. This build-up can cause serious damage. Lactic acidosis caused by metformin is rare and has occurred mostly in people whose kidneys were not working normally. Lactic acidosis has been reported in about one in 33,000 patients taking metformin over the course of a year. Although rare, if lactic acidosis does occur, it can be fatal in up to half the people who develop it. It is also important for your liver to be working normally when you take metformin. Your liver helps remove lactic acid from your blood. Make sure you tell your doctor before you use metformin if you have kidney or liver problems. You should also stop using metformin and call your doctor right away if you have signs of lactic acidosis. Lactic acidosis is a medical emergency that must be treate Continue reading >>
Metformin - Oral, Glucophage
are allergic to dapagliflozin or any of the ingredients in FARXIGA. Symptoms of a serious allergic reaction may include skin rash, raised red patches on your skin (hives), swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing. If you have any of these symptoms, stop taking FARXIGA and contact your healthcare provider or go to the nearest hospital emergency room right away have severe kidney problems or are on dialysis. Your healthcare provider should do blood tests to check how well your kidneys are working before and during your treatment with FARXIGA Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems Ketoacidosis occurred in people with type 1 and type 2 diabetes during treatment with FARXIGA. Ketoacidosis is a serious condition which may require hospitalization and may lead to death. Symptoms may include nausea, tiredness, vomiting, trouble breathing, and abdominal pain. If you get any of these symptoms, stop taking FARXIGA and call your healthcare provider right away. If possible, check for ketones in your urine or blood, even if your blood sugar is less than 250 mg/dL Kidney problems. Sudden kidney injury occurred in people taking FARXIGA. Talk to your doctor right away if you reduce the amount you eat or drink, or if you lose liquids; for example, from vomiting, diarrhea, or excessive heat exposure Serious urinary tract infections (UTI), some that lead to hospitalization, occu Continue reading >>
What Is The Effect Of A Glass Of Wine After Taking Metformin?
It is generally acceptable to drink a glass of wine while taking metformin; however, it's best to be careful because of the risk of lactic acidosis. Additionally, there is a risk of hypoglycemia when a diabetes patient drinks alcohol, whether or not the patient takes metformin. Symptoms of hypoglycemia include hunger, shakiness, nervousness, sweating, dizziness, sleepiness, confusion, difficulty speaking, anxiety and weakness. Symptoms of lactic acidosis include nausea, vomiting, hyperventilation, abdominal pain, lethargy, anxiety, hypotension, rapid or irregular heart rate and metal status changes. If you take metformin or are diabetic, ask your doctor if it's safe to drink alcoholic beverages. Video of the Day Metformin is a biguanide, a type of oral medication used to treat Type 2 diabetes by helping control the amount of glucose in the blood. It primarily works to reduce gluconeogenesis, glucose production by the liver, but also aids in blood glucose control by increasing insulin sensitivity and decreasing glucose absorption in the gastrointestinal tract. The most common side effects of metformin are gastrointestinal related, but rarely, lactic acidosis can occur. Hypoglycemia is an unlikely side effect of metformin when it is used alone. The liver is largely responsible for clearing lactate from the body, and when a patient takes metformin, the rate of clearance by the liver is reduced. This is part of the reason for the correlation between taking metformin and the risk of lactic acidosis. Dr. Thomas Higgins, an endocrinologist at Boulder Medical Center, cautions against prescribing metformin to patients with conditions that predispose them to lactic acid accumulation. For example, use of metformin, which is not metabolized but cleared via tubular secretion into th Continue reading >>
Metformin: Current Knowledge
Go to: Abstract Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces sever complications. Metformin drug has been shown to prevent diabetes in people who are at high risk and decrease most of the diabetic complications. Recent reports on metformin, not only indicate some implications such as renoprotective properties have been suggested for metformin, but some reports indicate its adverse effects as well that are negligible when its benefits are brought into account. We aimed here to review the new implications of metformin and discuss about the concerns in the use of metformin, referring to the recently published papers. Keywords: Diabetes, diabetes mellitus, diabetic nephropathy, glucose, metformin, new applications, polycystic ovary syndrome, renoprotection Go to: INTRODUCTION Diabetes mellitus is a group of metabolic disorders in which the blood glucose is higher than normal levels, due to insufficiency of insulin release or improper response of cells to insulin, resulting in high blood pressure. The resultant hyperglycemia produces the classical symptoms of polyuria, polydipsia and polyphagia. It may also cause nerve problems, kidney problems, and blindness, loss of limbs, and sexual dysfunction, increase in heart attack or stroke.[1] Metformin (a biguanide derivative), by controlling blood glucose level decreases these complications. Metformin works by helping to restore the body's response to insulin. It decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.[2] Metformin, other than hypoglycemic activity, has b 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 >>
Holiday Drinking: How 8 Common Medications Interact With Alcohol
MORE From the glasses of wine with Thanksgiving dinner to the champagne toast on New Year's, alcohol is often a familiar sight at holiday celebrations. But if you're taking one or more medications a day — whether they're over-the-counter or prescription — is it safe to raise a glass or two, or should you avoid drinking altogether? In some cases, mixing alcohol with medications can be dangerous. Some drugs contain ingredients that can react with alcohol, making them less effective. Drinking while on other types of medications might have a negative effect on your symptoms or the disease itself. For example, consuming alcohol can reduce blood-sugar levels, leading to poor control of diabetes. [7 Ways Alcohol Affects Your Health] Knocking a few back can also intensify the sleep-inducting effect of medications that may cause drowsiness, making it risky to get behind the wheel or use dangerous machinery. "The danger of combining alcohol and some medications is real and sometimes fatal," said Danya Qato, a practicing pharmacist and doctoral candidate in health services research at Brown University in Providence, R.I. "Alcohol works in various and unexpected ways to impact the effectiveness of a medication," Qato told LiveScience. Older people are at a particularly high risk for drug-alcohol interactions because they often take more medications than younger adults do, and are more susceptible to alcohol's effects on thinking and motor skills, which may result in falls and other injuries. Aging also slows the body's ability to break down alcohol, so its negative effects are felt sooner, and it remains in an older person's bloodstream longer. Knowing which of the eight common medication classes below may interact harmfully with alcohol, and what side effects may occur as a re Continue reading >>
Metformin And Alcohol / Food Interactions
There is 1 alcohol/food/lifestyle interaction with metformin: metformin drug Interactions There are 703 drug interactions with metformin metformin disease Interactions There are 4 disease interactions with metformin which include: The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. Unknown No information available. Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright Continue reading >>
Is It Safe To Mix Metformin And Alcohol?
If you’re taking metformin to treat your diabetes, you may be wondering how this drug affects your ability to drink safely. Drinking alcohol can affect your diabetes symptoms directly, but there are additional risks if you drink alcohol with metformin. This article gives you information on how alcohol interacts with metformin and also how drinking alcohol can affect your diabetes. With any medicine you take, you should be aware of interactions that can happen if you use other substances. Metformin and alcohol can interact to increase your risk of harmful effects. You are at much greater risk of these effects if you frequently drink a lot of alcohol or you binge drink (drink a lot in short periods). These effects include an extremely low blood sugar level, called hypoglycemia, and a condition called lactic acidosis. Hypoglycemia Drinking alcohol while you’re taking metformin may cause extremely low blood sugar levels. Some symptoms of low blood sugar levels can be similar to symptoms of having too much alcohol. These include: drowsiness dizziness confusion Tell the people who are with you while you drink that you have diabetes. They can help you watch for these symptoms. If you or the people around you notice these symptoms, stop drinking and eat something right away to help increase your blood sugar level. If your symptoms of hypoglycemia are severe, such as losing consciousness, and you do not have a glucagon hypoglycemia rescue kit, someone with you should call 9-1-1. A glucagon hypoglycemia rescue kit includes human glucagon (a natural substance that helps balance your blood sugar level), a syringe to inject it, and instructions. You can use this kit for severe hypoglycemia when eating food will not help. If you are not familiar with this kit, talk to your doctor Continue reading >>
Metformin And Alcohol
Tweet It is generally recommended that people not use metformin and alcohol at the same time. Taking metformin and alcohol together can increase your risk of developing a life-threatening condition called lactic acidosis. However, drinking small amounts of alcohol should not be a problem for most people taking the medication. Before taking metformin, be sure to talk to your healthcare provider about drinking alcohol while taking the drug. An Overview of Metformin and Alcohol Metformin (Glucophage®) is a prescription medication licensed as a type 2 diabetes treatment. Often, people are warned to avoid alcohol entirely while taking metformin. This may (or may not) be good advice, depending on your particular situation. Metformin, Alcohol, and Lactic Acidosis Taking metformin increases your chance of developing a life-threatening condition called lactic acidosis (see Metformin and Lactic Acidosis). Drinking large amounts of alcohol also increases your risk for lactic acidosis, and combining metformin and large amounts of alcohol can be dangerous (due to the risk of lactic acidosis). As a result, drinking large amounts of alcohol (either on a daily basis or as "binge drinking") is not recommended while taking metformin. Small amounts of alcohol should not be a problem for most people taking metformin. However, because other medical conditions may also increase your risk of lactic acidosis (including kidney or liver problems), there may be some situations where avoiding alcohol entirely might be a good idea. Metformin and Alcohol: Suggestions It is usually not necessary to completely avoid alcohol while taking metformin. However, drinking large amounts of alcohol while taking metformin is not recommended. Be sure to ask your healthcare provider if it would be okay to drink Continue reading >>
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 >>
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 >>
