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What is a contraindication to the use of metformin?


What is a contraindication to the use of metformin?

المعلومة

Safe use of metformin requires normal renal function. In fact, any degree of renal insufficiency is a contraindication for metformin use. Metformin is not recommended if the creatinine is over 1.5 mg per deciliter in a man or over 1.4 mg per deciliter in a woman.

المرجع

NEJM

dr.tabban's picture
by

Quote:
Metformin is not recommended if the creatinine is over 1.5 mg per deciliter in a man or over 1.4 mg per deciliter in a woman.

يمكن مشان ازدياد خطر حدوث حماض لبني

على الهامش هاد الدواء :
يزيد الحساسية للانسولين و لايسبب نقص سكر الدم و يسبب نقص الوزن...
و يسبب اعراض هضمية عابرة

qusei

Quote:
لايسبب نقص سكر الدم و يسبب نقص الوزن...

مشان هيك بنستعملو أكتر شي عند؟؟

dr.tabban's picture
dr.tabban


عند المرضى زائدي الوزن!

qusei


يس.

exactly.

dr.tabban's picture
dr.tabban

Quote:
In fact, any degree of renal insufficiency is a contraindication for metformin use

Also it's not given to heart failure pts
يستعمل ايضا عند مرضى الPCO لانه يترافق مع مقاومة للانسولين

Ghufran's picture
Ghufran
بعد التخرج


المتفورمين يعمل بالإضافة لزيادة الحساسية للأنسولين عند مرضى PCO على تقليل مستوى التستوستيرون و على دعم الإباضة

Al Durra's picture
Al Durra
بعد التخرج

Quote:
على الهامش هاد الدواء :
يزيد الحساسية للانسولين

أنا اللي بعرفه أنه بينقص Gluconeogenesis بشكل أساسي Rolling Eyes

DAM's picture
DAM

Quote:
أنا اللي بعرفه أنه بينقص Gluconeogenesis بشكل أساسي

Yes it’s the main effect. But Metformin also increases the peripheral uptake of glucose & that improve insulin sensitivity
By the way wut’s the mechanism of Lactic acidosis as a side effect of Metformin & why it’s higher in renal insufficiency?

Ghufran's picture
Ghufran
بعد التخرج

Metformin’s mechanism of action is thought to be by increasing glucose transport into glucose utilizing cells and by decreasing hepatic gluconeogenisis. Biguanide therapy decreases the activity of the enzyme pyruvate dehydrogenase and the transport of mitochondrial reducing agents, and thus enhances anaerobic metabolism. As inhibition of pyruvate dehydrogenase leads to a decreased ability to channel these precursors into aerobic metabolism this causes increased metabolism of pyruvate to lactate and an increase in lactic acid production. Any renal impairment will result in a reduced clearance of lactic acid and metformin.
دمعة's picture
دمعة


طيب بينعطى يالـ COPD (كحالة من الحماض التنفيسي)، أم أنه مضاد استطباب؟

DAM's picture
DAM


بحثت في UTD عن مضادات استطباب المتفورمين ...لم يذكروا COPD صراحة و لكن تحدث بشكل عام عن حالات Hypoxia أنه لا يفضل إعطاؤه

CONTRAINDICATIONS — Hypersensitivity to metformin or any component of the formulation; renal disease or renal dysfunction (serum creatinine 1.5 mg/dL in males or 1.4 mg/dL in females or abnormal creatinine clearance from any cause, including shock, acute myocardial infarction, or septicemia); acute or chronic metabolic acidosis with or without coma (including diabetic ketoacidosis)

Note: Temporarily discontinue in patients undergoing radiologic studies in which intravascular iodinated contrast materials are utilized.

WARNINGS / PRECAUTIONS
Box warnings: Lactic acidosis: See concerns related to adverse effects.

Concerns related to adverse effects: Cardiovascular mortality: Administration of oral antidiabetic drugs has been reported to be associated with increased cardiovascular mortality; metformin does not appear to share this risk. Lactic acidosis: [U.S. Boxed Warning]: Lactic acidosis is a rare, but potentially severe consequence of therapy with metformin. Lactic acidosis should be suspected in any diabetic patient receiving metformin who has evidence of acidosis when evidence of ketoacidosis is lacking. Discontinue metformin in clinical situations predisposing to hypoxemia, including conditions such as cardiovascular collapse, respiratory failure, acute myocardial infarction, acute congestive heart failure, and septicemia.

و هنا بعض التفصيل أيضاً

Lactic acidosis — Metformin may cause lactic acidosis. In one study, the incidence of lactic acidosis in patients taking metformin was 9 per 100,000 person-years [15]. This compares with a rate of 40 to 64 per 100,000 patient-years in those taking phenformin, a previously approved biguanide that was removed from the market because of this side effect. However, in a systematic review of 176 studies (including 17,156 patients taking metformin and 8943 other patients), there were no cases of lactic acidosis [16]. This suggests that not only is lactic acidosis extremely rare with metformin therapy, but also that the risk may be no different than that with placebo or other hypoglycemic drugs [16,17].

Serum lactate concentrations are usually less than 2 mmol/L in patients taking metformin, values that are not clinically important. Therefore, routine screening of serum lactate levels is not recommended.

  Predisposing factors — Clinically significant lactic acid accumulation has occurred only in the presence of several predisposing conditions; all are relative or absolute contraindications to the institution of metformin therapy [2,18,19]. These conditions are: Renal insufficiency (serum creatinine concentration above 1.4 mg/dL [124 µmol/L] in women and 1.5 mg/dL [132 µmol/L] in men), or low creatinine clearance. Concurrent liver disease or alcohol abuse, Heart failure; however, despite safety concerns, metformin use has been common in patients with diabetes and heart failure. (See "Heart failure in diabetes mellitus", section on Metformin). Past history of lactic acidosis, Decreased tissue perfusion or hemodynamic instability due to infection or other causes, Hypoxic states or serious acute illness Hemodynamic instability

يبدو و العلم عند الله أن COPD إذا كان under controlled و المريض لا يعاني من hypoxia ...فالمتفورمين لا يعتبر مضاد استطباب صريح

إذا كان عند أحدكم علم أوسع بهذا فليخبرنا و لكم جزيل الشكر

Al Durra's picture
Al Durra
بعد التخرج

Quote:
Biguanide therapy decreases the activity of the enzyme pyruvate dehydrogenase and the transport of mitochondrial reducing agents, and thus enhances anaerobic metabolism. As inhibition of pyruvate dehydrogenase leads to a decreased ability to channel these precursors into aerobic metabolism this causes increased metabolism of pyruvate to lactate and an increase in lactic acid production. Any renal impairment will result in a reduced clearance of lactic acid and metformin

also metformin through decreaseing gulconeogenesis decreases the uptake of lactate
Lactic Acidosis is a risk in renal insufficiency coz Metformin is excreted by kidneys & its accumulation will increase its effect in increasing Lactate
Regarding COPD:
those pts usually have compensatory R.acidosis, & renal excretion is well so i think they can take Metformin

Ghufran's picture
Ghufran
بعد التخرج

Quote:
those pts usually have compensatory R.acidosis, & renal excretion is well so i think they can take Metformin

anyway in case of tissue Hypoxia & respiratory failure in advanced disease, it should be avoided
i think dr.Al Durra wrote a wide explanation up

Ghufran's picture
Ghufran
بعد التخرج


كمان لازم نوقف الميتفورمين عند استعمال المواد الضليلة من أجل التصوير

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