Skip to main content
Top
Published in: International Journal of Clinical Pharmacy 6/2007

01-12-2007 | Original Paper

Contraindications to metformin therapy among patients with type 2 diabetes mellitus

Author: Waleed M. Sweileh

Published in: International Journal of Clinical Pharmacy | Issue 6/2007

Login to get access

Abstract

Objective

The biguanide, metformin, is a commonly prescribed oral antihyperglycemic agent. However, there are several clinical conditions that are considered as contraindications to the use of metformin among patients with type 2 diabetes mellitus. The aim of this study was to investigate the presence and nature of contraindications to metformin therapy among patients with type 2 diabetes mellitus.

Method

A retrospective study of the medical files of diabetic patients available at Alwosta clinic, north Palestine was carried out. Information about disease and medication profile of the patients was retrieved and analyzed using SPSS during the study period in 2004/2005. Focus was on metformin users who have contraindications to metfromin therapy.

Main outcome measure

Presence and number of contraindications to metformin therapy.

Results

Two hundred and seventy-two type 2 diabetic patients were identified. One hundred and twenty four of those diabetic patients were metformin users. Approximately, 60% of patients in the metformin group had a least one contraindication. Congestive heart failure and renal impairment were the most quantitatively present contraindications.

Conclusion

Contraindications to metformin therapy are common among type 2 diabetic patients and mostly disregarded. Patients have to be critically assessed before starting therapy and in case of metformin prescribing; dose should be adjusted based on the presence of risk factors for metformin adverse effects.
Literature
1.
go back to reference Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2003;27 Suppl 2:S1–152. Available: www.diabetes.ca/cpg2003/chapters.aspx Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2003;27 Suppl 2:S1–152. Available: www.diabetes.ca/cpg2003/chapters.aspx
2.
go back to reference Cheng AYY, Fantus IG. Oral antihyperglycemic therapy for type 2 diabetes mellitus. CMAJ 2005;172(2):213–26.PubMed Cheng AYY, Fantus IG. Oral antihyperglycemic therapy for type 2 diabetes mellitus. CMAJ 2005;172(2):213–26.PubMed
3.
go back to reference DeFronzo RA, Goodman AM & the Multicenter Metformin Study Group. Efficacy of metformin in patients with non-insulin dependent diabetes mellitus. N Engl J Med 1995;333:541–9. DeFronzo RA, Goodman AM & the Multicenter Metformin Study Group. Efficacy of metformin in patients with non-insulin dependent diabetes mellitus. N Engl J Med 1995;333:541–9.
4.
go back to reference Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med 2002;237:25–33. Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med 2002;237:25–33.
5.
go back to reference UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352:854–65, 1557. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352:854–65, 1557.
6.
go back to reference Fanghanel G, Sanchez-Reyes L, Trujillo C, Sotres D, Espinosa-Campos J. Metformin’s effects on glucose and lipid metabolism in patients with secondary failure to sulfonylureas. Diabetes Care 1996;19:1185–9.PubMedCrossRef Fanghanel G, Sanchez-Reyes L, Trujillo C, Sotres D, Espinosa-Campos J. Metformin’s effects on glucose and lipid metabolism in patients with secondary failure to sulfonylureas. Diabetes Care 1996;19:1185–9.PubMedCrossRef
7.
go back to reference Garber AJ, Duncan TG, Goodman AM. Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose–response trial. Am J Med 1997;103:491–7.PubMedCrossRef Garber AJ, Duncan TG, Goodman AM. Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose–response trial. Am J Med 1997;103:491–7.PubMedCrossRef
8.
go back to reference Nagi DK, Yudkin JS. Effects of metformin on insulin resistance, risk factors for cardiovascular disease, and plasminogen activator inhibitor in NIDDM subjects. Diabetes Care 1993;16:621–9.PubMedCrossRef Nagi DK, Yudkin JS. Effects of metformin on insulin resistance, risk factors for cardiovascular disease, and plasminogen activator inhibitor in NIDDM subjects. Diabetes Care 1993;16:621–9.PubMedCrossRef
9.
go back to reference Stumvoll M, Nurjhan N, Perriello G, Dailey G, Gerich JE. Metabolic effects of metformin in non-insulin dependent diabetes mellitus. N Engl J Med 1995;333:550–4.PubMedCrossRef Stumvoll M, Nurjhan N, Perriello G, Dailey G, Gerich JE. Metabolic effects of metformin in non-insulin dependent diabetes mellitus. N Engl J Med 1995;333:550–4.PubMedCrossRef
11.
go back to reference Holstein A, Stumvoll M. Contraindications can damage your health–is metformin a case in point? Diabetologia. 2005;48(12):2454–9. Epub 2005 Nov 11. Holstein A, Stumvoll M. Contraindications can damage your health–is metformin a case in point? Diabetologia. 2005;48(12):2454–9. Epub 2005 Nov 11.
12.
go back to reference Misbin RI. The phantom of lactic acidosis due to metformin in patients with diabetes. Diabetes Care 2004;27:1791–3.PubMedCrossRef Misbin RI. The phantom of lactic acidosis due to metformin in patients with diabetes. Diabetes Care 2004;27:1791–3.PubMedCrossRef
13.
go back to reference Lactic Acidosis Study Group. Natural history and course of acquired lactic acidosis in adults. Am J Med 1994;97:47–54.CrossRef Lactic Acidosis Study Group. Natural history and course of acquired lactic acidosis in adults. Am J Med 1994;97:47–54.CrossRef
14.
go back to reference Sulkin TV, Bosman D, Krentz AJ. Contraindications to metformin therapy in patients with NIDDM. Diabetes Care 1997;20:925–8.PubMedCrossRef Sulkin TV, Bosman D, Krentz AJ. Contraindications to metformin therapy in patients with NIDDM. Diabetes Care 1997;20:925–8.PubMedCrossRef
16.
go back to reference Bristol-Meyers Squibb. Prescribing information for glucophage. Princeton, New Jersey, November 14, 1997. Bristol-Meyers Squibb. Prescribing information for glucophage. Princeton, New Jersey, November 14, 1997.
17.
go back to reference Misbin RI, Green L, Stadel BV, Gueriguian JL, Gubbi A, Fleming GA. Lactic acidosis in patients with diabetes treated with metformin. N Engl J Med 1998;338:265–6.PubMedCrossRef Misbin RI, Green L, Stadel BV, Gueriguian JL, Gubbi A, Fleming GA. Lactic acidosis in patients with diabetes treated with metformin. N Engl J Med 1998;338:265–6.PubMedCrossRef
18.
go back to reference Brown JB, Pedula K, Barzilay J, Herson MK, Latare P. Lactic acidosis rates in type 2 diabetes. Diabetes Care 1998;21:1659–63.PubMedCrossRef Brown JB, Pedula K, Barzilay J, Herson MK, Latare P. Lactic acidosis rates in type 2 diabetes. Diabetes Care 1998;21:1659–63.PubMedCrossRef
19.
go back to reference Franzetti I, Paolo D, Marco G, Emanuela M, Elisabetta Z, Renato U. Possible synergistic effect of metformin and enelapril on the development of hyperkalaemic lactic acidosis. Diabetes Res Clin Pract 1997;38:173–6.PubMedCrossRef Franzetti I, Paolo D, Marco G, Emanuela M, Elisabetta Z, Renato U. Possible synergistic effect of metformin and enelapril on the development of hyperkalaemic lactic acidosis. Diabetes Res Clin Pract 1997;38:173–6.PubMedCrossRef
20.
go back to reference Chan NN, Fauvel NJ, Feher MD. Non-steroidal anti-inflammatory drugs and metformin: a cause for concern? Lancet 1998;352:201. Chan NN, Fauvel NJ, Feher MD. Non-steroidal anti-inflammatory drugs and metformin: a cause for concern? Lancet 1998;352:201.
21.
go back to reference Salpeter S, Greyber E, Pasternak G, Salpeter E. Risk of fatal and non-fatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002967. Review. Salpeter S, Greyber E, Pasternak G, Salpeter E. Risk of fatal and non-fatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD002967. Review.
Metadata
Title
Contraindications to metformin therapy among patients with type 2 diabetes mellitus
Author
Waleed M. Sweileh
Publication date
01-12-2007
Publisher
Springer Netherlands
Published in
International Journal of Clinical Pharmacy / Issue 6/2007
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-007-9095-1

Other articles of this Issue 6/2007

International Journal of Clinical Pharmacy 6/2007 Go to the issue

Editorial

Editorial