Talk:Metformin

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Article Milestones Date Process Result January 14, 2007 Good article nominee Listed Current Status: Good article

Contents 1 older entries 2 Codeine 3 Metformin and aspirin 4 Avandamet 5 Contraindications 6 Suggestions from GA review

[edit] older entries

i think the relative importance of using metformin in the treatment of type 2 diabetes mellitus should be underlined given the results of the united kingdom prospective diabetes study (ukpds). it was the only agent that reduced cardiovascular mortality and morbidity - if i had type 2, i'd be the first in line to want metformin, ahead of sulphonylureas etc.

I totally agree. I'll see if I can find the reference. JFW | T@lk 22:08, 27 October 2005 (UTC)

i think these are the refs:

UKPDS 34 Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. UKPDS Study Group Lancet (1998); 352: 854-865

UKPDS 33 Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UKPDS Study Group Lancet (1998); 352: 837-853

User:62.6.139.10

Well, the first reference was already there and I've updated it further. JFW | T@lk 00:49, 30 October 2005 (UTC)

have added the word "cardiovascular" in front of complications. pernickety, but in UKPDS, sulphonylureas decreased microvascular but not macrovascular complications.

there is also an argument that metformin is no longer being the "only" drug shown to decrease CVS complications - the PROactive trial showed that pioglitazone reduced death, MI, bypass surger, strokes but not peripheral vascular disease interventions. this has led to some controversy as the trial used a composite primary endpoint (death+MI+CVA+amputation etc) which was not significantly reduced. i therefore wonder if the word "only" should be removed.

[edit] Codeine

Despite the claim of Jfdwolff (22:38, 27 October 2005 (sorted things a bit - removed the codeine stuff (does not relieve cramping))), codeine is effective for the relief of cramping caused by metformin. Codeine is indicated for diarrhea and pain relief, and as such it is immediately relevant to the common gastrointestinal side effect of metformin. This is not the place for details on the mechanism of action of codeine/morphine, but in short, the resulting morphine has a relaxing, even paralytic effect, that particularly affects the entire gastrointestinal tract (this is the cause of loss of appetite and constipation in long-term morphine users). Whether it is always effective is anther matter, hence the word "should". Caveats, such as codeine being appropriate only for short-term use, might be warranted, but in my opinion belong under [codeine]. --Anthony Duff 22:41, 4 January 2006 (UTC)

So why codeine and not loperamide, a non-centrally acting opioid constipant? JFW | T@lk 23:12, 4 January 2006 (UTC)

That's a good question to which I have found no certain answer. However, it seems "well-known" that loperamide is not effective for relieving diarrhea caused by metformin, while codeine is. Apparently, the (unknown) mechanism of induction of diarrhea caused by metformin is different than for ordinary diarrhea. A distinguishing feature of metformin-induced diarrhea is that it is associated with strong, painful intestinal cramping that occurs irrespective of what is in the colon. The initial bowel motions may be quite solid. Loperamide apparently works by making the colon insensitive to its contents, and metformin-induced diarrhea seems not to be triggered by the physical contents of the colon.

This, at least, is my best guess. With further investigation, I cannot find anything better. I freely admit that I do not know why loperamide doesn't work, if indeed it doesn't.

If metformin is causing pain, cramping and/or diarrhea, then the standard action is for the metformin dose to be reduced. However, I think this brief mention of codeine is important because it gives short-term, immediate relief to the person who is in actual pain. --Anthony Duff 23:22, 5 January 2006 (UTC)

[edit] Metformin and aspirin

Why is metformin perscribed with aspirin even though aspirin is a blood thinner and can cause bleeding? Does metformin have to be taken with another drug, such as aspirin?

Not necessarily, but diabetics are at risk for stroke and heart attack, the risk of which is reduced significantly by a low daily dose of aspirin. JFW | T@lk 16:16, 25 January 2006 (UTC)

The last line states that metformin did not receive FDA approval for type 2 DM in 1994 - a typo surely?

[edit] Avandamet

Is that Avandamet stuff really necessary on this page? It's entirely tangential to an article about metformin, and would be better put on a page of its own so as not to distract from, er, people reading about metformin! This may just be the slight beef I have with drug company names invariably appearing in the first few lines of every bleedin' drug article - but really this is irrelevant to what metformin is, and pretty uninteresting to boot.

Anyone want to argue to preserve it?

Nmg20 23:14, 3 August 2006 (UTC)

[edit] Contraindications

This section appears to give medical advice (use of "should" and recommendation to patients). Per WP:MEDMOS, could it be rewritten to be more encyclopedic language? Or would the language be weakened to be merely passively reporting on guidelines. Perhaps I'm reading it wrong? Wrt the last sentence, is "any radiographic procedure" really the guideline? Surely dental and x-rays of broken bones are OK? Colin°^Talk 22:44, 12 January 2007 (UTC)

I'll see what I can do about that, although AFAIK overuse of passive voice is somewhat frowned upon. As for that last sentence, it's actually "before any radiographic procedure involving iodinated contrast"; the problem is actually the use of contrast, so no problem with plain films, dental stuff etc. Fvasconcellos 23:25, 12 January 2007 (UTC)

Perhaps my second sentence was ambiguous. I wasn't recommending passive voice, I saw that as a possible negative consequence of rephrasing. I'm not sure how best to phrase it and wondered if fixing one "problem" just introduced another. Colin°^Talk 08:50, 13 January 2007 (UTC)

Ah, sorry about that. I've rephrased the sentences anyway, it does indeed look better (to me at least). Thank you for your edits BTW. Fvasconcellos 12:56, 13 January 2007 (UTC)

[edit] Suggestions from GA review

• Try to use more patient-friendly language. I changed some, but other parts remain a little technical.
• metformin will not induce hypoglycemia. could use a reference.

Overall, excellent. TimVickers 01:59, 14 January 2007 (UTC)