Metformin should be avoided in patients with acute or unstable heart failure because of the increased risk of lactic acidosis. It also should be avoided in patients with hepatic impairment, according to the labeling.
This medicine is not recommended in patients 80 years of age and older who have kidney problems.
Taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements will help.
Metformin is contraindicated in patients with creatinine clearance below 15ml/min. Impaired hepatic function may significantly limit the ability to clear lactate. Metformin should be avoided in patients with severe hepatic insufficiency (see Contraindications) and used with caution in patients with milder disease.
Because metformin is cleared by the kidneys, it may accumulate when renal function decreases, with the potential for exposure-dependent toxicity that could precipitate lactate accumulation.
Metformin is primarily excreted unchanged by the kidney, and renal impairment may cause the accumulation of metformin leading to an elevated metformin concentration, and this has been proposed to lead to lactic acidosis [5].
Metformin does have an associated risk of lactic acidosis, as well as a few frequently cited contraindications, most notably glomerular filtration rate (GFR) <30 mL/minute, hemodynamic instability, and need for contrast imaging [1].
Metformin is the cornerstone of diabetes therapy and should be considered in all patients with type 2 diabetes. Both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE)1,2 recommend it as first-line treatment for type 2 diabetes.
Metformin had no significant effect on ambulatory blood pressure. Thus, metformin has, if any, only a minor clinically insignificant effect on blood pressure in nondiabetic hypertensives. The study does not support the hypothesis that circulating insulin is a major regulator of blood pressure in hypertension.
Because the pancreas of a person with type 1 diabetes cannot produce insulin, these medications are not effective – and therefore, metformin combination drugs would not have a benefit for a person with type 1 diabetes.
An effective substitute for Metformin is a compound known as berberine or berberine hydrochloride, which is obtained from many plant species, including goldenseal, barberry, Oregon grape, and turmeric.
However, elderly patients are more likely to have age-related kidney problems, which may require caution in patients receiving metformin. This medicine is not recommended in patients 80 years of age and older who have kidney problems.
Giugliano et al. have reported that metformin may decrease blood pressure and increase insulin sensitivity in obese, non-diabetic, hypertensive women.
It is estimated that 20-25% of patients taking metformin have heart failure. Metformin has been shown to have favorable effects on the course of heart failure in experimental models.
Abstract. Abstract—Metformin, an antihyperglycemic agent used for treatment of type 2 diabetes mellitus, lowers blood pressure in humans and experimental animals. We recently demonstrated that short-term administration of metformin may lower blood pressure by reducing sympathetic neural outflow.
Metformin lowers your blood sugar levels by improving the way your body handles insulin. It's usually prescribed for diabetes when diet and exercise alone have not been enough to control your blood sugar levels.
You can treat type 2 diabetes without medication by focusing on: Eating a healthy, balanced diet. Losing weight to achieve a BMI in the healthy range. Living an active life.
What should your blood sugar be when on metformin? Once metformin has started to work, it should help keep your blood glucose levels in the normal range. This means fasting glucose of 100 mg/dL or lower and post-meal levels of 140 mg/dL or lower.
Clinically apparent liver injury from metformin is very rare, fewer than a dozen cases having been described in the literature despite widespread use of this agent for several decades. The liver injury usually appears after 1 to 8 weeks, typically with symptoms of weakness and fatigue followed by jaundice.
Metformin has a black box warning for lactic acidosis — a condition where too much lactic acid builds up in the blood. It's a serious problem and can lead to death. If you experience these symptoms, seek medical attention right away.
Metformin is often a first-choice treatment for Type 2 diabetes. It's not known to be harmful to your kidneys or other organs. But if you have kidney problems, there's a greater risk of a serious condition called lactic acidosis. Your healthcare provider should watch your kidney function while you're taking metformin.
The recommendations advise clinicians to consider discontinuing metformin in people aged 80 and older, those with gastrointestinal complaints during the last year, and/or those with Glomerular Filtration Rate (GFR) ≤60 ml/min.
A doctor will often use certain criteria to determine whether it is safe for an individual to stop taking metformin. These criteria include: having a fasting or pre-meal blood glucose level of 80–130 milligrams per deciliter (mg/dL) having a random or after-meal blood glucose level of under 180 mg/dL.