-
Metformin MOA
- 1. decreases hepatic glucose production
- 2. improve insulin sensitivity and dec intestinal absorption of glucose
-
Metformin elimination
urinary excretion
-
metformin starting dose elderly and non elderly
- noneld: 500-1000mg
- eld: 500 mg
-
metformin and endothelial function
- improves
- inc Ach stimulated arterial blood flow in PVD
-
Metformin Contraindications
- SCr ≥1.5 (males)
- SCr ≥1.4 (females)
- CrCl < 60 ml/min
- acute or chronic metabolic acidosis
- radiologic studies w/ iodinated contrast materials (+ 48 hrs after)--> renal dysfuntion
-
Metformin precautions
- ≥ 80 yrs; not max dose
- meds that affect renal fx (cationic drugs --> amiloride, digoxin, procainamide, quinidine, ranitidine, triamterene trimethoprim)
- conditions predisposing pt to renal insufficiency or hypoxia (CHF, COPD, shock, MI)
- before surgical procedures
- alcohol --> lactate metabolism pts
- hepatic disease
-
metformin side effects
- GI: diarrhea (slow titration), N/V, epigastric fullness
- Dermatologic: rash, photosensitivity, urticaria
- dec vitamin B12 absorption: anemia
- lactic acidosis: rare
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