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Item
#7
Metformin
Prescribing Guidelines Often Ignored
Metformin
can be pulled from market if prescribers don’t develop a better
understanding of the prescribing guidelines.
According
to a report published in the February 25th issue of the Archives
of Internal Medicine, many hospitalized patients receive metformin
therapy despite having contraindications that increase their risk
of lactic acidosis.
The product labeling
for metformin identifies several clinical factors or patient
characteristics that increase the lactic acidosis risk. However,
the current findings suggest that many physicians are unaware of
these prescribing guidelines.
In
more than one-quarter of hospital admissions involving metformin
therapy, at least one dose of the drug was given despite the
presence of absolute contraindications, Dr. Amy T. Calabrese, from
the University of Pittsburgh, and colleagues state. In fact,
treatment with the drug is actually continued in many cases with
contraindications.
Dr.
Calabrese's team analyzed data from 263 hospitalizations in which
metformin therapy was given. The most common contraindication was
elevated serum creatinine, which was present or developed during
32 admissions. Furthermore, in only eight of these 32 patients was
the drug appropriately discontinued.
The
most common precautionary condition violated was the use of
metformin in patients receiving cationic agents, which occurred in
97 admissions, the researchers note.
Due
to the retrospective nature of the study, the problem of
inappropriate metformin prescribing practices may actually be more
widespread than indicated, the investigators point out.
"It is essential that
physicians develop a better understanding of the prescribing
guidelines for metformin," the authors state. Not only will
this help reduce the risk of lactic acidosis, but it may also
prevent metformin from being pulled from the market--which has
happened with several other drugs that were used in patients with
labeled contraindications.
Arch Intern Med 2002;162:434-437.
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