Diabetics given drug despite side effect danger

May 17, 2002

Last Updated: 2002-05-14 17:01:37 -0400 (Reuters Health)

NEW YORK (Reuters Health) - One in five diabetics who are prescribed the

drug metformin may have other conditions that put them at risk of a

life-threatening side effect of the drug, researchers report.

Metformin, marketed under the name Glucophage, is used to treat type 2

diabetes, which usually strikes in adulthood and is linked to obesity.

The drug reduces blood sugar levels by curbing the liver's glucose

production. However, some patients who take metformin are at increased

risk of a complication called lactic acidosis, a potentially

life-threatening build-up of lactic acid in the blood that can damage

vital organs.

Currently, the drug is marketed with a " black-box warning " cautioning

that metformin should not be prescribed for patients with kidney disease

and people taking drugs for congestive heart failure. Both groups are

more likely than other diabetics to develop lactic acidosis.

During the first year metformin was available, 47 cases of lactic

acidosis were reported, and 20 of the patients died. This represents a

42% risk of death in those who develop the problem.

In a study, North Carolina researchers reviewed 100 charts of diabetic

patients who were taking metformin. They found that 22% of patients who

were prescribed the drug had kidney disease, were taking drugs for heart

failure, or were suffering from both conditions.

These findings were reported in a research letter in the May 15 issue of

the Journal of the American Medical Association.

Metformin is the most commonly prescribed medication for diabetes in the

US, with over 25 million prescriptions written in 2000 alone.

" Because our assessment of the prevalence of contraindications to

metformin use relies on a chart review, it may underestimate the

frequency of contraindications and it is difficult to determine whether

clinicians are aware they are prescribing metformin against a black-box

warning, " Dr. Cheryl Horlen of University and colleagues write.

Another group of researchers based at the University of Pittsburgh in

Pennsylvania recently reported that more than one quarter of diabetics

given metformin at the hospital had a condition that placed them at

higher risk of complications.

SOURCE: Journal of the American Medical Association 2002;287:2504-2505.

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