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Biguanide (Side effects (lactic acidosis (severe (fatigue, wt loss, nausea…
Biguanide
Side effects
diarhea
lactic acidosis
mild
lab values abnormality
severe
fatigue
wt loss
nausea
abdominal pain
dyspnea
cardiac dysrhythmia
tender hepatomegaly
peripheral edema
ascites
encephalopathy
jaundice
nausea
gas
dose related
metallic taste
goes away
decr. absorption of folate & B12
benefits
decr. A1C by 1.0-1.5%
decr. fbs by 3.3-3.9 points
incr. HDL
decr. LDL & TG
NO weight gain
NO hypoglycemmia
caution
eGFR below 60 ml/min
reduce dose to 1000 mg/d
heart problems
liver problems
alcholol use
#
timing
onset
peak
duration
full effetiveness
2 wks
contraindications
eGFR below 30 ml/min
hepatic failure
Heart failure
pathophysiology
reduce hepatic glucose production
enhances insulin sensitivity
inhibits GI absorption of glucose
drug
Metformin
Glucophage
start: 500 mg bid
max: 2000 mg
MR Metformin
start 1000 mg
max: 2000 mg (with supper)
Glumetza