After an angiogram, why would insulin, Metformin (MET), Jardiance (Empagliflozin), and DPP-4 (Dipeptidyl Peptidase-4) inhibitors be discontinued and for what duration?

From the Guidelines

After an angiogram, medications like insulin, metformin, Jardiance (empagliflozin), and DPP-4 inhibitors are typically stopped temporarily due to concerns about kidney function and contrast dye interactions, with the most recent and highest quality study suggesting that these medications should be held for 24-48 hours after the procedure, depending on kidney function test results 1.

Reasons for Stopping Medications

• The contrast dye used during angiograms can temporarily stress the kidneys, potentially leading to kidney function decrease and accumulation of metformin, causing lactic acidosis.
• SGLT-2 inhibitors like Jardiance may increase dehydration risks and affect kidney function.
• DPP-4 inhibitors are generally stopped as a precaution.

Management of Medications

• Insulin may be managed differently, with reduced doses rather than complete discontinuation, especially for Type 1 diabetics.
• The primary reason for stopping these medications is to prevent potential kidney damage and other complications.
• Blood sugar may be managed with alternative methods or modified insulin regimens as needed during this time.

Resumption of Medications

• Medications are typically restarted within 24-48 hours of the resolution of symptoms and the presence of normal patterns of eating and drinking, as recommended by the most recent consensus guidelines 1.
• Basal and bolus insulin may be increased by 10%-20% if blood glucose is elevated.
• Renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, sodium/glucose cotransporter 2 inhibitors, and metformin should be temporarily stopped, according to the consensus recommendations 1.

From the Research

Medication Management After Angiogram

• The decision to stop medications such as insulin, metformin, Jardiance, and DPP-4 inhibitors after an angiogram depends on various factors, including the patient's medical condition, the type of angiogram, and the presence of any complications 2.
• There is no direct evidence from the provided studies that specifically addresses the management of these medications after an angiogram.
• However, studies have investigated the use of these medications in patients with type 2 diabetes, including their efficacy and safety in combination with other treatments 3, 4, 5.
• In general, the management of medications after an angiogram is individualized and depends on the patient's specific needs and medical history.
• It is essential to consult with a healthcare professional to determine the best course of action for managing medications after an angiogram.

Duration of Medication Stoppage

• The duration of medication stoppage after an angiogram is not specified in the provided studies.
• The decision to stop medications and for how long should be made on a case-by-case basis, taking into account the patient's medical condition, the type of angiogram, and the presence of any complications.
• Studies have shown that the management of medications, including aspirin, during the perioperative period is crucial to minimize the risk of bleeding and other complications 6.
• However, the provided studies do not specifically address the management of insulin, metformin, Jardiance, and DPP-4 inhibitors after an angiogram.

Considerations for Medication Management

• When managing medications after an angiogram, healthcare professionals should consider the patient's medical history, including the presence of any comorbidities, such as type 2 diabetes 3, 4, 5.
• The potential benefits and risks of continuing or stopping medications should be carefully weighed, taking into account the patient's individual needs and medical condition.
• Healthcare professionals should consult with relevant guidelines and clinical trials to inform their decision-making regarding medication management after an angiogram 2, 6.