From the Guidelines
To safely manage your condition with medication, it is crucial to follow your healthcare provider's instructions carefully and be aware of potential interactions and side effects, as emphasized in the most recent and highest quality study available 1.
Key Considerations for Safe Medication Management
- Take medications exactly as prescribed, including the correct dosage, timing, and duration.
- Keep a complete list of all medications you're taking, including over-the-counter drugs and supplements, to share with all healthcare providers to prevent harmful interactions.
- Establish a consistent routine for taking medications, perhaps using pill organizers, smartphone reminders, or linking medication times to daily activities.
- Never stop taking prescribed medications without consulting your healthcare provider, even if you feel better, as sudden discontinuation can cause withdrawal symptoms or condition worsening.
- Be vigilant about potential side effects and report any unusual symptoms to your healthcare provider promptly.
Monitoring and Adjustments
- Attend all follow-up appointments to monitor your condition and medication effectiveness, allowing your provider to make necessary adjustments.
- Understanding how your medications work and why they're prescribed can improve adherence and help you recognize potential issues earlier, as highlighted in 1 and 1.
- For specific conditions like diabetes and chronic kidney disease, guidelines such as those from KDIGO 1 provide recommendations on medication management, including the use of metformin and monitoring of kidney function.
Special Considerations
- In older adults, managing polypharmacy is crucial to prevent drug interactions and toxicity, as discussed in 1.
- For patients with multiple conditions, a systematic approach to medication management, including regular review and adjustment of medications, is necessary to ensure safe and effective treatment, as suggested in 1 and 1.
From the FDA Drug Label
7 DRUG INTERACTIONS
Table 3 presents clinically significant drug interactions with metformin hydrochloride extended-release tablets Table 3: Clinically Significant Drug Interactions with metformin hydrochloride extended-release tablets Carbonic Anhydrase Inhibitors Clinical Impact: Carbonic anhydrase inhibitors frequently cause a decrease in serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis Concomitant use of these drugs with metformin hydrochloride extended-release tablets may increase the risk for lactic acidosis. Intervention: Consider more frequent monitoring of these patients. Examples: Topiramate, zonisamide, acetazolamide or dichlorphenamide Drugs that Reduce Metformin Hydrochloride Extended-Release Tablets Clearance Clinical Impact: Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology (12. 3)]. Intervention: Consider the benefits and risks of concomitant use with metformin hydrochloride extended-release tablets. Examples: Ranolazine, vandetanib, dolutegravir, and cimetidine. Alcohol Clinical Impact: Alcohol is known to potentiate the effect of metformin on lactate metabolism Intervention: Warn patients against excessive alcohol intake while receiving metformin hydrochloride extended-release tablets. Insulin Secretagogues or Insulin Clinical Impact: Coadministration of metformin hydrochloride extended-release tablets with an insulin secretagogue (e.g., sulfonylurea) or insulin may increase the risk of hypoglycemia. Intervention: Patients receiving an insulin secretagogue or insulin may require lower doses of the insulin secretagogue or insulin. Drugs Affecting Glycemic Control Clinical Impact: Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control Intervention: When such drugs are administered to a patient receiving metformin hydrochloride extended-release tablets, observe the patient closely for loss of blood glucose control. When such drugs are withdrawn from a patient receiving metformin hydrochloride extended-release tablets, observe the patient closely for hypoglycemia Examples: Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid.
To safely manage your condition with medication, consider the following key points:
- Be aware of the potential for lactic acidosis and its symptoms, and notify your healthcare provider immediately if you experience any unusual symptoms.
- Avoid excessive alcohol intake, as it can potentiate the effect of metformin on lactate metabolism.
- If you are taking insulin secretagogues or insulin, you may require lower doses to avoid hypoglycemia.
- Inform your doctor about all concomitant medications, as some may interact with metformin and affect glycemic control.
- Regularly monitor your blood glucose levels and renal function while receiving metformin hydrochloride extended-release tablets 2.
Additionally, as stated in the patient counseling information:
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Information). Lactic Acidosis: Explain the risks of lactic acidosis, its symptoms, and conditions that predispose to its development Advise patients to discontinue metformin hydrochloride extended-release tablets immediately and to promptly notify their healthcare provider if unexplained hyperventilation, myalgias, malaise, unusual somnolence or other nonspecific symptoms occur Counsel patients against excessive alcohol intake and inform patients about importance of regular testing of renal function while receiving metformin hydrochloride extended-release tablets Instruct patients to inform their doctor that they are taking metformin hydrochloride extended-release tablets prior to any surgical or radiological procedure, as temporary discontinuation may be required [see Warnings and Precautions (5. 1)].
It is essential to follow these guidelines and consult your healthcare provider for personalized advice on managing your condition with medication 2.
From the Research
Safe Management of Condition with Medication
To safely manage your condition with medication, consider the following points:
- It is essential to be aware of the potential risks of drug interactions, unwanted effects, and adverse reactions, especially when taking multiple medications 3.
- Age-related changes in pharmacokinetics and pharmacodynamics can affect the way medications work in the body, and some medications may need to be used with special caution 3.
- Patient adherence to the prescribed regimen is crucial, and a partnership between the physician and patient in therapeutic decision making can improve outcomes 3, 4.
- Certain medications, such as metformin, may interact synergistically with other drugs, allowing for lower doses and potentially reducing side effects 5.
- Factors contributing to poor medication adherence include suboptimal health literacy, lack of involvement in treatment decision-making, and complex drug regimens 4.
Strategies for Improving Medication Adherence
Some strategies for improving medication adherence include:
- Simplifying drug regimens and providing clear instructions 4.
- Involving patients in the treatment decision-making process and encouraging them to take an active role in their care 4, 6.
- Using health information technology to improve communication and access to care 4.
- Providing education and support to patients and their families to improve health literacy and adherence 4, 6.
Patient Involvement in Drug Administration
Patient involvement in drug administration can improve safety and outcomes, and patients should be encouraged to: