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Research suggests diabetes drug being prescribed even when contraindicated

CHAPEL HILL Some doctors prescribe metformin, the most widely used type 2 diabetes treatment drug, for patients also suffering from congestive heart failure or kidney dysfunction or both despite clear warnings on drug packaging not to do so, a new study indicates.

The study, conducted at the University of North Carolina at Chapel Hill, showed 22 of 100 randomly selected patients on metformin had one or both of the contraindications.

Our findings are consistent with several recent studies in Europe that documented similar rates of inappropriate metformin prescribing, said Dr. Cheryl Horlen, who conducted the research as a pharmacy resident at UNC. We are concerned that these patients may be at risk of a serious medical condition known as lactic acidosis, which can be life-threatening.

In the first 14 months after its release in the United States, the Food and Drug Administration received reports of 47 confirmed cases of lactic acidosis associated with metformin, said Horlen, now an assistant professor of pharmacy practice at Campbell University. Those cases had a 42 percent mortality rate. In the absence of contraindications, the drug is considered safe and effective.

A report on the study appears as a letter in the May 15 issue of the Journal of the American Medical Association. Besides Horlen, authors are Drs. Robb Malone, Betsy Bryant, Timothy Carey, Michael Pignone and Russell Rothman of the UNC department of medicine faculty and Dr. Betty Dennis of the UNC Hospitals Pharmacy.

We performed a retrospective review of hospital charts of patients receiving metformin through the outpatient pharmacy at an academic medical center, Horlen said. We found 241 patients who had two or more prescriptions for metformin within a nine-month period and then randomly selected 100 of those for the chart review.

She and colleagues found 14 of the patients had congestive heart failure only, five had kidney dysfunction only and three
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Contact: David Williamson
david_williamson@unc.edu
919-962-8596
University of North Carolina at Chapel Hill
14-May-2002


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