Metformin NSAIDs

These include mesalazine, metformin, NSAIDs, tetracyclines (except doxycycline and minocycline), chloramphenicol, lithium, methotrexate, chloroquine, fibrates, chlorpropamide and glibenclamide, Clinically, it is useful to measure urine output per hour or per 24 hours as a fall in urine output in the presence of adequate fluid intake often indicates or warns of some impairment of renal function. Furthermore, it is neither expensive nor time-consuming to perform a quick test for albumin, casts and red cells in the urine, and to measure pH. Creatinine clearance values are often used to determine the safe doses for several drugs (e.g. NSAIDs, ciclosporin). 

Drugs that can precipitate lactic acidosis in patients taking metformin include ACE inhibitors, thiazide diuretics, NSAIDs, and drugs such as furosemide, nifedipine, cimetidine, amiloride, triamterene, trimethoprim, and digoxin, which are all secreted in the renal tubules, compete with metformin, and can contribute to increased plasma metformin concentrations (76). 

The combination of metformin, which itself does not cause hypoglycemia, with an ACE inhibitor, nitrofurantoin, and an NSAID, which all have glucose-lowering effects, and poor food intake may have led to hypoglycemia in this case. 

The authors reported that two other cases of metformin-associated lactic acidosis with concurrent NSAID therapy have been reported to the Committee on Safety of Medicines in the UK. Indometacin can impair kidney function and may have done so in this case. Phenformin can cause tubular damage and oliguria in animals (145) and so it is conceivable that metformin-induced renal damage may also have contributed. 

METFORMIN NS AIDS Possibility oft plasma levels of metformin if there is renal impairment due to NSAIDs. Phenylbutazone is likely to i renal elimination of metformin and t plasma levels. 

Examples of some drugs whose activity is increased in liver disease include oral anticoagulants, metformin, chloramphenicol, NSAIDs and sulphonylureas. It is well known that drugs such as opioids should be used in reduced dosage in patients with hepatic dysfunction doses need to be titrated, Therefore, if adverse drug interactions with opioids occur in patients with liver dysfunction, the consequences such as respiratory depression could be life-threatening,... 

ASA = aspirin NSAIDs = non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen, and diclofenac CNS stimulants include drugs such as pseudoephedrine, dextroamphetamine, theophylline, and caffeine MAO = monoamine oxidase CNS depressants include drugs such as benzodiazepines, barbiturates, and ethanol SSRIs = selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, and paroxetine. Antidiabetic agents include drugs such as insulin, glipizide, glyburide, and metformin. 

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