Vomiting metformin

Metformin 1500-2000 mg by mouth daily in 2-3 divided doses15 Anorexia, nausea, vomiting, diarrhea, flatulence, lactic acidosis... 

Metformin ER (1% to 5%) - Abdominal distention, abdominal pain, constipation, diarrhea, dizziness, dyspepsia/heartburn, flatulence, headache, nausea/vomiting, taste disturbance, upper respiratory tract infection. 

Adverse gastrointestinal symptoms (nausea, vomiting, anorexia, metallic taste, abdominal discomfort, and diarrhea) occur in up to 20% of individuals taking metformin this can be minimized by starting at a low dose and slowly titrating the dose upward with food. Like phenformin, metformin can cause lactic acidosis, but its occurrence is rare except when renal failure, hypoxemia, or severe congestive heart failure is present or when coadministered with alcohol. Metformin is also contraindicated in persons with hepatic dysfunction, but it appears to be safe for use in the hepatic steatosis that often occurs with fatty infiltration of the liver in poorly controlled type II diabetics. 

The most common toxic effects of metformin are gastrointestinal (anorexia, nausea, vomiting, abdominal discomfort, and diarrhea), which occur in up to 20% of patients. They are dose-related, tend to occur at the onset of therapy, and are often transient. However, metformin may have to be discontinued in 3-5% of patients because of persistent diarrhea. Absorption of vitamin B12 appears to be reduced during long-term metformin therapy, and annual screening of serum vitamin B12 levels and red blood cell parameters has been encouraged by the manufacturer to determine the need for vitamin B12 injections. In the absence of hypoxia or renal or hepatic insufficiency, lactic acidosis is less common with metformin therapy than with phenformin therapy. 

In 82 children aged 10-16 years with type 2 diabetes, metformin lowered HbAic and fasting blood glucose compared with placebo (12). More patients who took placebo had to drop out because more medication was necessary. Most of the adverse events (abdominal pain, diarrhea, nausea, vomiting) occurred during metformin treatment. 

A 42-year-old man developed nausea and vomiting and felt suicidal. He had type 2 diabetes and was taking metformin (56). His blood lactate concentration was 8.9 mmol/1, bicarbonate 16 mmol/1, and pH 7.2. Severe hypotension required intensive care. The lactate concentration rose to 22 mmol/1 and the bicarbonate fell to 6.7 mmol/1 and the pH to 6.89. The metformin concentration was high at 191 mg/1. He survived, having been treated with intermittent hemodialysis. 

The use of metformin in polycystic ovarian syndrome, which is often accompanied by insulin resistance or other aspects of the metabolic syndrome, has been systematically reviewed (101). Metformin was therapeutically less effective than weight loss. Adverse effects were nausea, vomiting, and gastrointestinal disturbances. 

A 52-year-old man with advanced HIV infection taking many medicines took metformin 500 mg bd for 6 days (146). He became increasingly unwell, with nausea, vomiting, abdominal pain, lethargy, and jaundice. His pH was 7.28 and lactic acid 15 mmol/1. Antiviral drugs and metformin were withdrawn, but he died after 30 hours. 

Of 210 patients with type 2 diabetes, 179 completed a randomized study of the effects of five different doses (0.045, 0.225, 0.45, 0.6, and 0.75 mg) or metformin 100 mg bd for 12 weeks after a 4-week metformin run-in phase. The numbers of people who reported nausea and vomiting were small (4%) and comparable to the incidence with metformin (6%) (15). Careful upwards titration allows higher doses (2 mg/day) to be tolerated (2). 

Abdominal discomfort is frequent with metformin (15-25%), and nausea, vomiting, and diarrhea occur even in the absence of lactic acidosis. Other effects include flatulence, abdominal bloating, anorexia, and a metallic taste. Anorexia and weight loss are often seen at the beginning of treatment. Phenformin can cause hemorrhagic gastritis (65). 

Metformin can cause adverse gastrointestinal effects with anorexia, nausea and vomiting. Patients may experience a metallic taste and there may be weight loss, which in some diabetics could be an advantage. Hypoglycaemia is less of a problem with metformin than with sulphonylureas. 

Biguanides. Metformin acts peripherally to increase glucose uptake by an unknown mechanism.. As it does not increase insulin release, it rarely cau-scs hypoglycaemia. Adverse effects include nausea, vomiting, diarrhoea and. very (Kcasionally, fatal lactic acidosis. 

B. Lactic acidosis from metformin or phenformin may begin with nonspecific symptoms such as malaise, vomiting, myalgias, and respiratory distress. The mortality rate for severe lactic acidosis is reportedly as high as 50%. 

A 59-year-old woman with type 2 diabetes mellitus and coronary artery disease, taking fenofibrate, hsinopril, metformin, fluvastatin, and atenolol, was given cimetidine for gastroesophageal reflux disease and immediately developed nausea and vomiting followed by diarrhea. She had low hemoglobin, carbon... 

A 28-year-old woman who was taking metformin 1500 mg/day for polycystic ovary syndrome underwent hysterosalpingography for secondary infertility and 4 hours later developed severe epigastric pain, nausea and vomiting, shivering, and a temperature of 38.1°C. She had leukopenia (1.0 x 10 /1) and a blood film showed a shift to the right with minimal immature forms. The serum tryptase concentration was not raised. The full blood count improved after about 3 hours. Clinically she improved within a few hours and the blood count was normal after 48 hours. 

A 64-year-old woman with mild chronic renal impairment who was taking metformin 3 g/day, allopurinol 300 mg/day, verapamil 120 m day, irbesartan 300 m day, and forosemide 25 mg/ day, developed nausea, vomiting, and abdominal pain 6 days after a surgical procedure [38 ]. The serum creatinine concentration had risen to 500 j,mol/l, and the pH was 7.16 with a serum bicarbonate of 11 mmol/1. She was treated with sustained low-efficiency daily dialysis (SLEDD) with GENIUS . Acid-base balance returned to normal after three treatments. 

A 49-year-old woman who was taking metformin, losartan, bendroflumethiazide, and atenolol, developed diarrhea and vomiting after general anesthesia for a minor procedure [39 ]. Her symptoms continued for 5 days and worsened with the development of dyspnea. Her pH was less than 6.8 and the serum creatinine concentration was 769 p,mohl. She was treated with continuous hemofiltration for 4 days and made a good recovery. 

A six-month, open-label randomised study without placebo group in women with polycystic ovarian syndrome receiving metformin 1000 mg daily was conducted in 66 patients. The most common adverse event reported for metformin was vomiting n = 1), nausea (n = 3), diarrhea (n = 9). [24 ]... 

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