Vitamin B12 deficiency due to metformin is a less common, but potentially severe complication that is often overlooked. Patients at risk for vitamin B12 deficiency include those taking more than 1,000 mg daily of metformin for three years or longer. Patients receiving metformin therapy should be monitored for signs and symptoms of vitamin B12 deficiency such as megaloblastic anemia or peripheral neuropathies.
Also, advise patients on metformin to take a multivitamin with B12 and encourage them to get their recommended daily amount of calcium, although there's no proof this will prevent B12 deficiency.
While neuropathy can be related to hyperglycemia, vitamin B12 deficiency should be ruled out as a cause, especially in those patients with diabetes who are taking metformin.
In patients with vitamin B12 deficiency, supplemental oral vitamin B12 should be administered. Calcium supplementation to assure that the recommended daily allowance is being met can also be considered
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Monday, September 27, 2010
Tuesday, September 14, 2010
Clinically Significant Statin Drug Interactions
Perhaps the most serious consequence of statin interactions is rhabdomyolysis. The risk of myopathy is increased when statins are coadministered with medications that inhibit their metabolism. Atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor) are CYP3A4 substrates and when coadministered with potent CYP3A4 inhibitors the incidence of myopathy is increased by about five fold.
The extent of interaction between atorvastatin and CYP3A4 inhibitors is less than that with lovastatin and simvastatin. Lovastatin and simvastatin are termed "sensitive substrates" because their levels may be increased five-fold or higher by CYP3A4 inhibitors.
Fluvastatin (Lescol) is primarily metabolized by CYP2C9 and to a lesser extent by CYP3A4 and CYP2D6. Pravastatin (Pravachol) is not significantly metabolized by the cytochrome P450 system and does not interact with other CYP substrates. Rosuvastatin (Crestor) is also not extensively metabolized by the cytochrome P450 system. Statins are substrates for P-glycoprotein; therefore, drugs that inhibit p-glycoprotein (e.g., cyclosporine, diltiazem, etc) may increase statin levels.
The increased risk of myopathy is well recognized when statins and fibric acid derivatives are coadministered since both classes of drugs have the potential for inducing myopathy. However, the risk is less with fenofibrate than gemfibrozil. This may be because gemfibrozil inhibits hepatic glucuronidation of statins, thereby interfering with statin elimination.
In managing statin interactions, choosing a non-interacting medication or switching to a non-interacting statin (i.e., for chronic therapy) may be the safest or easiest option. For certain statin interactions, reducing the statin dose may be an acceptable management technique.
Interactions between lovastatin or simvastatin and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole) are managed by stopping the statin as soon as the interacting drug is started. Recommendations vary, but some experts suggest restarting the statin three days or so after the interacting drug has been discontinued. The cardiovascular risk of stopping a statin must be considered when managing drug interactions. Stopping a statin for up to six weeks in a stable patient appears safe. The cardiovascular risk of stopping a statin is higher in unstable patients. Morbidity and mortality is increased in acute myocardial infarction (MI) patients whose statins are discontinued.The results of statin discontinuation in high risk patients may be seen quickly. In one study there was increased risk of in-hospital death in patients with non-ST segment elevation MI whose statin was discontinued. In addition, stopping statin therapy in acute ischemic stroke patients resulted in early neurologic deterioration and poorer outcomes in an unpublished study. Therefore, statins should only be discontinued in acute MI or stroke when indicated (e.g., rhabdomyolysis).
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
The extent of interaction between atorvastatin and CYP3A4 inhibitors is less than that with lovastatin and simvastatin. Lovastatin and simvastatin are termed "sensitive substrates" because their levels may be increased five-fold or higher by CYP3A4 inhibitors.
Fluvastatin (Lescol) is primarily metabolized by CYP2C9 and to a lesser extent by CYP3A4 and CYP2D6. Pravastatin (Pravachol) is not significantly metabolized by the cytochrome P450 system and does not interact with other CYP substrates. Rosuvastatin (Crestor) is also not extensively metabolized by the cytochrome P450 system. Statins are substrates for P-glycoprotein; therefore, drugs that inhibit p-glycoprotein (e.g., cyclosporine, diltiazem, etc) may increase statin levels.
The increased risk of myopathy is well recognized when statins and fibric acid derivatives are coadministered since both classes of drugs have the potential for inducing myopathy. However, the risk is less with fenofibrate than gemfibrozil. This may be because gemfibrozil inhibits hepatic glucuronidation of statins, thereby interfering with statin elimination.
In managing statin interactions, choosing a non-interacting medication or switching to a non-interacting statin (i.e., for chronic therapy) may be the safest or easiest option. For certain statin interactions, reducing the statin dose may be an acceptable management technique.
Interactions between lovastatin or simvastatin and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole) are managed by stopping the statin as soon as the interacting drug is started. Recommendations vary, but some experts suggest restarting the statin three days or so after the interacting drug has been discontinued. The cardiovascular risk of stopping a statin must be considered when managing drug interactions. Stopping a statin for up to six weeks in a stable patient appears safe. The cardiovascular risk of stopping a statin is higher in unstable patients. Morbidity and mortality is increased in acute myocardial infarction (MI) patients whose statins are discontinued.The results of statin discontinuation in high risk patients may be seen quickly. In one study there was increased risk of in-hospital death in patients with non-ST segment elevation MI whose statin was discontinued. In addition, stopping statin therapy in acute ischemic stroke patients resulted in early neurologic deterioration and poorer outcomes in an unpublished study. Therefore, statins should only be discontinued in acute MI or stroke when indicated (e.g., rhabdomyolysis).
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Wednesday, September 8, 2010
10 Tips on Hemorrhoids
1.Hemorrhoids are masses of swollen veins in the lower rectum (internal hemorrhoids) or at the anus (external hemorrhoids).
2.Symptoms of internal hemorrhoids include:
Bright red rectal bleeding
Staining of undergarments with mucus
3.Symptoms of external hemorrhoids include:
Pain and itching when irritated by constipation or diarrhea
Difficulty with hygiene
4.Hemorrhoids are caused by:
Straining
Work strain (lifting, etc.)
Straining while defecating
Chronic constipation
Passing hard, dry, small stools
Laxative abuse
5.Do not assume rectal bleeding is from hemorrhoids. See your doctor to rule out cancer or other disease.
6.To prevent or manage hemorrhoids, increase your fiber and fluid intake. Consider adding a fiber supplement.
7.Avoid straining at stool or sitting on the toilet for a long time.
8.Clean the external rectal area gently with soap and water following stool evacuation.
9.Try a topical cream or sitz baths to reduce inflammation.
10.See your doctor if you don't improve.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
2.Symptoms of internal hemorrhoids include:
Bright red rectal bleeding
Staining of undergarments with mucus
3.Symptoms of external hemorrhoids include:
Pain and itching when irritated by constipation or diarrhea
Difficulty with hygiene
4.Hemorrhoids are caused by:
Straining
Work strain (lifting, etc.)
Straining while defecating
Chronic constipation
Passing hard, dry, small stools
Laxative abuse
5.Do not assume rectal bleeding is from hemorrhoids. See your doctor to rule out cancer or other disease.
6.To prevent or manage hemorrhoids, increase your fiber and fluid intake. Consider adding a fiber supplement.
7.Avoid straining at stool or sitting on the toilet for a long time.
8.Clean the external rectal area gently with soap and water following stool evacuation.
9.Try a topical cream or sitz baths to reduce inflammation.
10.See your doctor if you don't improve.
Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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