Article (Scientific journals)
Understanding and overcoming metformin gastrointestinal intolerance.
Bonnet, Fabrice; Scheen, André
2017In Diabetes, Obesity and Metabolism, 19 (473-481)
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Keywords :
Metformin; gastrointestinal intolerance; microbiota; type 2 diabetes mellitus
Abstract :
[en] Metformin is the most widely prescribed drug for patients with type 2 diabetes mellitus and the first-line pharmacologic option as supported by multiple international guidelines, yet a rather large proportion of patients cannot tolerate metformin in adequate amounts because of its associated gastrointestinal (GI) adverse events (AEs). GI AEs typically encountered with metformin therapy include diarrhoea, nausea, flatulence, indigestion, vomiting, and abdominal discomfort, with diarrhoea and nausea being the most common. Although starting at a low dose and titrating slowly may help prevent some of metformin's GI AEs, some patients are unable to tolerate metformin at all and it may also be difficult to convince patients to start metformin again after a bout of GI AEs. Despite this clinical importance the underlying mechanisms of metformin's GI intolerance are poorly known. This review discusses the epidemiology of metformin GI intolerance; its underlying mechanisms; genotype variability and associated factors affecting metformin GI intolerance, such as comorbidities, co-medications, and bariatric surgery; clinical consequences, and therapeutic strategies to overcome metformin GI intolerance. These strategies include appropriate titration of immediate-release metformin, use of extended-release metformin, the promise of delayed-release metformin and gut microbiome modulators, and alternative pharmacological therapies when metformin cannot be tolerated at all. Given the available data, all efforts should be made to maintain metformin before considering a shift to another drug therapy.
Disciplines :
Pharmacy, pharmacology & toxicology
Endocrinology, metabolism & nutrition
Author, co-author :
Bonnet, Fabrice
Scheen, André  ;  Université de Liège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
Understanding and overcoming metformin gastrointestinal intolerance.
Publication date :
2017
Journal title :
Diabetes, Obesity and Metabolism
ISSN :
1462-8902
eISSN :
1463-1326
Publisher :
Blackwell, Oxford, United Kingdom
Volume :
19
Issue :
473-481
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
This article is protected by copyright. All rights reserved.
Available on ORBi :
since 24 March 2017

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