Biguanides Drug Information PDF

Drug Information Table Biguanides – metformin (Glucophage) THERAPEUTIC USE Type 2 diabetes mellitus ADVERSE DRUG REACTIONS Lactic acidosis (rare, but potentially fatal) Nausea, diarrhea, vomiting Unpleasant metallic taste Vitamin deficiencies (vitamin B12, folic acid) INTERVENTIONS Monitor for indic...

Drug Information Table Biguanides – metformin (Glucophage) THERAPEUTIC USE Type 2 diabetes mellitus ADVERSE DRUG REACTIONS Lactic acidosis (rare, but potentially fatal) Nausea, diarrhea, vomiting Unpleasant metallic taste Vitamin deficiencies (vitamin B12, folic acid) INTERVENTIONS Monitor for indications of lactic acidosis. For signs of lactic acidosis, stop drug therapy immediately. Expect that severe lactic acidosis will require hemodialysis. Monitor for persistent nausea, vomiting, or diarrhea. Monitor fluid intake and output. Monitor for indications of vitamin B12 or folic acid deficiency. Recommend the appropriate supplements. Monitor renal function upon initial therapy and yearly afterward ADMINISTRATION Give orally twice a day with the morning and evening meals (immediate-release) or once a day with the evening meal (extended-release). Make sure clients swallow the extended-release form whole and do not crush or chew it. CLIENT INSTRUCTIONS Avoid drinking alcohol. Report weakness, fatigue, lethargy, or hyperventilation. If these symptoms develop, stop taking the drug and seek medical care immediately. Expect these effects to diminish as drug therapy continues. Lie down when feeling nauseated. Maintain adequate carbohydrate and fluid intake. Report weakness, fatigue, pallor, or reddened tongue. CONTRAINDICATIONS Diabetic ketoacidosis Cardiopulmonary, hepatic, or renal insufficiency Alcoholism Heart failure Severe infection Shock Acute myocardial infarction Hypoxemia Lactic acidosis PRECAUTIONS Diarrhea Dehydration Anemia Pituitary insufficiency Gastroparesis Gastrointestinal obstruction Hyperthyroidism Older adults INTERACTIONS Alcohol and cimetidine (Tagamet) increase the risk of lactic acidosis. Any contrast medium containing iodine increases the risk of acute renal failure, thus worsening lactic acidosis. Nifedipine (Procardia), furosemide (Lasix), morphine, antifungals, and many other drugs increase hypoglycemic effects.