[CARPA] Fwd: Re: swapping to Metformin XR

Thu Apr 19 10:13:10 EST 2007

The advantage of the normal metformin or gliclazide with BD or TDS
dosing is that missing one dose out of the day but taking the other
one/two means that at least some of the drug gets on board! Case by case
assesment rather than blanket policy??

Erik van den Berg
Outreach Pharmacist
Cairns Base Hospital

PH 4050-6287
FAX 4050-6585

>>> MichaelW.Nixon at nt.gov.au 04/19/07 9:54 am >>>

I am finding such a lot of non-compliance amongst the Aboriginal
diabetic population and I'm slowly changing all my patients over to SR
metformin (up to 2gms) in the hope that there may be more compliance by
a once daily dose in the morning - to be had with their weetbix or
porridge! - So far seems to be working. Just watch the Kidneys! - Mike.

Dr Michael W Nixon
DMO Reg.  Rm 126,  Block 4, RDH
(Chair MSHR, Ethics Research Committee)
Box 40596
CASUARINA NT 0811
Ph 892 28358 Mob 0427 618 915

"Alex Hope" <wombat at octa4.net.au> 
Sent by: carpa-bounces at ozdocit.org 
18/04/2007 09:36 PM Please respond to
Central Australian Rural Practitioners Association       
<carpa at ozdocit.org>

To
carpa at ozdocit.org cc
Subject
[CARPA] Fwd: Re: swapping to Metformin XR

Would be good to have input from a few more people on this topic.
I haven't tried it with any of my patients yet.
Alex
(scroll down for email exchange)
Dr Alex Hope

Community GP,
Ltyentye Apurte Community Government Council Health Centre,
CMB Santa Teresa,
via Alice Springs,
NT 0872.

Ph  08 8956 0911
Fax 08 8956 0910
Mobile 0408 085 143

PLUG FOR THE CARPA LIST SERVER

The CARPA list server aims to foster networking and discussion between
health professionals working throughout Australia, particularly in
isolated situations and/or Aboriginal health.
To see the collection of prior postings to the list, visit the CARPA
Archives here:

http://ozdocit.org/pipermail/carpa/ 

To sign up for the CARPA discussion emails go here:

http://ozdocit.org/cgi-bin/mailman/listinfo/carpa 

For more information about CARPA in general go here:

www.carpa.org.au 

***********Here Followeth a  Forwarded Message***********

On 18/04/2007 at 8:18 PM Ciara.OSullivan at nt.gov.au
<Ciara.OSullivan at nt.gov.au> wrote:

>Hi there
> 
>The recommended maximum dose of metformin XR is 2 g daily, which is
pretty
>much in line with the total dose of standard metformin we are mostly
using
>now.
> 
>Ideally metformin XR is taken nocte ... but this is not very practical
and
>I think we just have to compromise over this detail.
> 
>Cheers - Ciara
>
>-----Christine Connors/THS/NTG wrote: -----
>
>To: Ciara O'Sullivan/THS/NTG at NTGeMAG
>From: Christine Connors/THS/NTG
>Date: 04/16/2007 10:01AM
>cc: Alan Evans/THS/NTG at NTGeMAG, Heinz Deiter/THS/NTG at NTGeMAG, John
>Hester/THS/NTG at NTGeMAG, Louise Elliott/THS/NTG at NTGeMAG, Nick
>Tyllis/THS/NTG at NTGeMAG, russell.thompson at wynhealth.org.au, Stephen
>Brady/THS/NTG at NTGeMAG, Stephen Foster/THS/NTG at NTGeMAG,
wombat at octa4.net.au 
>Subject: Re: swapping to Metformin XR
>
>so what is other people's experience
>will patients take the 4 tabs to make 2gm daily or do they prefer the
>usual 1gm bd?
>
>Ciara: apart from the obvious issue of big tablets, is there any
issues
>taking metformin XR as 3gm single daily dose?
>
>
>Dr. Christine Connors
>Program Director PCD
>NT Department of Health & Community Services
>Phone: (08) 8922 8218
>Fax: (08) 8922 7714
>Mobile: 0401 116 121
>email: christine.connors at nt.gov.au 
>
>
>
>
>
>
>
> Ciara O'Sullivan/THS/NTG
>
>
>Ciara O'Sullivan/THS/NTG 
>
>14/04/2007 07:31 PM
>To
>
>Alan Evans/THS/NTG at NTGeMAG, Stephen Foster/THS/NTG at NTGeMAG, John
>Hester/THS/NTG at NTGeMAG, Louise Elliott/THS/NTG at NTGeMAG, Nick
>Tyllis/THS/NTG at NTGeMAG, Heinz Deiter/THS/NTG at NTGeMAG,
>russell.thompson at wynhealth.org.au 
>
>cc
>
>Christine Connors/THS/NTG at NTGeMAG, wombat at octa4.net.au, Stephen
>Brady/THS/NTG at NTGeMAG
>
>Subject
>
>Re: swapping to Metformin XR
>
>
>
>Hi team
> 
>Metformin XR is now available in most remote clinics.
> 
>I would like to emphasise that metformin XR and standard metformin 500
mg
>tablets are equivalent and when swapping from a usual treatment dose
of
>standard metformin of 1 g bd, you need to prescribe metformin XR 4
tablets
>daily. No down-titration is needed with subsequent up-titration.
> 
>YES!!! The metformin XR tablets are pretty big and are actually the
same
>size (but bulkier) than metformin 1 g tablets. You need to show the
>patients what they are getting as some patients are horrified and
refuse
>to swap. 
> 
>I think using metformin XR in usual treatment doses of 2 g per day is
very
>useful for patients on few other tablets. However use of metformin XR
>poses some real problems for us as clinicians; on the one hand we want
to
>provide convenient once daily medications (improves compliance) but on
the
>other hand, prescribing 4 whoppers in addition to a handful of other
>morning medications is very off putting for many patients (reduces
>compliance).
> 
>This is the doctors' s dilemma. However, the solution is not to
prescribe
>half the previous standard dose of meformin (ie swapping from
metfrormin 1
>g bd to metformin XR 1 g od) which potentially deprives the patient
of
>useful treatment, and this is what I am seeing on a lot of the scripts
at
>the moment!
> 
>Cheers - CIara

*********** END FORWARDED MESSAGE  ***********
_______________________________________________
CARPA mailing list
CARPA at ozdocit.org 
http://ozdocit.org/cgi-bin/mailman/listinfo/carpa 

*****************************************************************
This email, including any attachments sent with it, is
confidential and for the sole use of the intended recipient(s).
This confidentiality is not waived or lost, if you receive it and
you are not the intended recipient(s), or if it is transmitted/
received in error.

Any unauthorised use, alteration, disclosure, distribution or
review of this email is strictly prohibited.  The information
contained in this email, including any attachment sent with
it, may be subject to a statutory duty of confidentiality if it
relates to health service matters.

If you are not the intended recipient(s), or if you have
received this email in error, you are asked to immediately
notify the sender by telephone collect on Australia
+61 1800 198 175 or by return email.  You should also
delete this email, and any copies, from your computer
system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy,
distribute or take any action(s) that relies on it; any form of
disclosure, modification, distribution and/or publication of this
email is also prohibited.

Although Queensland Health takes all reasonable steps to
ensure this email does not contain malicious software,
Queensland Health does not accept responsibility for the
consequences if any person's computer inadvertently suffers
any disruption to services, loss of information, harm or is
infected with a virus, other malicious computer programme or
code that may occur as a consequence of receiving this
email.

Unless stated otherwise, this email represents only the views
of the sender and not the views of the Queensland Government.
****************************************************************

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://ozdocit.org/pipermail/carpa/attachments/20070419/55fcef41/attachment.html