[CARPA] Fwd: Re: swapping to Metformin XR

Jane Burns burnsj at westnet.com.au
Thu Apr 19 11:31:06 EST 2007 

Hi Fran
I am famliar with using medazalam IV but have just found out that RAN
have been using other routs for some time can I have some info on
this and can you give me a website so that I can keep up with what is
being used
regards Jane Burns

---- Original Message ----
From: Fran.Vaughan at cdu.edu.au
To: carpa at ozdocit.org
Subject: Re: [CARPA] Fwd: Re: swapping to Metformin XR
Date: Thu, 19 Apr 2007 10:57:53 +0930

>The pharmacokinetics of metformin is tricky. Metformin is absorbed in
>the upper GI tract and is water soluble making it hard to release the
>drug slowly in a XR form and to keep it in the right place long
>enough
>to release and be absorbed. 
>
>Thus it was necessary to formulate it into a polymer that forms a
>gelatinous mass in the stomach. The size of this mass, a concurrent
>meal
>and the natural diurnal slowing of the GI tract at night together
>provide the best conditions for absorption because of delayed passing
>
>through the gut. There is also a saturation effect with doses greater
>than 2g not having a proportional increase in absorption. One also
>wonders about the impact of 6 "gelatenous masses" in the gut at the
>same
>time?
>
>All the trials on the XR formulation were done with dosing with the
>evening meal and I have wondered by how much this is reduced in
>reality
>if given with a morning meal. And whether a reduction in absorption
>is
>more than offset by an increase in compliance. In other words, is
>morning metformin XR 2g better than morning regular metformin 1g (the
>evening dose being forgotten?). 
>
>I'd be interested to hear if there are actual clinical benefits like
>lower HbA1cs in your patients? 
>
>The other issue is one of side effects. Having a smaller amount of
>drug
>released into solution in the gut at any one time might logically be
>associated with less GI side effects. The trials showed no difference
>between XR and regular metformin but the numbers were low. Has anyone
>noticed an impact on GI side effects? 
>
>Fran Vaughan
>Pharmacist
>
>>>> <MichaelW.Nixon at nt.gov.au> 19/04/2007 9:24 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
>
>
>
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>***********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
>
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