Proton Pump Inhibitors - CME Conferences
Proton Pump Inhibitors - CME Conferences Proton Pump Inhibitors - CME Conferences
6 th Annual Primary Care Spring Conference Thursday, April 12, 2012 Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus The Cochrane Library 2010, Issue 4 • Main results: – Pooled data from 347 comparative trials and cohort studies revealed no cases of fatal or nonfatal lactic acidosis in 70,490 patient years of metformin use or in 55,451 patients-years in the non-metformin group. Using Poisson statistics the upper limit for the true incidence of lactic acidosis per 100,000 patient-years was 4.3 cases in the metformin group and 5.4 cases in the non-metformin group. – There was no difference in lactate levels, either as mean treatment levels or as a net change from baseline, for metformin compared to non-metformin therapies. • Authors’ conclusions: – “There is no evidence from prospective comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis, or with increased levels of lactate, compared to other anti-hyperglycemic treatments.” Proposed Recommendations for Use of Metformin Based on e-GFR Diabetes Care 2011;34:1435 eGFR (ml/min per 1.73m2) Action >60 No renal contraindication to metformin >45 Continue use Increase monitoring of renal function (every 3–6 months) 30 Prescribe metformin with caution Use lower dose (e.g., 50%, or half-maximal dose) Closely monitor renal function (every 3-6 months) Do not start new patients on metformin
6 th Annual Primary Care Spring Conference Thursday, April 12, 2012 Metformin • Metformin HCl Immediate release tabs • 500 mg $12.99/60 Glucophage $69.99/60 • 850 mg $61.99/60 Glucophage $113.29/60 • 1000 mg $31.97/60 Glucophage $141.08/60 • Metformin Extended release tabs • 500 mg $18.00/60 Glucophage XR $69.99/60 Glumetza $233.40/60 • 750 mg $65.98/60 Glucophage XR $107.98/60 • 1000 mg $169.62/60 Glumetza $515.98/60 • Drugstore.com 4-2012 Sulfonylureas • Glipizide Immediate release • 5 mg $13.45/60 Glucotrol $43.99/30 • 10 mg $13,00/60 Glucotrol $81.89/60 • Glipizide XL (Extended release) • 10 mg $23.99/30 Glucotrol XL $48.99/30 • Glimepiride • 2 mg $13.99/30 Amaryl $39.99/30 • 4 mg $14.99/30 Amaryl $63.99/30 • Glyburide AVOID! • 5mg $18.99/30 Micronase $41.99/30 Diabeta $45.75/30 Drugstore.com 4-2012 Wayne Weart, Pharm D Cost Effective Rx
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6 th Annual Primary Care Spring Conference Thursday, April 12, 2012<br />
Metformin<br />
• Metformin HCl Immediate release tabs<br />
• 500 mg $12.99/60 Glucophage $69.99/60<br />
• 850 mg $61.99/60 Glucophage $113.29/60<br />
• 1000 mg $31.97/60 Glucophage $141.08/60<br />
• Metformin Extended release tabs<br />
• 500 mg $18.00/60 Glucophage XR $69.99/60<br />
Glumetza $233.40/60<br />
• 750 mg $65.98/60 Glucophage XR $107.98/60<br />
• 1000 mg $169.62/60 Glumetza $515.98/60<br />
• Drugstore.com 4-2012<br />
Sulfonylureas<br />
• Glipizide Immediate release<br />
• 5 mg $13.45/60 Glucotrol $43.99/30<br />
• 10 mg $13,00/60 Glucotrol $81.89/60<br />
• Glipizide XL (Extended release)<br />
• 10 mg $23.99/30 Glucotrol XL $48.99/30<br />
• Glimepiride<br />
• 2 mg $13.99/30 Amaryl $39.99/30<br />
• 4 mg $14.99/30 Amaryl $63.99/30<br />
• Glyburide AVOID!<br />
• 5mg $18.99/30 Micronase $41.99/30<br />
Diabeta $45.75/30<br />
Drugstore.com 4-2012<br />
Wayne Weart, Pharm D<br />
Cost Effective Rx