Contraindicated combinations
Iodine-containing radiopaque agents: on the background of functional renal failure in patients with diabetes mellitus, a radiological study using iodine-containing radiocontrast agents can cause the development of lactic acidosis. Treatment with metformin should be canceled depending on the function of the kidneys 48 hours before or during the X-ray examination using iodine-containing radiopaque means and not to resume earlier 48 hours after, provided that during the examination the renal function was found to be normal.
Unrecommended combinations
Alcohol: acute alcohol intoxication increases the risk of developing lactic acidosis, especially in the case of:
- malnutrition, low-calorie diet;
- liver failure.
During taking the drug should avoid drinking alcohol and drugs containing ethanol.
Combinations that require caution
Danazol: It is not recommended to take danazol concurrently to avoid hyperglycemic action of the latter. If it is necessary to treat danazol and after stopping the reception of the latter, correction of the dose of metformin is required under the control of the concentration of glucose in the blood.
Chlorpromazine: when taken in high doses (100 mg per day) increases the concentration of glucose in the blood, reducing the release of insulin. When treating with neuroleptics and after stopping the intake of the latter, correction of the dose of the drug under the control of the concentration of glucose in the blood is required.
Glucocorticosteroids (GCS) systemic and local effects reduce glucose tolerance, increase the concentration of glucose in the blood, sometimes causing ketosis. In the treatment of GCS, and after discontinuation of the latter, correction of the dose of metformin is required under the control of the concentration of glucose in the blood.
Diuretics: simultaneous administration of "loop" diuretics can lead to the development of lactic acidosis due to possible functional renal failure. Do not assign metformin, if the SC is below 60 ml / min.
Assigned in the form of injections beta2-adrenomimetics: increase the concentration of glucose in the blood due to stimulation of beta2adrenoreceptors. In this case, it is necessary to monitor the concentration of glucose in the blood. If necessary, the appointment of insulin is recommended.
With the simultaneous use of the above medicines, more frequent monitoring of blood glucose concentration may be required, especially at the beginning of treatment. If necessary, the dose of metformin can be adjusted during treatment and after its termination.
Angiotensin converting enzyme inhibitors and other antihypertensive drugs can reduce the concentration of glucose in the blood. If necessary, the dose of metformin should be adjusted.
With the simultaneous use of metformin with derivatives of sulfonylurea, insulin, acarbose, salicylates possibly the development of hypoglycemia.
Nifedipine increases absorption and CmOh metformin.
Cationic drugs (amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim and vancomycin), secreted in the renal tubules, compete with metformin over the tubular transport systems and can lead to an increase in its CmOh.