June 17, 2020
Metformin, a medication that many patients with Type-ll diabetes are very familiar with, can be both a blessing and a curse. While on one hand Metformin is an extremely effective first-line drug used to treat Type-ll diabetes, many patients taking it report a variety of unpleasant side effects: nausea, diarrhea, bloating, gastrointestinal distress, and increased liver enzymes are just a few of the potential side effects that occur in up to 50% of patients taking the drug. Due to these side effects, many patients are either not as optimally complaint with therapy as they could be, or simply stop taking the medication altogether.
Fortunately, thanks to the help of compounding, an alternative is available that can help patients continue to receive the benefits Metformin can offer them! Transdermal Metformin Therapy (TMT) is a novel delivery method that provides the benefits of oral Metformin therapy, while reducing or eliminating the side effects associated with oral administration. This is also good news for patients diagnosed with PCOS, or polycystic ovarian syndrome, whom rely on Metformin to regulate their androgen and insulin levels.
Because delivering Metformin transdermally is a relatively new idea, many providers are simply unfamiliar with it. While TMT is a novel therapy, there is certainly evidence behind its use transdermally, as well as clinical data supporting its effectiveness. Several case studies were cited in which transdermal Metformin was successfully compounded and utilized by patients who were previously unable to tolerate Metformin taken by mouth. One patient, for example, initially presented with her blood glucose levels averaging between 250-350 mg/dL before treatment. At a follow up two months later, her fasting glucose levels had dropped to below 150mg/dL, and her A1C levels decreased by 0.6%. A second patient, who typically had average blood glucose levels between 400-500 mg/dL without treatment had reduced her average blood glucose readings throughout the day to 250 mg/dL after 4 weeks of topical treatment. Both of these patients were reportedly using a dose of 50mg of Metformin applied topically twice daily to the inner wrist.
When prescribing transdermal Metformin, one advantage and key point is that a patient's dose is generally only 10% of their oral dose. For example, instead of taking 500mg of Metformin twice daily, a patient would apply 50mg topically to the inner wrists twice daily (10% of the oral dose). The dose can then be titrated to effect, so blood glucose levels should be monitored while on therapy in order to ensure optimal dosing.
Clinícal Guidelines Task Force, International Diabetes Federation (2005). "Glucose control: oral therapy". In: Global Guideline for Type 2 Diabetes. Brussels: International Diabetes Federation, 35-8. Retrieved on Mar. 04, 2014
June 03, 2020
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