New advice on monitoring at-risk patients with reduced vitamin B12 from metformin
The UK government has published a new drug safety update on the use of metformin and its effects on a patient's vitamin B12 levels.
The drug metformin is authorised for the treatment of type 2 diabetes mellitus and for use in patients who are at high risk of developing the disease. There are immediate-release and modified-release pills of metformin as well as an oral solution.
A common adverse effect of metformin therapy is now recognised to be decreased vitamin B12 levels, or vitamin B12 deficiency. This is especially true for patients receiving greater doses, being treated for longer periods of time or those whon hae preexisting risk factors. Therefore, patients using metformin who exhibit signs of vitamin B12 deficiency have been advised to have their serum levels of vitamin B12 checked. Additionally, it is suggested practioners consider routine monitoring for patients who have vitamin B12 insufficiency risk factors.
Recently, the MHRA and brand leader Glucophage (metformin) in Europe examined the known adverse medication reaction of vitamin B12 insufficiency. The MHRA determined that the product information for medications containing metformin needs to be revised following this study.
The most recent research indicates that this adverse medication reaction happens more commonly than previously thought. It has been added to the Glucophage product information for doctors and patients that vitamin B12 deficiency is a frequent adverse medication reaction and may affect up to 1 in 10 people who use it.
The product information has also been revised to address the fact that patients with risk factors known to result in vitamin B12 deficiency as well as those receiving higher doses of metformin and longer treatment are at an increased risk of experiencing this adverse response.
The revised product information now advises medical providers to check vitamin B12 levels in people who present with anaemia or neuropathy and that patients with risk factors for vitamin B12 insufficiency should consider routine vitamin B12 monitoring.
The product details for additional medications containing metformin, such as fixed-dose combination drugs including metformin, will also be updated.
NICE recommends new treatment for patients with short bowel syndrome
The National Institute for Health and Care Excellence (NICE) has recommended a new potentially life-changing treatment for patients with short bowel syndrome over 1 year old, published on 1 June 2022.
After having surgery to remove an abnormal bowel, patients who are in a stable condition can use teduglutide (also marketed under the name Revestive and manufactured by Takeda).
This surgery may be required in adults for a variety of conditions, including Crohn's disease. It is frequently caused by surgery for necrotising enterocolitis or other conditions in premature babies and children. Some children are born with short bowel syndrome.
Short bowel syndrome is a life-threatening chronic condition in which the body fails to absorb enough nutrients from food. People develop the condition when they do not have enough small intestine, which is the part of the body where the majority of nutrients are absorbed during digestion.
Short bowel syndrome is currently treated by administering nutrients and fluids intravenously via a drip, also known as parenteral support, in addition to providing the best supportive care. Treatments that control bowel movements, fluid restriction and dietary changes are examples of the best supportive care.
Teduglutide improves nutrient and fluid absorption from the remaining intestine. According to the company, approximately 70 people in the UK are eligible for the treatment.
Clinical trial evidence suggests that teduglutide, when compared to placebo, reduces the number of days per week that people with short bowel syndrome require parenteral support.