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    Just over one year ago here at Diabetes Flashpoints, we discussed the possibility that hundreds of thousands of people with both diabetes and kidney disease might benefit from taking the diabetes drug metformin. As we noted then, this drug has carried a “black box” warning on its label — mandated by the U. Food and Drug Administration (FDA) — ever since it became available in the United States in 1994, due to concerns about lactic acidosis. Lactic acidosis is much more common in people with impaired kidney function. This rare but extremely serious reaction was found to be an unacceptably common side effect of a drug related to metformin — phenformin — which was pulled from the U. Since metformin’s warning label is based, in part, on concerns about a different drug entirely, many researchers have tried to estimate how safe metformin is for people with diabetes whose kidney function is impaired. Last year, we noted that many researchers believe metformin is safe for people with mild to moderate kidney disease, defined as having an estimated glomerular filtration rate (e GFR) of 30–60 ml/min. And one study found that using a safety cutoff of an e GFR of 30 ml/min, nearly one million people in the United States who currently don’t take metformin because of the FDA’s labeling might be able to safely do so. The evidence, it seems, has only grown stronger in favor of metformin being more widely prescribed to people with kidney disease. As noted in a recent article at Diabetes In Control.com, the blood-glucose-lowering benefits of loosening restrictions on metformin could be enormous. One study cited in the article, published last August in the journal Diabetes Care, found that depending on how e GFR is calculated, as many as 834,000 people could be newly eligible for metformin if the eligibility threshold were set at an e GFR of 45 ml/min or higher. Metformin in People With Kidney Disease - Diabetes Self. Diabetic CKD Patients Survive Longer With Metformin - Renal and. Metformin Treatment in Patients With Type 2 Diabetes and Chronic.
     
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    First 4 weeks: 60 mg/m²/day or 2 mg/kg/day PO divided q8hr until urine is protein free for 3 consecutive days; not to exceed 28 days; dose not to exceed 80 mg/day Subsequent 4 weeks: 40 mg/m² or 1-1.5 mg/kg PO every other day; not to exceed 80 mg/day Maintenance in frequent relapses: 0.5-1 mg/kg/dose PO every other day for 3-6 months Treatment may have to be individualized Acne Adrenal suppression Delayed wound healing Diabetes mellitus GI perforation Glucose intolerance Hepatomegaly Hypokalemic alkalosis Increased transaminases Insomnia Menstrual irregularity Myopathy Neuritis Osteoporosis Peptic ulcer Perianal pruritus Pituitary adrenal axis suppression Pseudotumor cerebri (on withdrawal) Psychosis Seizure Ulcerative esophagitis Urticaria Vertigo Weight gain Documented hypersensitivity Systemic fungal infection, varicella, superficial herpes simplex keratitis Receipt of live or attenuated live vaccine; Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term ( Use with caution in cirrhosis, diabetes, ocular herpes simplex, hypertension, diverticulitis, following myocardial infarction, thyroid disease, seizure disorders, hypothyroidism, myasthenia gravis, hepatic impairment, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy Thromboembolic disorders or myopathy may occur Delayed wound healing is possible Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored) Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy Parenteral forms (prednisolone sodium phosphate) have been discontinued Suppression of hypothalamic-pituitary-adrenal axis may occur particularly in patients receiving high doses for prolonged periods or in young children; discontinuation of therapy should be done through slow taper Posterior subcapular cataract formation associated with prolonged use of corticosteroids Prolonged use of corticosteroids may increase risk of secondary infections Increase in intraocular pressure associated with prolonged use of corticosteroids Long-term use associated with fluid retention and hypertension Development of Kaposi's sarcoma associated with prolonged corticosteroid use Acute myopathy associated with high dose of corticosteroids Corticosteroid use may cause psychiatric disturbances If product is used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients; steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be checked frequently Steroids after cataract surgery may delay healing and increase incidence of bleb formation Use of ocular steroids may prolong course and may exacerbate severity of many viral infections of the eye (including herpes simplex) Prednisolone shown to be teratogenic in mice when given in doses 1-10 times human dose; dexamethasone, hydrocortisone, and prednisolone were ocularly applied to both eyes of pregnant mice five times per day on days 10 through 13 of gestation; a significant increase in the incidence of cleft palate observed in fetuses of treated mice; there are no adequate well-controlled studies in pregnant women; prednisolone should be used during pregnancy only if potential benefit justifies potential risk to fetus Not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk; systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects Because of potential for serious adverse reactions in nursing infants from prednisolone, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Leeds Formulary Formulary Wysolone 5 Prednisolone 5mg 15 Tablets/Strip. Prednisolone Prednisolone Tablets Side Effects.
     
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