Proton pump inhibitors do not impair the effectiveness of metformin in patients with diabetes. (February 2015)

• Record Type: Journal Article
• Authors: Flory, James; Haynes, Kevin; Leonard, Charles E.; Hennessy, Sean
• Is Part Of: British journal of clinical pharmacology. Volume 79:Number 2(2015:Feb.)
• Page Start: 330
• Page End: 336
• Publication Date: 2015-02
• Subjects: Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.12506
• Languages: English
• ISSNs: 0306-5251

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bcp12506-sec-0001" sec-type="section"> <title>Aims</title> <p>In order to exert its pharmacodynamic effect, the diabetes drug metformin needs to be taken up into hepatocytes by the organic cation transporter (OCT) system. A recent <italic>in vitro</italic> study found that proton pump inhibitors (PPIs) inhibit OCT1, OCT2 and OCT3, suggesting that PPIs might reduce metformin's effectiveness. This pharmacoepidemiologic study looked for evidence of a clinical effect of such an interaction.</p> </sec> <sec id="bcp12506-sec-0002" sec-type="section"> <title>Methods</title> <p>This was an observational cohort study examining changes in glycosylated haemoglobin (HbA1c) with exposure to metformin and to PPIs as single agents and in combination. The aim was to assess evidence of a deleterious drug−drug interaction.</p> </sec> <sec id="bcp12506-sec-0003" sec-type="section"> <title>Results</title> <p>PPIs did not reduce the effectiveness of metformin, and indeed were associated with a minimally better glycaemic response by − 0.06 HbA1c percentage points (95% confidence interval, −0.10, −0.01) in metformin initiators.</p> </sec> <sec id="bcp12506-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Despite a mechanistic basis for a potential drug–drug interaction, we found no evidence of a deleterious interaction between PPIs and metformin.</p> </sec> </abstract>