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Proton pump inhibitors do not impair the effectiveness of metformin in patients with diabetes
Author(s) -
Flory James,
Haynes Kevin,
Leonard Charles E.,
Hennessy Sean
Publication year - 2015
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12506
Subject(s) - metformin , medicine , drug , diabetes mellitus , pharmacology , pharmacodynamics , drug interaction , observational study , organic cation transport proteins , confidence interval , type 2 diabetes , pharmacokinetics , endocrinology , transporter , chemistry , biochemistry , gene
Aims 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 in vitro 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. Methods 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. Results 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. Conclusions Despite a mechanistic basis for a potential drug–drug interaction, we found no evidence of a deleterious interaction between PPIs and metformin.