6 NEWS
6 NEWS
12 JULY 2024 ausdoc . com . au
‘ Metformin safe in first trimester ’
Rachel Fieldhouse PREGNANT women with type 2 |
care specific interest group , said the study was “ timely and welcome ” |
The US study , published in the Annals of Internal Medicine , used |
After adjusting for age , obesity status and other comorbidities , there |
However , the authors said their findings were limited by a lack of |
diabetes can safely use metformin |
given the limited range of medicines |
real-world data to emulate two |
was no significant between-group |
data for potential confounders , such |
in the first trimester , according to |
that can be used in |
clinical trials to |
difference in the risk of stillbirth , |
as glycaemic control . |
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US epidemiologists who report no increased risk for congenital malformations or non-live births .
The Harvard University-led team say the findings suggest that current recommendations to switch from metformin to insulin during preg-
|
pregnancy .
“ This research adds weight to the safety profile of metformin previously established in the second trimester and
|
This research adds weight to the safety profile . |
investigate the teratogenicity of metformin use in the first trimester .
The first compared outcomes for 1200 pregnant
|
termination or pregnancy loss , the authors said .
The risk of major congenital malformations was also comparable between treatments .
Their second emulated trial , which included 8500 women with
|
Dr Cheung said the new evidence backing the use of metformin — which is listed as a category C medicine in Australia — was important .
“ Pregnant women are generally excluded from clinical trials , which makes generalising effectiveness of
|
nancy based on teratogenicity con- |
may improve confi- |
|
women prescribed |
pregestational type 2 diabetes who |
medication in pregnancy problem- |
cerns “ may require reconsideration ”. |
dence in both clinicians and women |
insulin in addition to metformin , |
received metformin , insulin or no |
atic ,” the Gold Coast GP said . |
Dr Ka-Kiu Cheung , chair of the RACGP ’ s antenatal and postnatal |
who use metformin in pregnancy ,” she told Australian Doctor . |
and 600 women who discontinued metformin for insulin monotherapy . |
treatment before pregnancy , also showed comparable risks . |
Ann Intern Med 2024 ; 18 Jun . |
I love him beyond all reason , and care for him above all else .
BECAUSE THEY ’ RE TOO IMPORTANT
MDO cannabis hit
FROM PAGE 1 cannabis prescribing has increased dramatically since it became a therapeutic option for doctors through the TGA special access schemes in 2016 .
There are currently 2800 doctors who can prescribe medicinal cannabis under its authorised prescriber pathway .
Another 5722 doctors have applied to prescribe the drug via Special Access Scheme-B since 2018 .
Decisions were based on ‘ a range of factors ’.
PBS Information : Authority required . Refer to PBS schedule for full authority information .
BEFORE PRESCRIBING ; PLEASE REVIEW APPROVED PRODUCT INFORMATION AVAILABLE ON REQUEST FROM 1800 274 276
MINIMUM PRODUCT INFORMATION EpiPen ® Adrenaline Auto-Injector 0.3mg / 0.3mL EpiPen ® Jr . Adrenaline Auto-Injector 0.15mg / 0.3mL . The following are not a complete listing : Indications : For the emergency treatment of anaphylaxis ( acute severe allergic reaction ) due to insect stings or bites , foods , drugs or other allergens . Contraindications : Contraindications are relative , as this product is intended for use in life-threatening emergencies . Certain arrhythmias , cerebral arteriosclerosis , vasopressor drug contraindication , shock ( except anaphylactic shock ), certain types of general anaesthesia . Precautions : Sulfite allergy , intravenous administration , ventricular fibrillation , prefibrillatory rhythm , tachycardia , myocardial infarction , cardiovascular disease , organic heart disease , cardiac dilation , cerebral arteriosclerosis , prostatic hypertrophy , elderly , individuals with diabetes , hypertension , narrow angle glaucoma , hyperthyroidism , organic brain damage , psychoneurosis , phenothiazine-induced circulatory collapse , Parkinsonism . Avoid injection into hands , feet , ears , nose , buttocks , genitalia . Use in Pregnancy : Pregnancy Category A . Excreted in breast milk . Use with caution when maternal blood pressure is in excess of 130 / 80 . Interactions : CNS medicines , alpha and beta adrenergic blockers , some general anaesthetics , hypoglycaemic agents . Adverse Effects : Anxiety , restlessness , tachycardia , respiratory difficulty , tremor , weakness , dizziness , headache , dyspnoea , cold extremities , pallor , sweating , nausea , vomiting , sleeplessness , hallucinations , flushing of face and skin . Psychomotor agitation , disorientation , impaired memory , potentially fatal ventricular arrhythmias , severe hypertension which may lead to cerebral haemorrhage and pulmonary oedema . Angina may occur in patients with CAD . Dosage : Single intramuscular injection into anterolateral aspect of thigh , repeat as directed if symptoms recur or have not subsided . Adults ≥30kg : EpiPen ® Auto-Injector ( 0.3mg adrenaline ) Children 15 – 30kg : EpiPen ® Jr . Auto-Injector ( 0.15mg adrenaline ). The prescribing physician may choose to prescribe more or less than this amount ; please refer to relevant guidelines .
EPIPEN ® and EPIPEN ® JR are Viatris Company trademarks . Copyright © 2022 Viatris Inc . All rights reserved . Alphapharm Pty Ltd , trading as Viatris . Level 1 , 30-34 Hickson Road , Millers Point NSW 2000 . ABN 93 002 359 739 . Tel 1800 274 276 . Date of preparation : Sept 2022 . EPI-2022-0310 . MYL0695 .
Regulators , including the Medical Board of Australia , have expressed concern over the rise of single-treatment clinics where prescribing is largely restricted to medicinal cannabis .
However , despite the volume of scripts now being written , according to the TGA website there were just 126 adverse event reports between March 2023 and March 2024 , ranging from psychotic disorders , suicidal ideation and paranoia , to nausea , vertigo and eye swelling .
AHPRA has also released figures on notifications against prescribing doctors which show there have been 309 complaints against just over 200 practitioners to date .
It said many patient complaints related to the cost of scripts or being prescribed lower doses than requested .
But other practitioners had also reported colleagues for inadequate or inappropriate history taking or examination , overprescribing , and prescribing without authority , AHPRA said .