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Re: Metformin vs. Actos/Avandia ? Dr. Sam, please helpFrom: Sue (anonymous@obgyn.net)Sat, 2 Jun 2001 13:58:59 -0500 (CDT)
>Why would Metformin be prescribed instead of Actos or Avandia?< Met is the "first line of defense" against PCOS, according to my RE. Apparently, it works very well in the majority of cases and there is little need for the other "2nd" or "3rd" generation insulin sensitizers. Additionally, there is little risk of liver damage with Met, and there is a small chance of that occurring with the other two you mentioned, so "the path of least resistance" is usually chosen. I took met for more than a year and developed some problems; now I am on Actos with hepatic function levels being drawn every 3 months. So far no problems with my liver enzymes. I'm not looking for any, and any problems would be very rare, but anyhow....
>My gyn keeps insisting that only Metformin should be used for insulin While your Gyn is likely very competent, it's clear that s/he doesn't have all the pertinent info on PCO. My recommendation would be to get thyself to a RE, and soon. There's no reason that Met is more appropriate over the others for PCO pts who aren't diabetic. I'm not diabetic and it was never a consideration for my RE.
>My primary care doc says that actos or avandia would be the way to go because the way in which they work differently from met would preserve my pancreas which will only last me until I'm 40 (I'm 26 now) if I continue with no meds or use metformin.< Again, your PCP sounds somewhat under-informed as well. Met (as well as any other insulin sensitizer) will preserve your pancreas. If you understood her to say that if you are not medicated at all (i.e., no insulin sensitizer), your pancreas will quit, she's right. But Met doesn't have that affect; it in fact keeps this organ functioning in the way it should.
>There is also the concern that I'm on a cocktail of medications for my asthma/allergies (claritin, >liquibid, flovent singulair, albuterol), and what interactions they might have with insulin senstizing agents, especially metformin.< In addition to finding a RE, ask about seeing (getting a referral to, if you need it) a perinatologist. I, too, am on a "cocktail" of medications for allergies/asthma (Zyrtec, Nasonex, Atrovent[inhaler], and I take a baby aspirin for an antibody in my system that is linked to multiple miscarriages). I had no problems with cross-medicating like this and taking Met. I currently have no difficulties on this regimen with Actos. The perinatologist can inform you on chances of difficulties during pgy (if that's your goal) and the wisdom of continuing on your medicine should you end up there. Perinatologists are also very good at percentages and statistics; the one I saw rattled off statistical percentages of this and that with little effort, and seemed to be knowlegeable about all the medication I was on and would continue to be on, should I get pg. I'm told that this is pretty common in the field.
>Both doctors have decided that I need to go see an endocrinologist and My only advice on this is to keep an appt with a RE, even if you opt to see a regular E. My experience with an E was less than desirable; he treated mostly diabetics and while he was familiar with PCO, wasn't up on the latest information and thus kept pushing me towards diet pills and liquid fasts. My RE is a great guy who is completely up on all his research (he treats 500-600 women in our state with the condition), and is considered the top in his field. Good REs are out there, and while not all Es are bad, I recommend seeing a RE. Your ovaries are part of your reproductive system and your endocrine system at the same time, and this speciality of medicine is trained to treat both, not just one.
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