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Departments

Metformin With Either Histamine H2-Receptor Antagonists or Proton Pump Inhibitors: A Polypharmacy Recipe for Neuropathy via Vitamin B12 Depletion

  1. Matthew J. Zdilla
  1. Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, WV
  1. Corresponding author: Matthew J. Zdilla, mzdilla{at}westliberty.edu
Clinical Diabetes 2015 Apr; 33(2): 90-95. https://doi.org/10.2337/diaclin.33.2.90
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    FIGURE 1.

    Schematic representation of the sequelae of overweight/obesity and type 2 diabetes with regard to neuropathy and GERD. A positive feedback exists among neuropathy, GERD, management with acid-suppressing medications, and vitamin B12 deficiency. The figure illustrates an additive effect of concomitant metformin and acid-suppression therapy leading to neuropathy via compounded vitamin B12 depletion.

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  • TABLE 1.

    Incidence of Vitamin B12 Deficiency Among Individuals Managed With Metformin

    StudySample Size (n)Individuals With B12 Deficiency (n)Individuals With B12 Deficiency (%)
    Tomkin et al., 1971 (28)714*5.6
    Adams et al., 1983 (29)33—†—
    Hermann et al., 2004 (30)5319‡36
    Pflipsen et al., 2009 (31)1954423
    Qureshi et al., 2001 (32)702333
    Calvo Romero and Ramiro Lozano, 2012 (33)8178.6
    Sato et al., 2013 (34)62813
    • ↵* Twenty-one individuals (30%) were identified as having B12 malabsorption.

    • ↵† Twelve individuals (36%) were identified as having B12 malabsorption.

    • ↵‡ Individuals identified as being deficient had ≥1 abnormal B12 marker (e.g., subnormal/reduced cobalamin, reduced holotranscobalamin, elevated homocysteine, and elevated methylmalonic acid)

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Clinical Diabetes: 33 (2)

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April 2015, 33(2)
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Metformin With Either Histamine H2-Receptor Antagonists or Proton Pump Inhibitors: A Polypharmacy Recipe for Neuropathy via Vitamin B12 Depletion
Matthew J. Zdilla
Clinical Diabetes Apr 2015, 33 (2) 90-95; DOI: 10.2337/diaclin.33.2.90

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Metformin With Either Histamine H2-Receptor Antagonists or Proton Pump Inhibitors: A Polypharmacy Recipe for Neuropathy via Vitamin B12 Depletion
Matthew J. Zdilla
Clinical Diabetes Apr 2015, 33 (2) 90-95; DOI: 10.2337/diaclin.33.2.90
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