Metformin is one of the earliest drugs used to treat type 2 diabetes and
it has also been found to be one of the most effective and safest for
long-term use. It is reassuring to know as well that it is safe for use
in people with cirrhosis and helps to improve long-term survival. —AF
Continuation of metformin use after a diagnosis of cirrhosis significantly improved survival of patients with diabetes
Xiaodan Zhang et al.
The risks and benefits of metformin use in
cirrhotic patients with diabetes are debated. Although data on a
protective effect of metformin against liver cancer development have
been reported, metformin is frequently discontinued once cirrhosis is
diagnosed due to concerns about an increased risk of adverse effects of
metformin in patients with liver impairment. This study investigated
whether continuation of metformin after cirrhosis diagnosis improves
survival of patients with diabetes.
Diabetic patients diagnosed with cirrhosis between
2000 and 2010 who were on metformin at the time of cirrhosis diagnosis
were identified (n=250). Data were retrospectively abstracted from the
medical record. Survival of patients who continued versus discontinued
metformin after cirrhosis diagnosis was compared using the log-rank
test. The hazard ratio (HR) and 95% confidence interval (CI) were
calculated using Cox Proportional Hazards analysis.
172 patients continued metformin while 78
discontinued metformin. Patients who continued metformin had a
significantly longer median survival than those who discontinued
metformin (11.8 vs. 5.6 years overall, P < 0.0001; 11.8 vs. 6.0 years for Child A patients, P = 0.006; and 7.7 vs. 3.5 years for Child B/C patients, P =
0.04, respectively). After adjusting for other variables, continuation
of metformin remained an independent predictor of better survival with
a HR of 0.43 (95%CI: 0.24-0.78, P = 0.005). No patients developed metformin-associated lactic acidosis during follow-up.
Continuation of metformin after cirrhosis diagnosis
reduced the risk of death by 57%. Metformin should therefore be
continued in diabetic patients with cirrhosis if there is no specific
contraindication. (Hepatology 2014)
alerting consumers, pharmacy and health care professionals to a
nationwide recall of one lot of 81 mg Enteric Coated Aspirin Tablets
because of the possibility that the tablets in these bottles may
actually contain tablets with 500 mg of acetaminophen, the active
ingredient in other pain relievers such as Tylenol. The aspirin,
intended for the treatment of minor aches and pains, was manufactured
and packaged by Advance Pharmaceutical Inc. under the label of Rugby
Risk: Consumers who inadvertently
take 500 mg of acetaminophen are at risk of severe liver damage if they
take other drugs containing acetaminophen, consume three or more
alcoholic drinks every day, or have liver disease. The label directions
on the mislabeled products instruct patients to take four to eight
tablets every four hours, but not more than 48 tablets in 24 hours.
Consumers who take 48 tablets daily of the defective product may be
ingesting up to 24,000 mg of acetaminophen, which is six times the
maximum recommended daily dose. The affected lot Enteric Coated Aspirin
Tablets is Lot 13A026 with an expiration date of January 2015.
who have the affected lot should immediately discontinue its use and
return it to the pharmacy or store where it was purchased.
should contact their physician or health care professional if they have
experienced any problems that may be related to taking or using this
product. Signs of liver damage include abdominal pain and swelling,
yellowish discoloration of the skin and eyes, and dark urine.
Consumers with questions may contact Advance Pharmaceutical Inc., Monday-Friday, 9 a.m.-5 p.m. ET at 631-981-4600, Ext. 308.
The U.S. Department of Health and Human Services (HHS) has released a
new guideline to improve patient safety by reducing unexpected disease
transmission through organ transplantation. This guideline updates the
1994 U.S. Public Health Service (PHS) guideline for preventing
transmission of human immunodeficiency virus (HIV) through organ
transplantation and adds guidance for reducing unexpected transmission
of hepatitis B virus (HBV) and hepatitis C virus (HCV) through organ
The 2013 PHS Guideline for Reducing Human Immunodeficiency Virus,
Hepatitis B Virus and Hepatitis C Virus Transmission through Organ
Transplantation, published in Public Health Reports, recommends the use
of more sensitive tests so that patients can be informed of risks to the
greatest extent possible and protected from unintentional infections
caused by transplanted organs.
Results from a 2010 survey
of 5,000 health care workers, most of whom were nurses, illustrates the
disparity between how well clinicians believe they are doing in
preventing infections and how they behave, Mr. Fricker said (Am J Infect
Control 2010;38:789-798). Although most respondents said they followed
recommended infection control practices, 6% said they sometimes or
always used single-dose vials for multiple patients and 1% said they
reused a syringe for more than one patient after discarding the needle.
is a misconception that changing a needle is enough to be safe,” Mr.
Fricker said. “Many of these respondents were unaware of the risk for
spreading disease after changing a needle but reusing the same vial.”
Milk thistle (scientific name Silybum marianum)
is a plant from the aster family. Silymarin is an active component of
milk thistle believed to be responsible for the herb’s health-related
properties. Milk thistle has been used in Europe for treating liver
disease and jaundice since the 16th century. In the United States,
silymarin is the most popular dietary supplement taken by people with
Strength of Evidence
Much research supports the conclusion that there little evidence of benefit for milk thistle as a treatment for hepatitis C.
A 2012 controlled clinical trial,
cofunded by NCCAM and NIDDK, showed that two higher-than-usual doses of
silymarin were no better than placebo in reducing the high blood levels
of an enzyme that indicates liver damage. In the study, 154 people who
had not responded to standard antiviral treatment for chronic hepatitis C
were randomly assigned to receive 420 mg of silymarin, 700 mg of
silymarin, or placebo three times per day for 24 weeks. At the end of
the treatment period, blood levels of the enzyme were similar in all
Results of the HALT-C study
suggested that silymarin use by hepatitis C patients was associated
with fewer and milder symptoms of liver disease and somewhat better
quality of life, but there was no change in virus activity or liver
inflammation. The researchers emphasized that this was a retrospective
study (one that examined the medical and lifestyle histories of the
participants). Its finding of improved quality of life in patients
taking silymarin was not confirmed in the more rigorous 2012 study
A 2009 Cochrane systematic review
assessed the beneficial and harmful effects of milk thistle in patients
with alcoholic liver disease and/or hepatitis B or C liver diseases and
found that there is not enough high-quality evidence to support the use
of this intervention.
Available evidence from clinical trials in people with liver diseases suggests that milk thistle is generally well-tolerated.
Side effects can include a laxative effect, nausea, diarrhea, abdominal bloating and pain, and occasional allergic reactions.
In NIH-funded studies of silymarin in people with hepatitis C that
were completed in 2010 and 2012, the frequency of side effects was
similar in people taking silymarin and those taking placebos. However,
these studies were not large enough to prove that silymarin is safe for
people with chronic hepatitis C.
Other supplements have been studied for hepatitis C, but overall, no benefits have been clearly demonstrated.
Probiotics are live microorganisms that are intended to have a health benefit when consumed.
Strength of Evidence
Only a few studies have examined the effects of probiotics on hepatitis C.
Research hasn’t produced any clear evidence that probiotics are helpful in people with hepatitis C.
Most people can use probiotics without experiencing any side
effects—or with only mild gastrointestinal side effects such as
intestinal gas —but there have been some case reports of serious adverse
effects in people with underlying serious health conditions.
Strength of Evidence
Preliminary studies, most of which were conducted outside the United States, have examined the use of zinc for hepatitis C.
might help to correct zinc deficiencies associated with hepatitis C or
reduce some symptoms, but the evidence for these possible benefits
A few preliminary studies have looked at the effects of combining supplements such as lactoferrin, SAMe,
or zinc with conventional drug therapy for hepatitis C. The evidence is
not sufficient to draw clear conclusions about benefit or safety.
Zinc is generally considered to be safe when used appropriately, but it can be toxic if taken in excessive amounts.
Glycyrrhizin (or glycyrrhizic acid) is a compound found in licorice root.
Strength of Evidence
Glycyrrhizin has been tested in only a few clinical trials in patients with hepatitis C.
There is currently not enough evidence to determine if glycyrrhizin is helpful for hepatitis C.
In large amounts, glycyrrhizin or licorice can be dangerous in
people with a history of hypertension (high blood pressure), kidney
failure, or cardiovascular diseases.
consists of tiny silver particles suspended in liquid. Colloidal silver
products are often promoted for treating various diseases, including
Strength of Evidence
Scientific evidence does not support the use of colloidal silver
to treat any disease, and serious, irreversible side effects can result
from its use.
There is currently no research to support its use for hepatitis C.
Colloidal silver is known to cause serious side effects, including a permanent bluish discoloration of the skin called argyria.