17-Feb-10 10:00 AM  CST

Diabetes Med Stinks, Literally

A new report in the Annals of Internal Medicine medical journal suggests that a pungent fishy odor may be what’s turning some diabetes patients away from the oral drug metformin.

Metformin, also known as glucophage, is often the first choice of treatment for people with Type 2 diabetes. Nausea and gastrointestinal upset are the side effects most commonly associated with the drug. Researchers at the Medical College of Georgia in Augusta and the University of Georgia College of Pharmacy in Athens suggested that the fishy, dirty socks odor patients have complained about on Internet forums may be contributing to the drug's adverse side effects and is causing some patients to discontinue its use.

The side effects alone have been documented in consumer reports and medical journals. However, no direct correlation currently exists between the smell of metformin and the side effects, and though complaints of the smell are present on Internet messaging boards, they have not been documented in medical journals until now. Allen Pelletier, MD, of the Medical College of Georgia in Augusta and colleagues suggested in the paper that the reason why the smell has gone undocumented for so long is that patients, when complaining to doctors and pharmacists, are not elaborating on the adverse effects of metformin past their physical symptoms.

"Our cases show that the distinctive odor of metformin (independent of other, well-known gastrointestinal adverse effects of the medication) causes patients to stop taking the drug," Pelletier and colleagues wrote. "Patients may report that metformin nauseates them but do not further elaborate or distinguish this as a visceral reaction to the smell of the drug."

The odor is not universally reported by consumers, and the smell may largely depend on where and how the drug is manufactured. For example, in one case reported in the research paper and highlighted in Reuters, a man had been taking brand-name metformin (glucophage, made by Bristol-Myers Squibb) for years before he was switched to an immediate release, generic version. It was not until he switched to the generic version that he noticed the smell and refused to take the drug.

When prescribed appropriately, metformin causes few adverse effects. It is also one of the few anti-diabetic drugs that does not cause hypoglycemia if used alone.

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