Second pass at: Metformin co-administration and additive GI effects posts 91–120
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Building on post #90 rather than restating it.
Counterpoint on Metformin co-administration, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.
Collapsed as off-topic by two members at trust level 3 or above
Everything in post #92 holds. The case it does not cover is the one I have.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
Happy to be corrected if someone holds better data than mine.
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.
Adding thanks rather than a view. I do not have a view worth the space.
What I would want before treating Metformin co-administration as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing.
Answering the question post #99 raises rather than the one it answers.
A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.
Seconded. It reads as careful rather than confident, which is the right register.
Metformin co-administration is well covered in the tag pages, and the older discussions are better than the recent ones because they were argued out properly. Worth twenty minutes before adding to this one.
Taking post #103 at face value and following it one step further.
The reason Metformin co-administration keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.
Everything in post #103 holds. The case it does not cover is the one I have.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
Reporting the observation and leaving the explanation open deliberately.
Taking Metformin co-administration seriously for a moment rather than deflecting: the honest position is that the community has observations and no controlled comparison, and those two things support very different sentences.
Worth separating two things that post #107 runs together.
Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer.
Speaking for myself and not for anyone else who has posted here.
Marking my uncertainty on Metformin co-administration explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.
Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.
Worth separating two things that post #108 runs together.
I think the Metformin co-administration question is answerable and has not been answered, which is a more optimistic position than most of this thread.
Post #110 is right about the mechanism and I think understates the practical bit.
What I would tell a new member reading about Metformin co-administration for the first time: the confident posts are not the reliable ones, and the reliable ones are longer.
Collapsed as off-topic by two members at trust level 3 or above
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
Posting it because the silence on this was starting to look like agreement.
The most useful thing anyone has posted about Metformin co-administration in this category was a table of what had been measured and by whom. That is what I would want again.
Post #115 answers the question as asked. The question underneath it is different.
The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.
That distinction has done more work for me than anything else in this category.
I read post #116 twice before replying, because I had assumed the opposite.
A note on scope: what I am saying about Metformin co-administration applies to the case in the first post and I would not extend it further without checking.
Adding the measurement that post #118 says would settle it.
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
Flagging that the sources on this are thinner than the confidence in the thread suggests.