Metformin and Victoza as a first line?


#1

I was recently diagnose with Type 2. The doctor prescribed 1000 mg of Metformin and Victoza. BUT the pharmacists' nixed that immediately. Who is right? The doc or the pharmacist?? help...


#2

Hi Jem: It would help to have a little more information from you. How were you diagnosed, what symptoms were you having? And did the pharmacist give any explanation for his/her actions and decisions? And have you had a follow-up with the doctor? Sorry for your situation, but I am glad that you found TuDiabetes because it's a great place to ask questions and get support. A new diagnosis is not easy!


#3

The pharmacist should *NOT* be trumping the doctor, under any circumstances that I can think of. Another suspect that occurs to me might be the "invisible hand" of your insurer which may exclude coverage for something (although I can't think why, they should be shutting up and listening to your doctor too...).

I have a situation w/ the new CGM from Medtronic where it works with the old pump but that wasn't run by the FDA so you have to get the doc to RX it. I was flabbergasted at how quickly things fell into place (Medtronic are quite poised to sell their products I guess?) with that. I would question a pharmacist who questions a doc. I live pretty close to a convenient 24 hour Walgreens pharmacy and would be bummed to ditch the convenience but they are pretty cool. Did the pharmacist offer any explanation, like "oh, you don't want these side effects!"?


#4

Hi Jem, welcome, sorry you had to join our little club.

I take metformin + Victoza and it works well for me. My Doc says the protocol he follows is 1. metformin, 2. add Victoza, and then move to insulin.

Both drugs can cause digestive issues which for me at least went away rather quickly. Perhaps the pharmacist felt you would have an easier time adapting to one before starting the other. Also some get good results with metformin alone so it makes sense to try it first and see what happens.

Spend some time going through old posts here on tuD there is a wealth of information here.


#5

It is hard to second guess what is happening. Certainly, most doctors and pharmacists have been taught to start with a single medication (like metformin)and then move to combinations when that doesn't work. But more recent research points to better outcomes with starting a powerful combination treatment (like metformin and Victoza). If could be that your pharmacist is just second guessing your doctor, but we don't know. And we do expect that a pharmacist will intervene and counteract doctors orders in a range of matters. For instance, if the prescription is for something counterindicated. Metformin should not be taken if you have impaired liver or kidney function. Victoza should not be taken if you have a history of pacreatitis. Some medications should not be taken together, so for instance you should not take Metformin if you are having a contrast dye MRI.

What you really need to do is make you doctor and pharmacist deal with the conflict. In general, a pharmacist will never override a diagnosis and treatment decision by a doctor without good reason.


#6

Sorry such a short post. It was late, I was tired and frustrated.
My story: I was getting my annual physical, which is required for insurance purposes. They did a full blood panel. I have had high blood pressure for years, controlled on atenolol. I have high hiatal hernia so I take omeprazole. I was diagnosed with high cholesterol about 4 years ago so I also take Crestor, which has controlled things until recently. My blood panel showed elevated LDL cholesterol, triglycerides and low HDL. And my A1C was 7.7. She prescribed 1000mg Metformin and Victoza with the weekly increases. All 3 pharmacists were on duty when I went to get the scripts filled. They all stated that Victoza is not to be prescribed as a first line med. Since I had never been diagnosed until 2 weeks ago I should not take it. Other measures were to be tried first. It does state on the Victoza page itself, "Not to be used as a first line"..and the pharmacists' 4 drug sites that keep them updated, also states this. My insurance also refuses to pay for this drug with the warning, not a first line drug for diabetes. SO, I guess my question is: Has anyone else been prescribed the combo of Metformin and Victoza as a first line treatment....or right after being diagnosed with type 2?


#7

Let me be clear. The American Association of Clinical Endocrinologists has published a diabetes treatment protocol. These are the "experts." It clearly says that when you have an A1c > 7.5% that you can immediately start "dual therapy," and one of those is Metformin + Victoza (GLP-1). You have not been described Victoza as a first line, you have been described Met+GLP-1. I suspect that your insurance company is making these rules, not the pharmacist.

I would just make this your doctor's problem. He needs to call and make sure that you get your prescription approved and if necessary, your doctor needs to write a letter of medical necessity.


#8

I think in this case the pharmacist is right. I was diagnosed over five years ago. My first was med Metformin, which after a while stopped doing its job. then I went on insulin for a few years, it controlled the sugar, but my weight was out of control. I am like you I take blood pressure pills, and blood thinners. Finally I tried Victoza, I thought it was going to be my saving grace. I was so sick, and many days unable to eat. I finally had an upper GI, yes my ulcer was still there , but not the cause of my sickness. Throwing up etc. I joined this site and was thrilled to see that others had the same issues. I was encouraged to try keeping on the lower dose of Victoza for a while, which it did .6. Then it was time to increase the Victoza to 1.2. Sadly I became ill again…it never did control my bs numbers… I think that you should try all others before you go to Victoza… My insurance wouldn’t pay for Victoza, but I would have paid willingly if it had worked…I asked my doctor if I could take Metformin and Victoza… A strong no was the answer… I would love to hear what your outcome was.



M


#9

Hi Jem,

Sorry that you are having to deal with T2! Especially on top of your other health challenges.

Glad that you found TuDiabetes, though!

I can't help with your question, but there are a lot of people here with relevant experience and knowledge. Even if some of them have different experiences from each other!

I hope that the med dilemma gets sorted out and you get a treatment that works for you!

Best wishes,

marty1492


#10

I am rather surprised that a doctor would prescribe a high dosage of Metformin (1000 mg) plus Victoza which is normally injected, as the first line of defense for someone newly diagnosed with type II diabetes. But then I'm from an old school where the preferred first line of treatment/defense for type II was always lifestyle changes, most importantly to diet and activity and quite often with an emphasis on weight loss. I therefore can understand the reaction of the pharmacist, though your doctor might know something about your health that doesn't come across in your posting.


#11

Recent studies have provided increased evidence that aggressive treatment from the very beginning leads to the best outcomes. This is probably due to lower blood sugar levels leading to less damage (glucotoxicity), which itself accelerates the progression of diabetes. The researcher Ralph DeFronzo recently announced preliminary results from a trial that started patients on a potent combination of metformin, Byetta and Actos and compared them against standard treatment. The results were significant with the triple treatment arm doing much better and in many cases achieving A1cs < 6% and essentially halting further progression. There may be some of us for whom lifestyle changes can be sufficient, but I have actually come to believe that if you are faced with a progression of your condition you should hit it hard and fast and do everything you can to get your A1c down below 6%.


#12

I would say hit it hard & fast with diet & lifestyle changes.
I'm a T2, dx at 13.1. I began on a combo of Glyburide and Metformin. The doctor & I kept close tabs for the first nine months or so, adjusting meds as needed. I also threw myself into (near) daily exercise and a lower carb diet. After 2 years, I stopped taking Glyburide. I continue to devise ways to lower my carb intake, trying new recipes and new foods. (Yes, I can enjoy a burger without a bun!)
My A1c is in the 6s, I have no side effects from Metformin, and I live pretty happily & healthfully with my diabetes.
Good luck to you in the upcoming year--it can be very stressful!


#13

First of all, thanks to all who responded. Appreciate all the input!
Second of all I am doing good.
I took the 1000mg of Metformin for one month by itself. It made me a little nauseous and surprisingly a bit weak. I didn’t seem to have the strength to carry out my daily tasks at work as usual. But that subsided.
After a month I had my levels rechecked. I went from an A1C of 7.7 to an A1C of 6.6
We then added the Victoza daily with increased dosages every 2 weeks. I just started the second level dosage 4 days ago. It also made me feel a bit ill. Truthfully I have this constant underlying nauseous feeling but nothing I can’t deal with. I have noticed a drastic decrease in my appetite.
I also wanted everyone to know that as soon as I found out I had D2 I quit drinking sodas, which I could kill a 12 pack of Pepsi a day with no problem. I also quit smoking after 30 years. I am on the patch with 3 weeks to go! Doing great, no setbacks.
I have lost 10 lbs since starting the Victoza a little over 2 weeks ago.
Here is to hoping that on my next check up my A1C is below 6!!


#14

Glad to know you are doing good on Metformin and Victoza. I was thrilled that the Victoza cut my appetite to almost zero…sadly it doesn’t work for me. I became very sick every time I bumped up the dose. I do believe it can work for many. I am back to Metformin…good luck.


#15

I have been on Victoza for 2.5 years and over time the side effects have all subsided. Hope you can reach your goal of <6


#16

I tried taking Victoza with Metiformin and it caused me vomiting on some occasions and it happened while out at restaurants and stores so I had to stop the metiformin and I’m fine though I do get very nauseaous and have vomited on a few occasions.


#17

Jem
The pharmacist shouldn’t over ride the dr. I was on just diet alone for awhile, then started with 500mg metformin and then 1000mg trice a day. Been on this for 7 yrs. I even asked about victosa but for me…numbers are good so she’s just leaving the way it is for now. But should let dr know what pharmacist did. Ask questions and find out why


#18

I never, in the three years I was on metformin 1500 mg a dag, noticed a single time when that drug lowered my bgs. In comparison Glyberide was very effective in lowering my BGs.