Re: 당뇨약 메트포민의 항암약물 사용법

[문형철]

beyond reason

초기용량은 1일 1회 메트로포르민염산염서방정 500mg을 저녁식사와 함께투여

최대용량은 하루 2000mg임

용량을 증가할때는 매주 500mg씩 증가시킴. 

주의해야 하는 환자

신장기능이상 환자

울혈성 심부전환자

메트포민 약물에 과민반응 경력이 있는 환자

혈관내 조영제 검사, 전신마취 수술을 해야 하는 경우 48시간전에 메트포민 복용중지

간기능장애

영양불량상태, 구토, 설사, 탈수증 등

임신부

매우 드물지만 메트로포민 장기투여시 비타민  B12 흡수 장애

매우 드물지만 신장 손상시에는 유산산증(혈중 젖산농도증가 - 혈중 pH저하, 전해질 불균형)이 발생할 수 있음. 알콜섭취하면 젖산대사에 영향을 미침. 

유산산증의 증상 피로, 권태, 근육통, 호흡곤란, 심한 졸음, 복부통증과 같은 비특이적인 증상수반. 산증이 심해질 경우 체온저하, 저혈압, 저항성 서맥부정맥 등

혈청전해질, 케톤, 혈당, 혈중 pH, 젖산농도와 메트포민산염 혈중농도측정 등으로 검사할 수 있음. 

신경계 장애 

- 미각손상

위장관 장애

오심, 구토, 설사, 복통 및 식욕부진과 같은 위장관장애

피부 

가려움증, 홍반, 두드러기, 발진 등

메트포민은 AMPK를 활성화하여 간, 지방, 근육세포에서 포도당이 분비되는 것을 차단함

인슐린 분비를 억제함. 

암세포에서 메트포민은 미토콘드리아 포도당 공급을 억제하여 암세포 사멸촉진

cc-0423.pdf

New Perspective for an Old Antidiabetic Drug: Metformin as Anticancer Agent

• Authors
• Authors and affiliations

• Alessandra Leone
• Elena Di Gennaro
• Francesca Bruzzese
• Antonio Avallone
• Alfredo Budillon

1. 1.
2. 2.
3. 3.

Conference paper

First Online: 11 October 2013

• 73Citations
 
• 6.4kDownloads

Part of the Cancer Treatment and Research book series (CTAR, volume 159)

Abstract

Metformin, an inexpensive, well-tolerated oral agent that is commonly used in the first-line treatment for type 2 diabetes, has become the focus of intense research as a potential anticancer agent. This research reflects a convergence of epidemiologic, clinical, and preclinical evidence, suggesting that metformin may lower cancer risk in diabetics and improve outcomes of many common cancers. Notably, metformin mediates an approximately 30 % reduction in the lifetime risk of cancer in diabetic patients. There is growing recognition that metformin may act (1) directly on cancer cells, primarily by impacting mitochondrial respiration leading to the activation of the AMP-activated protein kinase (AMPK), which controls energy homeostasis in cells, but also through other mechanisms or (2) indirectly on the host metabolism, largely through AMPK-mediated reduction in hepatic gluconeogenesis, leading to reduced circulating insulin levels and decreased insulin/IGF-1 receptor-mediated activation of the PI₃K pathway. Support for this comes from the observation that metformin inhibits cancer cell growth in vitro and delays the onset of tobacco carcinogen-induced lung cancer in mice and that metformin and its analog phenformin delay spontaneous tumor development cancer-prone transgenic mice. The potential for both direct antitumor effects and indirect host-mediated effects has sparked enormous interest, but has led to added challenges in translating preclinical findings to the clinical setting. Nonetheless, the accumulation of evidence has been sufficient to justify initiation of clinical trials of metformin as an anticancer agent in the clinical setting, including a large-scale adjuvant study in breast cancer, with additional studies planned.

Keywords

Metformin Phenformin Diabetes mellitus AMP-activated protein kinase PI₃K pathway