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'Fishy Smell' May Keep Patients From Diabetes Drug
Date:2/15/2010

Research letter reports what medical literature hasn't: metformin's odor is off-putting

MONDAY, Feb. 15 (HealthDay News) -- The commonly used diabetes medication metformin sometimes has such an unpleasant odor that people may stop taking it, experts say.

But they recommend that people let their doctors know if the smell of this oral drug is an issue for them, because different formulations -- especially the extended-relief version -- tend to have a milder odor, if any at all, reports a letter in the Feb. 16 issue of the Annals of Internal Medicine.

"Metformin is an excellent drug, but the immediate-release formulation may have an odor to it. The smell is fishy or like the inside of an inner tube, and in a patient's mind, because it smells like something that has gone bad, they may think the drug isn't good," explained one of the letter's authors, J. Russell May, a clinical professor at the University of Georgia College of Pharmacy at the Medical College of Georgia.

However, May said, "some metformin products on the market are extended-release and the drug is embedded and released slow, over time. These products have much less smell, if any."

May and his colleagues wrote the letter to the journal to raise awareness of this issue, especially because nausea is a commonly reported side effect of metformin. "Is it nausea from the medication, or is it because it smells bad?" May said.

Physicians at the Medical College of Georgia had two adult male patients with type 2 diabetes complain of the "dead fish" odor of metformin. The smell was significant enough that both of the men stopped taking the medication. One of the men switched to the extended-release version of the drug and no longer had any problems; the second man refused to try the extended-release version.

May and his colleagues searched the medical literature to see whether problems with the smell of metformin were common, but they f
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