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levonorgestrel ⇔ metformin          Applies to: Triphasil (ethinyl estradiol/levonorgestrel) and metformin           MONITOR:  The efficacy of oral hypoglycemic agents and insulin may be diminished by certain drugs, including thiazides and other diuretics, corticosteroids, estrogens, progestins, thyroid hormones, human growth hormone, phenothiazines, atypical antipsychotics, sympathomimetic amines, protease inhibitors, phenytoin, megestrol, danazol, isoniazid, asparaginase, pegaspargase, diazoxide, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. Patients with these conditions may be at increased risk for the development of lactic acidosis, which is a rare but serious metabolic complication associated with metformin accumulation in plasma usually at levels exceeding 5 mcg/mL. Discontinuation of metformin or supplementation with vitamin B12 may be necessary. 5 mg/500 mg, 170 received glipizide, and 177 received metformin. Prompt hemodialysis is also generally recommended in order to correct the acidosis and remove metformin.

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