@NeuroRN
Metformin is not metabolized. It is cleared from the body by tubular secretion and excreted unchanged in the urine; metformin is undetectable in blood plasma within 24 hours of a single oral dose.[87][114] The average elimination half-life in plasma is 6.2 hours.[87] Metformin is distributed to (and appears to accumulate in) red blood cells, with a much longer elimination half-life: 17.6 hours[87] (reported as ranging from 18.5 to 31.5 hours in a single-dose study of nondiabetics).[114]
There is some evidence that liver concentrations of metformin in humans may be 2 to 3 higher than plasma concentrations, due to portal vein absorption and first-pass uptake by the liver in oral administration.
Glimepride
Most sulfonylureas are extensively metabolized in the liver, primarily by the cytochrome P450 (CYP) 2C9 isoenzyme. The half-life of most sulfonylureas is relatively short, with the exception of chlorpropamide, which has a half-life of 24–48 h [19].
Jardiance
Acute Kidney Injury and Impairment in Renal Function: Empagliflozin causes intravascular volume contraction and can cause renal impairment. Acute kidney injury requiring hospitalization and dialysis has been identified in patients taking SGLT2 inhibitors, including empagliflozin; some reports involved patients younger than 65 years of age. Before initiating JARDIANCE, consider factors that may predispose patients to acute kidney injury. Consider temporary discontinuation in settings of reduced oral intake or fluid losses. Monitor patients for signs and symptoms of acute kidney injury. If it occurs, discontinue JARDIANCE and treat promptly.
Empagliflozin increases serum creatinine and decreases eGFR. Patients with hypovolemia may be more susceptible to these changes. Before initiating JARDIANCE, evaluate renal function and monitor thereafter. More frequent monitoring is recommended in patients with eGFR <60 mL/min/1.73 m2. Discontinue JARDIANCE in patients with a persistent eGFR <45 mL/min/1.73 m2.
