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I read with much interest the letter of Dr Alston on the potential relation between metformin-associated lactic acidosis and potential metformin antithiamine activity. It is about a tempting assumption, with a rationale resting on animal data,^1-3 but, to our knowledge, without well-documented human data. This assumption would probably deserve to be tested. However, in clinical practice, among our patients with denutrition and chronic alcohol consummation, often deprived of vitamin B₁, we have not observed any lactic acidosis under metformine therapy.

Emmanuel Andrès, MD; Esther Noel, MD
Strasbourg, France

1. Loubatieres AL, Loubatieres-Mariani MM, Alric R, Blayac JP, Valette G. Effects of thiamine pyrophosphate and sodium dichloroacetate on the increase of lactate and insulin outputs induced by phenformin on the isolated and perfused rat pancreas. C R Seances Soc Biol Fil. 1977;171:155-160. PUBMED 2. Valette G, Ribes G, Rondot AM, Loubatieres-Mariani MM, Loubatieres AL. Effect of cocarboxylase on hyperlactatemia and hyperpyruvicemia induced by phenformin in dogs. C R Seances Soc Biol Fil. 1975;169:121-125. PUBMED 3. Valette G, Ribes G, Loubatieres-Mariani MM, Loubatieres AL. Consequences of the chronic administration of phenformine on the blood thiamine level in the dog. C R Seances Soc Biol Fil. 1975;169:1562-1567. PUBMED

Arch Intern Med. 2003;163:983.

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Does Metformin Interfere With Thiamine?
Theodore A. Alston
Arch Intern Med. 2003;163(8):983.
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