"How it works" series: Vancomycin

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Vancomycin was the first antibiotic developed of the glycopeptide class.  It is termed "glyco-" because it has two saccharides and "peptide" because it has seven peptides, making a structure larger than almost all other antibiotics.  The main mechanism of action is inhibition of cell wall synthesis.  Under normal conditions in bacteria, as the cell wall is being formed,

Metformin in kidney dysfunction - restriction revised

Metformin is the preferred initial pharmacologic therapy in every patient with type 2 diabetes mellitus who does not have a contraindication or intolerance.  It is recommended as monotherapy after diagnosis, continued when adding other medications (including insulin regimens), and should even be considered to prevent diabetes in certain patients (see who at the bottom).  

Old labeling

From approval, the restriction on metformin related to kidney function was as follows