![]() ![]() Also, a Cochrane review published in 2003 did not find a single case of lactic acidosis in 347 trials with 70,490 patient-years of metformin treatment. 3 showed that metformin increases the risk of acidosis only at eGFR levels below 30 mL/min/1.73 m 2. Subsequently, an observational study published in 2018 by Lazarus, et al. 2 that found metformin is not associated with increased rates of lactic acidosis in patients with mild to moderate kidney disease. These labeling revisions were based on a systematic review by Inzucchi, et al. If the eGFR is below 45 mL/min/1.73 m 2 in a patient taking metformin, the risks and benefits of continuing treatment should be assessed, the dosage may need to be adjusted, and renal function should be monitored more frequently. ![]() If the eGFR is between 30 and 45 mL/min/1.73 m 2, metformin is not recommended.If the estimated glomerular filtration rate (eGFR) is below 30 mL/min/1.73 m 2, metformin is contraindicated.Metformin’s labeling, 1 revised in 2016, states the following: But the most recent guidelines have relaxed the criteria for metformin use in this patient population. What about the renal effects?īecause metformin is renally cleared, it has caused some concern about nephrotoxicity, especially lactic acidosis, in patients with impaired renal function. It should be considered in all adult patients with type 2 diabetes, with possible exceptions noted below. Metformin is an inexpensive agent that should be continued, if tolerated, in those who need additional agents for glycemic control. It may also have cardiovascular benefits. Metformin improves glycemic control without tending to cause weight gain or hypoglycemia. We do not endorse non-Cleveland Clinic products or services Policy Advertising on our site helps support our mission. Cleveland Clinic is a non-profit academic medical center. ![]()
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