Metformin use in renal impairment extended

12 January 2015

Metformin can now be used in patients with moderate renal impairment, provided the dose is reduced appropriately and there are no other risk factors for lactic acidosis.

Metformin is the initial drug of choice for patients with type 2 diabetes and an HbA1c ≥6.5% | SCIENCE PHOTO LIBRARY

For patients with a creatinine clearance of 45–59ml/min or an eGFR of 45–59ml/min/1.73m², the initial dose of metformin is 500mg or 850mg once daily in the morning with food. The maximum daily dose is 1g in two divided doses with monitoring of renal function every 3–6 months.

This change to the prescribing information reflects the advice given in the NICE clinical guideline on the management of type II diabetes, namely that metformin can be used with caution in patients with renal impairment but the dose should be reviewed if the patient's eGFR drops below 45ml/min/1.73m² and treatment discontinued if the eGFR drops below 30ml/min/1.73m².

The metformin drug entry in MIMS has been updated to reflect the current Glucophage SPCs.

The MIMS drug listings for products containing metformin in combination with other drugs (eg, dipeptidyl peptidase 4 inhibitors, SGLT2 inhibitors, pioglitazone) will be updated when the updated SPCs become available. Prescribers should refer to the product SPCs to check if a combination product is suitable for an individual patient with renal impairment.

View metformin drug records

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