Contra‐indications to metformin therapy are largely disregarded

Holstein, Andreas; Nahrwold, Daniel A.; Hinze, S; Egberts, E.‐H.

doi:10.1046/j.1464-5491.1999.00115.x

Cited by 121 publications

(101 citation statements)

References 21 publications

(16 reference statements)

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“…Furthermore, development of contraindications rarely results in discontinuation of metformin therapy [16]. These data have been confirmed in several other studies in various countries [17,18]. Despite this, lactic acidosis remains rare [8], even if case reports still continue to be published regularly [9,19].…”

Section: Introductionmentioning

confidence: 80%

Metformin revisited: A critical review of the benefit–risk balance in at-risk patients with type 2 diabetes

Scheen

Paquot

2013

Diabetes & Metabolism

143

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Metformin is unanimously considered as the first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of the presence of numerous contraindications corresponding to situations that may increase the risk of lactic acidosis. Various observational data from real life showed that many diabetic patients considered as "at risk" still receive metformin, often without appropriate dose adjustment, apparently without any harm, especially no increased risk of lactic acidosis. More interestingly, recent data suggest that type 2 diabetes patients who are considered as being "at risk" because of the presence of traditional contraindications still take benefit from metformin therapy, with a reduction of morbidity and mortality compared with other glucose-lowering agents, more particularly sulfonylureas. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, congestive heart failure, renal impairment or chronic kidney disease, hepatic dysfunction and chronic respiratory insufficiency, all conditions that may theoretically increase the risk of lactic acidosis. A special attention will be devoted to elderly patients with type 2 diabetes. Indeed, this population is growing rapidly and older patients may cumulate several comorbidities

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Section: Introductionmentioning

confidence: 80%

Metformin revisited: A critical review of the benefit–risk balance in at-risk patients with type 2 diabetes

Scheen

Paquot

2013

Diabetes & Metabolism

143

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“…Moreover, both retrospective population-based studies [12] and studies in selected cohorts [10,11,13,14,35,36] showed that the currently proclaimed contraindications and precautions for metformin therapy are frequently disregarded (Table 2). Interestingly, among the ∼2,500 patients followed in these studies only one case of lactic acidosis was reported, and even this one case could not be causally attributed to metformin since it was associated with intercurrent myocardial infarction and renal failure [12].…”

Section: Disregard Of Metformin Contraindications and Incidence Of Lamentioning

confidence: 99%

“…There is no evidence that old age should in itself be a reason to withhold metformin. It is important to point out, however, that 'hard' contraindications are far more likely to emerge in the elderly [11] than in the young, and these should therefore be regularly monitored.…”

Section: Suggested Modifications Of Metformin Contraindicationsmentioning

confidence: 99%

“…The first is that some patients do not tolerate it well, and the second is that traditional contraindications limit its use [5][6][7][8][9]. Although such contraindications are frequently overlooked in clinical practice, an increased incidence of serious side-effectsparticularly lactic acidosis-has not been observed [10][11][12][13][14]. This raises the question whether the contraindications, as currently outlined, deprive many patients with type 2 diabetes of the benefits of metformin.…”

Section: Introductionmentioning

confidence: 99%

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Contraindications can damage your health—is metformin a case in point?

2005

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Metformin is an effective anti-hyperglycaemic and cardioprotective agent, but a long list of contraindications precludes millions of patients with type 2 diabetes from using it. This is largely due to the historical experience of lactic acidosis with phenformin, despite the fact that metformin does not predispose to this when compared with other therapies. Contraindications such as old age, renal impairment and cardiac insufficiency are increasingly disregarded in clinical practice, yet there is no evidence that the incidence of lactic acidosis has changed. Metformin has been shown to improve metabolic control without causing lactic acidosis in elderly patients with multiple comorbidities, including explicit contraindications, and its use in patients with type 2 diabetes over the age of 70 with mild renal impairment did not produce a clinically relevant increase in plasma lactate. There is no correlation between levels of metformin and lactate in patients with lactic acidosis, and its prognosis is mainly related to the causal hypoxic underlying disease and comorbidities. These findings raise doubts about the pathogenetic significance of metformin in lactic acidosis. We propose that advanced age per se, mild renal impairment and compensated heart failure can no longer be upheld as contraindications for metformin. A clear re-definition of contraindications to metformin will enable more physicians to prescribe within guidelines.

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“…More impressively, in case of HF it may prolong survival for up to 2 years [17]. This is important, given that 10 --25% of T2DM patients receiving metformin may suffer from HF [50][51][52].…”

Section: Expert Opinionmentioning

confidence: 99%