Metformin, heart failure, and lactic acidosis: is metformin absolutely contraindicated?

Tahrani, Abd A; Varughese, George; Scarpello, J. H. B.; Hanna, Fahmy

doi:10.1136/bmj.39255.669444.ae

Cited by 124 publications

(108 citation statements)

References 21 publications

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“…Metformin, previously contraindicated in CHF, can now be used if the ventricular dysfunction is not severe, if patient's CV status is stable and if renal function is normal [3,45]. However, diabetic patients with elevated systolic blood pressure are at increased risk for developing acute decompensated CHF, which is often associated with decreased kidney function.…”

Section: Metformin In Patients With Congestive Heart Failurementioning

confidence: 99%

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

Scheen

Paquot

2013

Diabetes & Metabolism

148

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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: Metformin In Patients With Congestive Heart Failurementioning

confidence: 99%

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

Scheen

Paquot

2013

Diabetes & Metabolism

148

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“…117,118 Metformin, previously contraindicated in heart failure, can now be used if the ventricular dysfunction is not severe, if patient's cardiovascular status is stable, and if renal function is normal. 119 As mentioned, cardiovascular effects of incretin-based therapies, including those on ventricular function, are currently under investigation.…”

Section: Comorbiditiesmentioning

confidence: 99%

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

et al. 2012

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“…Observational and case-control studies demonstrated a reduction in all-cause mortality with metformin use in patients with diabetic heart failure compared with the use of alternate diabetes medications. 40 In accordance with this, the FDA removed heart failure as a contraindication in 2006. Expanding on this, investigators with the Reduction of Atherothrombosis for Continued Health (REACH) Registry assessed the impact of metformin in patients with diabetes and established atherosclerotic disease.…”

Section: Contraindicationsmentioning

confidence: 99%

“…38 In Thailand, 266 of 1458 diabetic patients taking metformin had a contraindication, most often chronic renal impairment (203 patients), yet none developed lactic acidosis over an average treatment duration of 4 years. 39 These studies and others 11,40,41 paint a picture of the frequent use of metformin outside of proscribed limits, yet reports of lactic acidosis remain rare.…”

Section: Contraindicationsmentioning

confidence: 99%

MALAdaptive: Do We Avoid Metformin Unnecessarily?

Terpening

2014

The Journal of the American Board of Family Medicine

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Metformin, heart failure, and lactic acidosis: is metformin absolutely contraindicated?

Cited by 124 publications

References 21 publications

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

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

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

MALAdaptive: Do We Avoid Metformin Unnecessarily?

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