met-FOR-min
Contraindicated in:
Severe renal impairment (CCr <30 mL/min)
;Iodinated contrast imaging procedure in patients with CCr 30–60 mL/min; a history of liver disease, alcoholism, or HF; or those who will be administered intra-arterial iodinated contrast; discontinue metformin and reevaluate renal function 48 hr after imaging procedure; may restart therapy if renal function stable
;Hepatic impairment
;Use Cautiously in:
Mild to moderate renal impairment (initiation of therapy not recommended if CCr 30–45 mL/min; if CCr becomes <45 mL/min during therapy, assess risk-to-benefit of continuing therapy)
;Chronic alcohol use/abuse
;Hypoxic states (acute HF, shock, MI, sepsis) (↑ risk of lactic acidosis)
;Older adults may be at ↑ risk of lactic acidosis
.F and E: LACTIC ACIDOSIS
GI: abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste
Hemat: ↓vitamin B12 levels
Drug-drug:
Acute or chronic alcohol ingestion, iodinated contrast media, topiramate, zonisamide, and acetazolamide may ↑ risk of lactic acidosis.
Drug-Natural Products:
Absorption: 50–60% absorbed after oral administration.
Distribution: Extensively distributed to tissues.
Half-Life: 17.6 hr.
Explain to patient the risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, or severe or continuing diarrhea occurs or if medical tests or surgery is required. Symptoms of lactic acidosis (chills, diarrhea, dizziness, low BP, muscle pain, abdominal pain, sleepiness, slow heartbeat or pulse, dyspnea, weakness) should be reported to health care provider immediately.
NDC Code
