Metformin and CM
Patients taking metformin. “New” guidelines based on eGFR:
Iodine-based contrast media (intravenous)
eGFR ≥ 30 mL/min/1.73 m2
. There is no need to discontinue metformin either before or after intravenous contrast medium exposure.
eGFR < 30 mL/min/1.73 m2
. Metformin is usually contraindicated and iodinated-based contrast media should be avoided.
Gadolinium-based contrast media (intravenous)
No special precautions are necessary.
References:
1. Bodmer M, Meier C, Krahanbuhl S, et al. Metformin, sulphonylureas or other antidiabetic drugs and the risk of lactic acidosis or hypoglycaemia. Diabetes Care 2008; 31:2086-2091.
2. Boer IH, Caramori ML, Chan JCN, et al. Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment. Practice Guideline Kidney Int. 2020; 98(4):839-848.
3. Kao TW, Lee KH, Chan WP, et al. Continuous use of metformin in patients receiving contrast medium: what is the evidence? A systematic review and meta-analysis. Eur Radiol. 2022; 32:3045-3055.
