Many Patients Given Metformin in Hospitals Despite Contraindications

Many patients who are treated with metformin (Glucophage) during hospital stays have medical conditions or undergo procedures that, when combined with metformin, put them at risk for developing lactic acidosis, a potentially life-threatening condition caused by a build-up of lactic acid that can lead to organ damage.

Amy T. Calabrese, PharmD, and colleagues from the University of Pittsburgh, writing in the February 25, 2002, issue of the Archives of Internal Medicine, evaluated the effects of metformin therapy on 204 patients who were admitted to the hospital during a six-month study period and who were given at least one dose of the drug.

In 71 admissions (27 percent), patients who had at least one absolute condition that made use of metformin inadvisable were given at least one dose of the drug during admission. In 29 of those admissions, treatment with metformin was continued, despite the risk. The most common contraindication, evidence of kidney dysfunction, was present or developed during admission in 32 of the patients. However, metformin therapy was stopped in only eight of those cases.

In 97 admissions, metformin was given even though the patients were undergoing studies involving intravenous contrast dyes, which is one of the most common conditions that should argue against using metformin, the researchers note.

“Many patients are treated with metformin despite having clinical conditions that place them at risk for developing lactic acidosis,” write the researchers. To avoid this problem, those prescribing the drug need to “develop a better understanding of the prescribing guidelines.”

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