BMJ  2007;335:508-512 (8 September), doi:10.1136/bmj.39255.669444.AE

Practice

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

Department of Diabetes and Endocrinology, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG

Many patients with type 2 diabetes are denied treatment with metformin because of "contraindications" such as cardiac failure, which may not be absolute contraindications

The first 150 words of the full text of this article appear below.

Introduction

Summary points Treatment with metformin is not associated with an increased risk of lactic acidosis among patients with type 2 diabetes mellitus who have no cardiac, renal, or liver failure Despite increasing disregard of contraindications to metformin by physicians, the incidence of lactic acidosis has not increased, so metformin may be safe even in patients with "contraindications" The vast majority of case reports relating metformin to lactic acidosis report at least one other disease/illness that could result in lactic acidosis Use of metformin in patients with heart failure might be associated with lower mortality and morbidity, with no increase in hospital admissions and no documented increased risk of lactic acidosis Further studies are needed to assess the risk of lactic acidosis in patients with type 2 diabetes and traditional contraindications to metformin

Metformin first became available in the United Kingdom in 1957 but was first prescribed in the United States only in . . . [Full text of this article]

Current contraindications to metformin use

Contraindications
Precautions

Data sources

Metformin and risk of lactic acidosis: what evidence?

Evidence from case reports
Epidemiological data
Disregard of contraindications

Cardiac failure and metformin

Canadian population data
Canadian cardiac failure data
US cardiac failure data

Conclusions

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