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?
A A Tahrani, specialist registrar in diabetes and endocrinology,
G I Varughese, specialist registrar in diabetes and endocrinology,
J H Scarpello, consultant physician,
F W F Hanna, consultant physician in diabetes and endocrinology
Department of Diabetes and Endocrinology, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG
Correspondence to: A A Tahrani abdtahrani@yahoo.co.uk
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
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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
ContraindicationsPrecautions
Data sources
Metformin and risk of lactic acidosis: what evidence?
Evidence from case reportsEpidemiological dataDisregard of contraindications
Cardiac failure and metformin
Canadian population dataCanadian cardiac failure dataUS cardiac failure data
Conclusions

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