HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Philbrick, A. M. Articles by Moores, K. G. PubMed PubMed Citation Articles by Philbrick, A. M. Articles by Moores, K. G.

ANN M. PHILBRICK, PHARM.D., is Assistant Professor, Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis; at the time of writing she was Postgraduate Year 2 Ambulatory Care Resident, Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics (UIHC), Iowa City. MICHAEL E. ERNST, PHARM.D., is Professor (Clinical), Department of Pharmacy Practice and Science, College of Pharmacy, and Professor (Clinical), Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa (UI), Iowa City; at the time of writing he was Associate Professor (Clinical), Department of Pharmacy Practice and Science, College of Pharmacy, and Associate Professor (Clinical) Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, UI. DEANNAL . MCDANEL, PHARM.D., is Assistant Professor (Clinical), Department of Pharmacy Practice and Science, College of Pharmacy, UI, and Clinical Pharmacy Specialist, Department of Pharmaceutical Care, UIHC. MARY B. ROSS, B.S .PHARM., M.B.A., is Assistant Director, Department of Pharmaceutical Care, UIHC, and Adjunct Associate Professor, College of Pharmacy, UI. KEVIN G. MOORES, PHARM.D., is Associate Professor (Clinical) and Director, Drug Information Service, College of Pharmacy, UI.

Address correspondence to Dr. Moores at the Drug Information Service, College of Pharmacy, University of Iowa, 100 Oakdale Campus N330OH, Iowa City, IA 52242-5000 (kevin-moores{at}uiowa.edu).

Purpose. The relationship among metformin use, plasma lactate levels, and lactic acidosis in patients with type 2 diabetes mellitus and the appropriateness of metformin use in patients with renal dysfunction are discussed. Summary. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes recommends metformin therapy as first-line therapy along with lifestyle modification to treat type 2 diabetes mellitus. Despite this recommendation, metformin may be underutilized due to the fear of metformin-associated lactic acidosis and because its use is contraindicated in patients with renal dysfunction. Several studies have attempted to characterize the relationship among plasma metformin levels, plasma lactate levels, and lactic acidosis. However, a causal relationship between metformin and lactic acidosis has not been definitively established. In the United States, the estimated rate of lactic acidosis among diabetic patients treated with metformin is similar to that of diabetic patients not taking metformin. Despite specific guidelines advising against prescribing metformin in renal dysfunction, published reports indicate that metformin is continued in 25% of patients after the contraindication is discovered. Individual studies point to a possible correlation between metformin levels and plasma lactate levels, but mortality does not appear to correlate with plasma metformin levels. These results indicate that there may not be a direct relationship between plasma lactate and metformin levels. Conclusion. Current studies point to a weak causal relationship between metformin and lactic acidosis. In patients without comorbid conditions that would predispose them to lactic acidosis, elevated serum creatinine levels should be considered a risk factor for the development of lactic acidosis but not an absolute contraindication. Index terms: Acidosis; Antidiabetic agents; Blood levels; Contraindications; Creatinine; Diabetes mellitus; Kidney diseases; Metformin; Pharmacokinetics; Protocols; Rational therapy; Toxicity