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Can phenformin-induced lactic acidosis be prevented?

E A Gale, R B Tattersall

British Medical Journal

|October 23, 1976

Summary

Phenformin use in diabetic patients is linked to lactic acidosis, especially with existing organ disease. Due to safety concerns and monitoring difficulties, withdrawing phenformin from general use is recommended.

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Area of Science:

Endocrinology
Pharmacology
Nephrology

Background:

Phenformin, an oral antidiabetic agent, carries a risk of lactic acidosis, particularly in patients with renal, cardiovascular, or hepatic compromise.
Established criteria for the safe prescription and monitoring of phenformin remain unclear.
Lactic acidosis is a serious adverse event associated with phenformin therapy.

Observation:

A review of eight diabetic patient deaths from lactic acidosis in Nottingham (1972-1975) revealed all were on therapeutic doses of phenformin.
Six of these patients had attended diabetic clinics shortly before their deaths.
Predisposing factors such as renal impairment and hypertension were present in some cases, but not all.

Findings:

The study identified significant risks associated with phenformin, including cases with pre-existing renal impairment and hypertension.
In two fatal cases, no clear predisposing factors were identified, suggesting unpredictable risks.
The numerous contraindications and monitoring challenges raise doubts about the safe administration of phenformin.

Implications:

The findings suggest that phenformin poses a substantial risk of lactic acidosis in diabetic patients.
Inadequate monitoring and numerous contraindications question the feasibility of safe phenformin use.
A recommendation is made to withdraw phenformin from general clinical practice due to safety concerns.

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