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Metformin and contrast media--a dangerous combination?
M M McCartney1, F J Gilbert, L E Murchison
1Department of Radiology, University of Aberdeen, Scotland, UK.
Clinical Radiology
|January 23, 1999
Summary
Metformin-associated lactic acidosis (MALA) is rare following contrast media, especially in patients with normal kidney function. Current guidelines advising metformin discontinuation before contrast imaging may be overly cautious.
Area of Science:
- Nephrology
- Endocrinology
- Radiology
Background:
- Metformin is a primary treatment for type II diabetes mellitus.
- Metformin-associated lactic acidosis (MALA) is a concern following intravenous contrast media administration.
- Current guidelines recommend withholding metformin for 48 hours before and after contrast procedures.
Purpose of the Study:
- To systematically review the literature on MALA following intravenous contrast media.
- To evaluate the safety of administering intravenous contrast media to patients taking metformin.
Main Methods:
- Systematic literature review of reported cases of MALA.
- Analysis of patient renal function and contraindications to metformin use.
Main Results:
- Most MALA cases occurred in patients with pre-existing renal impairment or other metformin contraindications.
- Only one case of lactic acidosis was reported in a patient with normal renal function after contrast media.
Conclusions:
- The risk of MALA following contrast media in metformin users with normal renal function is very low.
- Current guidelines on withholding metformin before contrast imaging may require modification.
- Intravenous contrast media administration appears safe for metformin patients with normal renal function.