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General questions 10: Metformin

General questions 10: Metformin
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General question number 10 what is metformin? Why is metformin warned for use in patients with a creatinine clearance less than 60?
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And here the correct answer: as the drug is primarily excreted by the kidneys. In fact metformin is excreted to greater than 80% exquisite unchanged by the kidneys and again if we have some information about the drug that will help us to make the right choice. Here again the fraction excreted insurance is 80% and here is why the drug is contraindicated because in renal failure increased plasma metformin could reduce the lactate metabolism.
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So that increased the blood level of lactic acid on the other hand renal insufficiency directly causes a decrease in lactate excretion suppose the inhibition of metabolism by metformin and a direct effect on lactate accretion both contribute to acidosis and that’s why metformin is contraindicated in diabetic patient with GFR less than 60 in fact the Taiwan FDA recommend if GFR is between 30 and 45 those should be reduced and if GFR is less than 30 then the drug is simply contraindicated
Continuing from the previous step, Prof. Lee explains the final general question this time.
This question is significant. Why is metformin warned for use in patients with a creatinine clearance less than 60?
The reason is that it is excreted to greater than 80% exquisite unchanged by the kidneys.
Besides, from the additional information he provides, we can know that Taiwan FDA recommend if GFR is between 30 and 45, we should reduce metformin dosage; if GFR is less than 30, then metformin is simply contraindicated.
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Pharmacokinetics: Drug Dosing in Renal Disease

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