RENAL FUNCTION | SUGGESTED MAXIMUM METFORMIN DOSE, mg/d | INTERVAL FOR MONITORING RENAL FUNCTION |
---|---|---|
eGFR, mL/min | ||
• ≥ 60 | ≤ 2550 | Every 6–12 mo |
• 45–59 | ≤ 2000 | Every 3–6 mo |
• 30–44 | ≤ 1000 | Every 3 mo |
• < 30 | NA* | NA* |
Dialysis | ||
• Peritoneal dialysis | 250 | NA |
• Hemodialysis | 500 (after dialysis) | NA |
eGFR—estimated glomerular filtration rate, NA—not applicable.
↵* Diabetes Canada6 and American Diabetes Association7 guidelines suggest avoiding metformin if eGFR is < 30 mL/min owing to risk of lactic acidosis. However, given the outcome benefits and the rare risk of lactic acidosis, it is sometimes used cautiously (eg, 500 mg/d) in individuals with stable renal function between eGFR of 15 and 30 mL/min. Consider nephrology consultation.