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Metformin renal impairment — GPhC CRA MCQ

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HardEndocrine TherapeuticsMetformin renal impairmentGPhC CRA

A 69-year-old with type 2 diabetes is discharged after dehydration-related acute kidney injury. Her current eGFR is 26 mL/min/1.73 m² and she is prescribed metformin MR 1 g twice daily plus dapagliflozin 10 mg daily. Which medicine reconciliation action is most appropriate?

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Correct answer: D — Withhold metformin and clarify the post-AKI diabetes plan before supply

The 2026 NICE pathway does not use metformin below eGFR 30 mL/min/1.73 m². Dapagliflozin can provide cardiorenal benefit at lower eGFR values, but after acute illness its restart still depends on clinical stability, hydration and the discharge plan. The pharmacist should therefore withhold the unsafe metformin order and clarify the intended regimen rather than independently substituting or applying one renal threshold to both medicines.

Reference: NICE NG28, Initial medicines—people with CKD: https://www.nice.org.uk/guidance/ng28/chapter/initial-medicines