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Metformin renal impairment — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentMetformin renal impairmentGPhC CRA

A 73-year-old man taking metformin 1g twice daily has a new eGFR result of 27mL/min/1.73m2 after treatment for dehydration. He also takes ramipril and furosemide. He feels weak and has reduced oral intake. What is the most appropriate action?

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Correct answer: D — withhold metformin and arrange urgent prescriber review of renal function and diabetes treatment

Metformin is contraindicated or requires stopping in severe renal impairment because lactic acidosis risk increases. Acute illness, dehydration and diuretic/ACE inhibitor use further increase concern for acute kidney injury. The pharmacist should advise withholding and arrange urgent clinical review. Increasing metformin would be unsafe.

Reference: BNF; NICE CKS: Diabetes type 2