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Lactate levels with chronic metformin use: a narrative review

Huang, W, Castelino, RL and Peterson, GM ORCID: 0000-0002-6764-3882 2017 , 'Lactate levels with chronic metformin use: a narrative review' , Clinical Drug Investigation , doi: 10.1007/s40261-017-0564-6.

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Abstract

Metformin has been associated with lactic acidosis.Lactate levels are not commonly tested in clinicalpractice, and it is unclear to what extent metformin wouldtypically increase lactate levels with chronic use. The aimof this review was to determine whether regular monitoringof the plasma lactate level would be beneficial in avoidinglactate accumulation and, ultimately, minimising the incidenceof lactic acidosis in metformin-treated patients.A comprehensive search of PubMed, Embase, Web ofScience, Cochrane and International PharmaceuticalAbstracts databases covering the period up to 30 May 2017was performed. Search terms included combinations of termsand keywords, including ‘‘metformin’’, ‘‘lactate’’, ‘‘lacticacid’’ and ‘‘lactic acidosis’’. Cases series of lactic acidosis ormetformin-associated lactic acidosis were excluded.Of 1539 potentially relevant articles, a total of 52reported lactate levels from routine/regular pathologicaltests in metformin users. The studies were subdivided intofour themes, regarding metformin usage and the reportedlactate levels in patients who: (1) did not havecontraindications to the use of metformin; (2) had contraindications,or renal impairment but without other contraindications;(3) exercised; or (4) also received anynucleoside reverse transcriptase inhibitor. Studies havereported that metformin treatment could increase lactatelevel of users. However, most results showed that thelactate level remained in the normal range.No definitive conclusions on the benefits of regular lactatemonitoring in patients taking metformin can be made. Futureresearch on larger populations focusing on the measurementof lactate levels with continuous metformin use is warranted.

Item Type: Article
Authors/Creators:Huang, W and Castelino, RL and Peterson, GM
Keywords: Metformin lactic acidosis diabetes safety
Journal or Publication Title: Clinical Drug Investigation
Publisher: Adis International Ltd
ISSN: 1173-2563
DOI / ID Number: 10.1007/s40261-017-0564-6
Copyright Information:

Copyright Springer International Publishing AG 2017

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