6.1.2.2 Biguanides

GREEN Metformin tablets 500mg, 850mg

> Review metformin dose when serum creatinine >130 micromol/litre or eGFR <45 ml/min/1.73 m2.

> Stop metformin if serum creatinine >150 micromol/litre or eGFR <30 ml/min/1.73 m2.

> Prescribe metformin with caution in those at risk of sudden deterioration of kidney function, or at risk of a

decline of eGFR to <45 ml/min/1.73 m2.

Metformin is recommended for reduction in the risk or delay of the onset of type 2 diabetes mellitus in adult, overweight

patients with impaired glucose tolerance and/or impaired fasting glucose, and/or increased HbA1c who are:

> at high risk for developing overt type 2 diabetes mellitus AND

> still progressing towards type 2 diabetes mellitus despite implementation of intensive lifestyle change for 3

to 6 months OR

> are unable to participate in an intensive lifestyle-change programme.

GREEN Metformin tablets (standard release)

*Second line treatment to intensive lifestyle-intervention

Metformin Oral Solution SF

Use restricted to those with swallowing difficulties/enteral tube feeding

GREEN Metformin 500mg/5ml oral solution SF

Metformin Sustained Release (SR) Tablets

In patients in whom slow dose titration does not reduce GI adverse effects, metformin sustained release tablets should be

used ONLY where intolerance to the immediate release preparation had been clearly documented and where it prevents

continuation of metformin therapy. A review of the evidence on the use of sustained release metformin preparations did

not find that their use in unselected patients reduced gastro-intestinal side effects.

Metformin sustained release tablets are supported purely as an attempt to ensure the largest number of patients are able

to stay on metformin therapy, hopefully delaying progression to other new drugs which often have a reduced evidence

base and/oradditional safety concerns.

GREEN Metformin sustained release (SR), tablets 500mg, 750mg, 1000mg

All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the

public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service.

Email: info.elmmb@nhs.net