At what eGFR should metformin be stopped?

FDA guidance: continue metformin at eGFR ≥45; assess risk/benefit at eGFR 30-44 (consider dose reduction); contraindicated at eGFR <30. Hold metformin 48 hours before and after IV contrast media if eGFR <60.

What is metformin-associated lactic acidosis (MALA)?

MALA occurs due to metformin accumulation (normally renally cleared) inhibiting mitochondrial respiratory chain Complex I, increasing anaerobic lactate production. Incidence is low (~3-9 per 100,000 patient-years) but mortality ~50%.

Metformin Renal Dose Adjustment — Lactic Acidosis Risk

Determine metformin dose adjustment or contraindication based on eGFR to prevent metformin-associated lactic acidosis (MALA) in type 2 diabetes patients with renal impairment per KDIGO and FDA recommendations.

Use the full interactive calculator below, or

Metformin Renal Dose Adjustment — Lactic Acidosis Risk

Frequently Asked Questions

At what eGFR should metformin be stopped?

What is metformin-associated lactic acidosis (MALA)?