Metformin and antihypertensive therapy with drugs blocking the renin angiotensin system, a cause of concern?

Gudmundsdottir, Helga; Aksnes, H; Heldal, Kristian; Krogh, Anne Kirstine Havnsøe; Frøyshov, Sten; Rudberg, N; Os, Ingrid

doi:10.5414/cnp66380

Cited by 25 publications

(15 citation statements)

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“…Lactic acidosis is an infrequent, but potentially life threatening complication of metformin use [27,28]. This study shows that despite the warning against metformin in patients with RI in national treatment guidelines, SPC and the literature, metformin is still used [17,20,28].…”

Section: Discussionmentioning

confidence: 99%

Use of renal risk drugs in patients with renal impairment

et al. 2015

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Drug related problems often occur in patients with renal impairment. Incorrect drug dose and inappropriate drug choice according to the patients' renal function were the most common problems. Patients with the most complex drug treatment, i.e. with increasing degree of renal impairment and increasing number of drugs, are at greater risk of drug related problems. The high acceptance rate for the pharmacist's interventions supports the inclusion of a clinical pharmacist in the multidisciplinary treatment team to increase awareness and optimisation of the drug treatment in this patient group.

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Section: Discussionmentioning

confidence: 99%

Use of renal risk drugs in patients with renal impairment

et al. 2015

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“…Other intercurrent conditions included gastrointestinal bleeding (20%), liver disease (20%), and pancreatitis (10%). Furthermore, most patients with type 2 diabetes mellitus are on a number of other therapeutic agents (such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, nonsteroidal anti-inflammatory drugs, and diuretics) that may exacerbate renal function impairment in the state of renal hypoperfusion [14,15]. Precautions should also be considered when these conditions are anticipated.…”

Section: Discussionmentioning

confidence: 99%

Impact of acute kidney injury on metformin-associated lactic acidosis

Wen

2009

Int Urol Nephrol

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“…In our population, more than 50% of patients were on ACEIs or ARBs (38% and 24%, respectively). It is possible that the inhibition of renal auto-regulation mechanism by ACEIs and ARBs may precipitate lactate and metformin accumulation, thereby predisposing to acidosis but this direct relation is still unclear [15]. We also found a significant number of patients previously treated with diuretics (43%).…”

Section: Discussionmentioning

confidence: 66%

Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

et al. 2015

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Background: Severe metformin-associated lactic acidosis (MALA) is a rare but potentially fatal side effect of metformin. The clinical presentation is often unspecific, thus hindering early recognition. We aimed to assess the prevalence of MALA in an intensive care unit (ICU) and describe the demographic and clinical characteristics according to patient outcome. Methods:We conducted a 13-year single-center retrospective study, including all patients admitted in ICU with a high anion-gap metabolic acidosis and hyperlactatemia secondary to therapeutic use of metformin, after excluding other medical causes of acidosis.Results: Twenty one patients were admitted in ICU due to severe MALA (less than 1% of all admissions) with an ICU mortality rate of 23.8% (N=5). The baseline clinical characteristics were similar in survivors and nonsurvivors, both with a high prevalence of cardiovascular comorbidities as well as frequent concomitant therapy with angiotensin-converting-enzyme inhibitors and diuretics. All patients were treated with continuous renal replacement therapy (CRRT) and other organ failure support. Normal acid-base balance was achieved in all survivors in the first 24 hours. At baseline, the clinical and laboratory features of nonsurvivors were undistinguishable from survivors. Conclusions:Severe MALA is a rare cause of admission in the ICU.Although early institution of supportive therapy, MALA can progress to severe multiple-organ failure, especially when diagnosis and CRRT are delayed. Clinicians should suspect of MALA in all diabetic patients taking metformin with unexplained high anion-gap metabolic acidosis and hyperlactatemia.

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Metformin and antihypertensive therapy with drugs blocking the renin angiotensin system, a cause of concern?

Cited by 25 publications

References 0 publications

Use of renal risk drugs in patients with renal impairment

Use of renal risk drugs in patients with renal impairment

Impact of acute kidney injury on metformin-associated lactic acidosis

Severe Metformin Associated Lactic Acidosis: A Case Series Of An Intensive Care Unit

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