Metformin in Diabetic Kidney Disease
Immediate release:
• Initial 500 mg or 850 mg once daily
• Titrate upwards by 50 mg/d or 850 mg/d every 7 days until maximum dose
eGFR 30-44: Initiate at half the dose and titrate upwards to half of maximum recommended dose
eGFR < 30: Stop metformin; do not initiate metformin
Monitor vitamin B12 annually if on metformin for more than 4 years or at risk of vitamin B12 deficiency
Monitor kidney function at least every 3-6 months
#Metformin #CKD #pharmacology #algorithm #management #kdigo #initiation #titration