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Brand names: Glucophage • Drug class: Biguanide
Metformin is the first-line diabetes drug — and it is safe in kidney disease down to eGFR 30, per the 2016 FDA label revision. Below 30 it's stopped because of lactic acidosis risk. The old 'never in kidney disease' fear is outdated.
Metformin is cleared by the kidneys. The 2016 label revision aligned use with eGFR: start at ≥45, use with monitoring at 30-44 (do not initiate), contraindicated <30. Acute kidney injury situations (dehydration, contrast, surgery) warrant temporary holds. Metformin itself does NOT damage kidneys.
FDA 2016 label: initiate at eGFR ≥45; do not initiate at 30-45; contraindicated <30
FDA Metformin label revision, 2016
KDIGO 2022: metformin remains first-line in type 2 diabetes with CKD eGFR ≥30
KDIGO Diabetes Guideline, 2022
Lactic acidosis risk ~4-10 per 100,000 patient-years — concentrated at eGFR <30 and acute illness
Pharmacovigilance data, 2023
Use the metformin eGFR eligibility checker. Key rules: check eGFR at least annually (more often if at risk); hold on the day of iodinated contrast and 48h after (or per local protocol); hold during severe vomiting/diarrhea; restart once kidney function is confirmed stable.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.