One or two intact local summaries. No averaged regimen, patient-specific dose or automatic source preference.
1 local source card selected. Local card fingerprints checked where supplied. This is not an original-document hash, source-currency guarantee or clinical approval. Record-level cautions below are the current library's cautions, not a frozen prior version.
Independent clinical review is pending. Confirm indication, exact formulation/route, population, renal measure and units, kidney-function stability, dialysis prescription, interacting drugs, monitoring and source revision. An RX mirror and its original label are not independent corroboration. Missing disagreement notes do not certify agreement.
These historical serum-creatinine cutoffs are not a current-label validation. A separately attributed current U.S. eGFR-based label must control current product-label dosing.
The preserved source uses historical serum-creatinine cutoffs. The imported U.S. immediate-release label instead uses indexed eGFR, and contraindicates use below 30 mL/min/1.73 m2. The old rule and current-label summary must not be blended.
The joint ADA/KDIGO 2022 consensus supports selected CKD use with a lower daily dose at eGFR 30-44. The U.S. label separately discourages initiation between eGFR 30 and 45 and requires benefit-risk reassessment for continued therapy below 45.
What to reconcile: Do not interpret a continuation strategy as automatic authorization for a new start. Reconcile label, guideline, acute illness and monitoring; document the plan, including when therapy should be held or reassessed.
Open this note and its source referencesThe book's table lists 25-50% of normal dose, maximum 2000 mg/day, at GFR 45-59; 25% at 10-45; and avoidance below 10. However, its Other information explicitly states manufacturer contraindication below 30 and a 1000 mg/day maximum at 30-44. The broad 10-45 row is therefore NOT reproduced as a current treatment algorithm.
metformin:rdh5-640-1 · Source locator: Dose in renal impairment; Other information
The book recommends avoidance for APD/CAPD, HD, high-flux HDF and CAV/VVHD. It describes metformin removal by HD/high-flux treatment, probable removal by CAV/VVHD and uncertain peritoneal removal.
metformin:rdh5-640-2 · Source locator: Dose in renal replacement
The current selected U.S. label contraindicates eGFR below 30. Do not apply the old 10-45 percentage row below that threshold. The handbook's normal-dose maximum of 3 g/day is not the selected U.S. IR maximum.
This reference does not select a regimen. Complete the indication, measured/estimated renal function and trend, dialysis setting, source rationale, monitoring and reassessment plan in your institution's approved documentation system. Confirm the complete current source before adopting its regimen.
Pinned reference: https://globalrph.com/blogCalcs/renal-dosing-master/compare.php?id=metformin&s1=rdh5-640&h1=1e127cff52e264fc19554d1d31b8b89865b8a57e31b3f3d6602b303206044e48