GlobalRPh Renal Dosing Masterv6.6
GlobalRPh source record

Metformin

Local official-label summaryBase record retrieved 2026-09-05See the evidence for this drug4 sources available - open source summaries, references and comparisons
READ THE SOURCE-SPECIFIC ANSWER

Renal guidance at a glance

Cautions / source differences (1)

Confirm the product, indication and renal measure. The selected summary is not a complete prescribing monograph.

Choose a source to read (4)

Display order is not a clinical ranking. Date of retrieval is not the label revision date. Sources are never merged into one regimen. Other sources and conflicts remain below.

1 additional source qualifications - review before use
First decide: new initiation or continued therapy

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.

Before applying: 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.

Also check: First decide: new initiation or continued therapy

Official source

Metformin hydrochloride immediate-release tablets

Product / population
Adults; oral immediate-release tablets, not extended-release or fixed combinations.
Renal measure
Not specified; verify before use
Adult starting dose and titration

Start 500 mg twice daily or 850 mg daily with meals. Increase by 500 mg weekly or 850 mg every 2 weeks according to response and tolerance; the labeled maximum is 2550 mg/day in divided doses.

Renal use and contrast procedures

Use indexed eGFR (mL/min/1.73 m2): below 30, treatment is contraindicated; starting treatment at 30-45 is not recommended. Reassess continuation if eGFR falls below 45 and discontinue below 30. Check renal function before treatment and periodically. For iodinated contrast, hold at/before the procedure with eGFR 30-60, specified liver/alcohol/heart-failure risks, or intra-arterial contrast; reassess after 48 hours and restart only when stable.

Source revision: | Retrieved: 2026-09-05. Retrieval date is not the revision date.

Source: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b51da8d7-ab4a-4c40-97c9-88bd379366d1

Scope: Source-read local summary; source-specific recommendations are not automatically interchangeable. GlobalRPh v6.6.

Full source card / provenance

All sources, comparison tools and evidence navigation
Source-first renal review

Evidence sources and renal implications

Choose a source to jump directly to its locally stored result. Qualitative precautions and evidence gaps remain visible even when no numerical clearance schedule is supplied.

Read 1 source difference / applicability notes

Preserved GlobalRPh source

Preserved original GlobalRPh source

Preserved historical content; not revalidated as current prescribing guidance.

Renal method: Read the measure and population stated in the original source sections.
Retrieved: 2026-09-05

Read local renal resultOpen original reference
Official product label

Metformin hydrochloride immediate-release tablets

Adults; oral immediate-release tablets, not extended-release or fixed combinations.

Renal method: See source.
Retrieved: 2026-09-05

Read local renal resultOpen original reference
Professional guidance

ADA/KDIGO 2022 - metformin in CKD

Dose or interval guidance. Use only the product, indication, renal metric and population described in this source.

Adults with type 2 diabetes and CKD; 2022 joint consensus, not asserted to be the latest 2026 guideline.

Renal method: Indexed eGFR, mL/min/1.73 m2.
Retrieved: 2026-09-07

Read local renal resultOpen original reference
Handbook

Renal Drug Handbook, fifth edition

Historical 2019 reference; renal bands retain the book's own method labels.

Renal method: See source.
Retrieved: 2026-09-05

Read local renal result

Source presence is not independent validation. A label mirror is not a second independent source; review the original reference and exact formulation.

Find text within this drug
Find a term without leaving this drug

Search the stored clinical text

Locate a word or phrase within this drug's source summaries. Choose all sources or one source to focus the search. The selection never hides warnings or source text, changes a dose, or proves that a renal finding is absent.

Find:

Enter at least two characters. Searches stay on this page and are not saved or sent.

All source summaries, original wording and provenance
Before applying a renal protocol

Check the setting. Compare whole sources.

No patient-specific dose is calculated. Context choices only display reminders; they do not validate, hide or change any regimen.

Share a reproducible source review

Choose sources below, then open a print-ready comparison with product scope, renal method, dates and cautions. Links can pin the exact local cards; they never contain patient values or choose a dose.

Open / share selected sources
Jump to renal guidanceRead 1 difference / caution notesClinician guide

Select two distinct source versions. The complete stored summaries will appear below.

Build a source-review outline for documentation

This creates a blank decision outline with the source identities you select, not a dose recommendation or completed clinical assessment. No patient fields are collected, saved or sent. Complete the clinical decisions in your approved documentation system.

Choose one or two sources above or use the source checkboxes below.

Renal-context checklist: population, kidney trend and dialysis

These prompts are a reading aid, not a prescription checklist or proof that all requirements have been met. No selections are stored or sent to a server.

Read the exact source scope, renal metric and date before selecting a row. No applicability assessment has been performed.

See source-specific renal methods and the clinical interpretation guide for the supporting context.

Read before choosing a regimen

Source differences and product cautions

Search differences across all drugs

These are specific issues found during source review, not an automated judgment that one source is universally correct. A label mirror and its original label are not independent evidence.

guideline vs label scope

First decide: new initiation or continued therapy

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.

How to use this: 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.

Metformin hydrochloride immediate-release tabletsADA/KDIGO 2022 - metformin in CKD

Source-specific interpretation; independent clinician adjudication pending.

Go directly to the relevant source section

Renal dosing and precautions

Choose a source, then jump to its renal or dialysis section. These links locate stored text; they do not merge regimens or certify that sources agree.

No dialysis or renal heading shown? Read the complete source summary. Absence of a heading is not evidence that dose adjustment is unnecessary.

Compare or copy source versions

All content below is stored locally. Read a whole source version; do not combine its dose with another source's interval, renal metric or dialysis assumptions.

Original content / product scopeMetformin hydrochloride immediate-release tabletsADA/KDIGO 2022 - metformin in CKDRenal Drug Handbook, fifth edition
Choose two source checkboxes below.
Historical source content is not a current prescription. Original GlobalRPh recommendations are preserved, not automatically certified as current. Product-label and professional additions below are separately attributed. Confirm indication, population, kidney-function method, monitoring and the full prescribing information before applying a regimen.

Important source distinctions

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.

Locally stored source content

Original GlobalRPh protocol

Clinical facts and comments transcribed into a structured reading format. This is not a byte-for-byte HTML archive. Original source: https://globalrph.com/renal/metformin/

Usual Dosing (Adults)

Immediate-release: start 500 mg twice daily or 850 mg daily; increase by 500 mg weekly or 850 mg every 2 weeks to 2,000 mg/day in divided doses; maximum 2,550 mg/day. Glucophage XR: start 500 mg with the evening meal; increase by 500 mg weekly to a maximum 2,000 mg with the evening meal.

GRPH-metformin-01 · Source section: Usual Dosing (Adults)Renal section finder

Renal Dosing

The historical source lists contraindications at serum creatinine above 1.5 mg/dL in males or above 1.4 mg/dL in females, or abnormal creatinine clearance (approximately below 60-70 mL/min).

GRPH-metformin-02 · Source section: Renal DosingRenal section finder

Hemodialysis

Contraindicated in the source.

GRPH-metformin-03 · Source section: HemodialysisRenal section finder
Separate U.S. product-label layer

FDA / DailyMed dosing and renal information

Official

Metformin hydrochloride immediate-release tablets

Open original reference

Open / share this exact local source

NIH/NLM DailyMed - U.S. prescribing information · Adults; oral immediate-release tablets, not extended-release or fixed combinations.

Renal method: Not specified in this summary.
Source date:
Retrieved: 2026-09-05

Source-read local summary; source-specific recommendations are not automatically interchangeable.

Adult starting dose and titration

Start 500 mg twice daily or 850 mg daily with meals. Increase by 500 mg weekly or 850 mg every 2 weeks according to response and tolerance; the labeled maximum is 2550 mg/day in divided doses.

metformin:dm-b51da8d7-ab4a-4c40-97c9-88bd379366d1-1 · Source locator: 2.1 Adult Dosage

Renal use and contrast procedures

Use indexed eGFR (mL/min/1.73 m2): below 30, treatment is contraindicated; starting treatment at 30-45 is not recommended. Reassess continuation if eGFR falls below 45 and discontinue below 30. Check renal function before treatment and periodically. For iodinated contrast, hold at/before the procedure with eGFR 30-60, specified liver/alcohol/heart-failure risks, or intra-arterial contrast; reassess after 48 hours and restart only when stable.

metformin:dm-b51da8d7-ab4a-4c40-97c9-88bd379366d1-2 · Source locator: 2.3 Renal Impairment; 2.4 Iodinated Contrast

Source identity and provenance
Source
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b51da8d7-ab4a-4c40-97c9-88bd379366d1
Retrieved
2026-09-05
Exact label title
Metformin hydrochloride immediate-release tablets
DailyMed Set ID
b51da8d7-ab4a-4c40-97c9-88bd379366d1
Labeler
Legacy Pharmaceutical Packaging LLC (repackager)
DailyMed page updated
2026-03-11
FDA application
ANDA marketing category; exact application number not captured
U.S. product identity basis
Exact named product and route appear in the selected U.S. prescription label; current retail availability was not independently assessed.
Hash meaning
Locally authored source summary, not original SPL/XML/PDF bytes
Local summary SHA-256
8682c718cb6337dd9cc96731f5390f03efbead53d13a0583d093848725464052
Separate handbook layer

Renal Drug Handbook cross-check

Handbook

Renal Drug Handbook, fifth edition

Open / share this exact local source

UK Renal Pharmacy Group / Ashley and Dunleavy / CRC Press · Historical 2019 reference; renal bands retain the book's own method labels.

Renal method: Not specified in this summary.
Source date: Not established
Retrieved: 2026-09-05

Historical handbook facts locally summarized; not a current U.S. label or a modern CRRT protocol.

Historical table and internal limitation

The 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

Renal replacement

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

Source-specific limits

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.

Source identity and provenance
Retrieved
2026-09-05
Handbook page
Printed page 640; PDF page 659
Hash meaning
Locally authored source summary, not original SPL/XML/PDF bytes
Local summary SHA-256
9b4a277b52070882fa64fcdd668930a908d3ce91a42f9d39ebdc908e937f8071
Separate professional-source layer

University and professional protocols

Professional

ADA/KDIGO 2022 - metformin in CKD

Open original reference

Open / share this exact local source

American Diabetes Association / KDIGO · Adults with type 2 diabetes and CKD; 2022 joint consensus, not asserted to be the latest 2026 guideline.

Renal method: Indexed eGFR, mL/min/1.73 m2.
Source date: 2022 ADA/KDIGO consensus, Diabetes Care 45:3075-3090
Retrieved: 2026-09-07

Dose or interval guidance. Use only the product, indication, renal metric and population described in this source.

Selected source text imported locally; independent clinical review pending. Not a complete prescribing monograph.

Renal dosing, restrictions and evidence limits

The consensus supports metformin in selected patients with type 2 diabetes and CKD at eGFR at least 30 mL/min/1.73 m2. Reduce to 1,000 mg daily at eGFR 30-44; consider reduction at 45-59 with high hypoperfusion or hypoxemia risk. Monitor eGFR every 3-6 months once below 60. A sick-day plan that holds metformin during acute illness may reduce lactic-acidosis risk, especially when AKI reduces clearance. The U.S. label separately discourages initiation at eGFR 30-45; distinguish a new start from continuation.

RDM34-professional-metformin-ada-kdigo2022-C1 · Source locator: Metformin subsection and consensus statement.

Source identity and provenance
Source family
professional_guidance
Source
https://diabetesjournals.org/care/article/45/12/3075/147614/Diabetes-Management-in-Chronic-Kidney-Disease-A
Retrieved
2026-09-07
Renal-function method
Indexed eGFR, mL/min/1.73 m2.
Source date/version
2022 ADA/KDIGO consensus, Diabetes Care 45:3075-3090
Hash meaning
SHA-256 of local authored summary only, not original HTML, PDF or SPL bytes.
Local summary SHA-256
8bf496600e75b3d5265459994114cc8bd69fb9ecbd664cf1cef3d4bcff69dd5f

Provenance and preservation

Additional summaries stored on this page: 1 official-label, 0 RX List, 1 professional, 1 handbook. Empty additional-source groups are not shown. A missing layer is not a no-adjustment recommendation.

Original source
https://globalrph.com/renal/metformin/
Source retrieval
2026-09-05. This is not the source publication or label revision date.
Original source type
globalrph individual
Local text SHA-256
6fa6e283be00fd69eca2a6e76c2b9e1a14cef8926f1206fe692400f191b891a9
Import versus clinical validation
Source-section locators identify where retained content came from. A source-section identifier does not assert that every numeric statement has been independently corroborated. The local text hash is not a hash of original HTML, an FDA PDF or SPL XML.

The original individual GlobalRPh pages commonly cite NIH/NLM DailyMed and instruct readers to review the applicable package insert for updates. That historical reference is preserved as context; it is not counted as an independently retrieved current label.

Read the full coverage report