Glucophage 500 mg/Glucophage Forte/Glucophage XR: Metformin (Glucophage XR) MUST NOT BE USED in the following cases: Hypersensitivity to metformin hydrochloride or to any of the excipients. Any type of metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis); Diabetic pre-coma; Severe renal failure (CrCl below 30 mL/min or eGFR below 30 mL/min/1.73m2; Acute conditions with the potential to alter renal function such as dehydration, severe infection or shock. Disease (especially acute disease or worsening of chronic disease) which may cause tissue hypoxia such as unstable congestive heart failure, respiratory failure, recent myocardial infarction or shock. Hepatic insufficiency, acute alcohol intoxication, alcoholism.
Intravascular administration of iodinated contrast materials in radiodiagnostic examinations can lead to renal failure. This may induce metformin accumulation and may expose to lactic acidosis. Therefore, metformin must be discontinued 48 hours before the test in patients with CrCl below 45 mL/min or eGFR below 45 mL/min/1.73m2 for intravenous administration or in patients with CrCl below 60 mL/min or eGFR below 60 mL/min/1.73m2 for intra-arterial administration. Metformin may not be reinstituted until 48 hours afterwards, and only after renal function has been re-evaluated and has not deteriorated further.
Metformin must be discontinued 48 hours prior to elective major surgical interventions and may not be reinstated until 48 hours afterwards, and only after renal function has been re-evaluated and has not deteriorated further.