Trends in metformin utilisation and dose appropriateness in Australia

J. Moon, S. S. Kumar, G. G. Graham, M. T. Baysari, K. M. Williams, W. Chen, A. Viardot, J. R. Greenfield, R. O. Day*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Purpose: The study aimed to (1) determine the trends in the utilisation of metformin in Australia, (2) determine the appropriateness of metformin dosing in an Australian teaching hospital and (3) gather the opinions of prescribers on the relationship between metformin dose and renal function. Methods: National prescription data between 1990 and 2012 were accessed. A retrospective audit (2008–2012) of metformin doses and patient renal function (20 % random sample of all in-patients prescribed metformin) was conducted at St Vincent’s Hospital (SVH), Sydney. Prescribers of metformin were interviewed (semi-structured; consultants at SVH) or surveyed (Australian endocrinologists) to gather their understanding of metformin dosing in relation to renal function. Results: Metformin utilisation increased fivefold nationally between 1995 and 2012. Metformin tended to be under-dosed in SVH patients with normal renal function (83.5 %) and over-dosed in patients with impaired renal function (estimated glomerular filtration rate (eGFR) <30 mL/min, 50 %). Consultants indicated that metformin doses needed to be reduced in renal impairment. Most endocrinologists (61 %) were comfortable prescribing metformin down to eGFRs around 30 mL/min. Conclusion: The use of metformin increased greatly over the period of the study. Metformin is prescribed frequently for patients with eGFR values below the minimal level approved in the product label (60 mL/min). While prescribers expressed their understanding of the need to reduce metformin doses in patients with renal impairment, we found that metformin doses were higher than appropriate in patients with impaired renal function. Metformin may be used safely when renal function is poor provided dosage is appropriately reduced.

Original languageEnglish
Pages (from-to)1489-1496
Number of pages8
JournalEuropean Journal of Clinical Pharmacology
Volume72
Issue number12
DOIs
Publication statusPublished - 1 Dec 2016

Keywords

  • Dosing appropriateness
  • Metformin
  • Renal function

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