Metformin is a biguanide, insulin-sensitizer that reduces blood sugar levels. There are concerns about the risk of lactic acidosis in patients on metformin having procedures requiring iodinated contrast, and in those with renal impairment or heart failure. The data on which these concerns are based are reviewed, with the conclusion that metformin therapy is rarely to blame for lactic acidosis. A generic policy of stopping metformin 48 h pre and post-procedure in all patients is counter-intuitive, lacks any evidence base and does not conform to the principles of best practice. In patients with heart failure, although the underlying condition can predispose to LA, existing evidence in fact suggests that metformin use is associated with improved outcome rather than elevated risk
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