Suspension of Metformin in Patients Receiving IV or IA Radiographic Contrast Material

Medical Directive ID: 
DIA-2021-001
Lead Contact Person: 
Karen Kennedy, Coordinator, Quality & Safety
Physician/Nurse Lead: 
Dr. Ian Ross, Site Chief, Diagnostic Radiology
Dr. Manas Sharma, Site Chief, Diagnostic Radiology
Program: 
Medical Imaging
Approval By: 
Medical Advisory Committee
Original Effective Date: 
Wednesday, February 12, 2014
Revised Date: 
Friday, January 15, 2021
To Be Reviewed Date: 
Tuesday, October 15, 2024
This Medical Directive Applies to the following sites: 
All LHSC sites
This Medical Directive Applies to the following patient population: 
In-Patients
Adults
Order: 

The Nurse/Medical Radiation Technologist will suspend Metformin/or oral diabetic medications containing metformin at the time of the Radiographic iodinated contrast administration (not before) in patients with renal disease stage IV or V (estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73m2). Metformin will remain suspended for at least 48 hours following the administration of iodinated radiographic contrast material. The Nurse/Medical Radiation Technologist will place an order for serum creatinine bloodwork to be completed two days (minimum 48 hours) following the procedure. Metformin must not be restarted until directed by the Most Responsible Professional (MRP).

Suspension of Metformin is also referenced in medical directive MED-2014-034 “Cardiac Catheterization Referrals by Regional Cardiac Care Coordinator”.

Note: The terms metformin and metformin HCl are used interchangeably.

Click the link to view the entire medical directive in detail: 

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