一些治療準則指出，在給予含碘顯影劑前，基於腎功能可能快速改變，服用metformin者應立即停用，且需依腎功能正常與否重新給藥。本研究探討某區域醫院使用metformin且開立顯影劑檢查的病患，醫師是否皆依據適應症、排除禁忌症或注意危險因子而使用metformin，在接受顯影劑檢查前，是否停用藥，且視腎功能正常與否重新投予，同時也探討兩藥併用是否增加腎功能變差或乳酸中毒機率。146位病患執行169次檢查的結果，97.9%病患依據適應症，84.3%排除血清肌肝酸值異常、88.2%排除大於80歲且腎功能異常、89%排除需治療之充血性心臟衰竭等禁忌症而使用metformin。危險因子部分，32.9%未注意病患有感染、脫水、噁心、嘔吐等壓力或手術，37.7%未注意病患併用腎毒性藥品。影像檢查部分，僅26.6%病患在檢查當天停用metformin。90.1%病患在檢查前測量腎功能，檢查後再確認者卻只有23.7%。腎功能正常者僅18.3%依據治療準則在投予顯影劑前停用metformin，且只有3.3%在檢查後停用48小時並依據腎功能重新給藥。5.6%病患併用藥物後腎功能變差，但未發現有乳酸中毒事件。藉由研究結果建議該院醫師處方顯影劑時應參考治療準則，排除禁忌症及注意危險因子而使用藥物，以提升metformin使用病患之用藥安全。
Administering iodinated contrast media to patients receiving metformin may cause acute alteration of renal function and lead to lactic acidosis. Therefore, some therapeutic guidelines suggest that patients given iodinated contrast media should stop taking metformin on the day of procedure. Renal function tests should be performed at least 48 hours after the procedure, and patients can start taking metformin again once normal results confirmed. This study was to review the appropriateness of metformin usage on patients receiving iodinated contrast media and to elucidate whether the incidence of renal insufficiency and lactic acidosis would increase in patients using metformin and iodinated contrast media concurrently.
Our results showed that 146 patients underwent 169 radiological procedures, 97.9% were treated with metformin based on its indication. Patients who were not contraindicated were included, which were serum creatinine within normal range (84.3%), age under 80 year old (88.4%) and without chronic congestive heart failure under management (89%). 32.9% patients with risk factors including surgery, infection, dehydration, nausea/vomiting were treated with metformin, so were 37.7% who had concurrent usage of drugs with renal toxicity. 26.6% of patients withheld metformin on the day of procedure. Renal function checked prior procedure were 90% of patients, whereas only 24% rechecked within three days afterwards. While 18.3% of those with normal renal function follow recommended guidelines of withholding metformin before the procedure, and only 3% withholding for 48 hours and resumed metformin according to their updated renal function. 5.6% patients developed renal function insufficiency when metformin and contrast media were used concurrently; however no lactate acidosis was found.
It is therefore strongly recommended for physicians to follow the therapeutic guidelines when issuing orders of radiological examination with contrast media for patients, especially for those taking with metformin concurrently.
