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August 14, 2002

Inappropriate Prescription for Metformin

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(6):694-695. doi:10.1001/jama.288.6.693

To the Editor: Dr Horlen and colleagues1 found that approximately 25% of prescriptions for metformin were to patients with diabetic contraindications such as CHF or renal failure. This finding must be interpreted with caution.

First, it is unclear whether patients with a contraindication have a higher relative risk of fatal lactic acidosis than those without contraindications. Although Horlen et al cite findings that 90% of patients with lactic acidosis had contraindications to metformin therapy, this does not provide an estimate of the relative risk of lactic acidosis across a population of patients with or without contraindications.