Contraindicated metiformin in patients with factors predisposing to lactic acidosis

contraindicated metiformin in patients with factors predisposing to lactic acidosis.
These predisposing factors/contraindications are:
● Impaired renal function (estimated glomerular filtration rate [eGFR] <30 mL/min)
● Concurrent active or progressive liver disease
● Active alcohol abuse
● Unstable or acute heart failure at risk of hypoperfusion and hypoxemia
● Past history of lactic acidosis during metformin therapy
● Decreased tissue perfusion or hemodynamic instability due to infection or other causes

The US Food and Drug Administration (FDA) revised its labeling of metformin, which previously had identified metformin as contraindicated in women and men with serum creatinine levels ≥1.4 mg/dL (124 micromol/L) and ≥1.5 mg/dL (133 micromol/L), respectively. The use of metformin is contraindicated in patients with an eGFR <30 mL/min, and the initiation of metformin is not recommended in patients with an eGFR between 30 and 45 mL/min.

#ADA_GUIDELINES:
*Metformin is contraindicated in individuals with:
*Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels ≥1.5 mg/dL [males], ≥1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia
*Known hypersensitivity to Metformin hydrochloride
*Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin