Gastrointestinal Radiology > Procedures > Contrast Caution


Recommendations for Iodinated Contrast Use
in Patients taking Metformin (Glucophage)

These recommendations have been reviewed by members of the U. Va. Department of Radiology and the Division of Endocrinology. They are based on the American College of Radiology recommendations, with some additions.
I.  General Recommendations: Any diabetic patient should have recent serum creatinine and estimated GFR prior to use of intravascular iodinated contrast medium.
II.  Recommendations for an elective contrast study using iodinated contrast medium:
  1. Normal serum creatinine
    1. Discontinue Metformin (Glucophage) for 48 hours prior to and for 48 hours after the contrast examination.
    2. Reevaluate renal function before reinstating Metformin therapy in any patient with clinical or laboratory evidence to suggest renal dysfunction.
  2. Abnormal serum creatinine - Do not use iodinated contrast media.
    3.
III.  Recommendations for an urgent contrast study using iodinated contrast medium:
  1. Abnormal serum creatinine
    1. Consider alternative non-contrast studies.
    2. If a contrast study is medically necessary, Metformin should be discontinued for 48 hours prior to and for 48 hours after the administration of iodinated contrast medium. Reevaluate renal function prior to reinstating Metformin therapy.
  2. Normal serum creatinine
    1. Iodinated contrast study may be done without waiting 48 hours.
    2. Patient should be well hydrated
    3. Low osmolar contrast media should be used.
    4. Metformin (Glucophage) should be immediately stopped and withheld for 48 hours after the contrast administration.
    5. Renal function should be closely monitored.
    6. Metformin (Glucophage) should not be reinstituted until after renal function has been reevaluated and found to be normal
    3.
IV.  Recommendations for an extremely urgent contrast study:
  1. In an emergent situation, the relatively small risk of complications related to the concurrent use of Metformin (Glucophage) and iodinated contrast media needs to be balanced against the patient's emergent clinical situation. If contrast is needed on an emergent basis to diagnose a potentially serious or life-threatening condition, it should be used with no delay.
    1. Low osmolar contrast should be used.
    2. The patient should be well hydrated, if possible.
    3. Metformin (Glucophage) should be withheld for 48 hours after the contrast administration.
    4. Renal function should be closely monitored.
    5. Metformin (Glucophage) should not be reinstituted until after renal function has been reevaluated and found to be normal.