Drug General Information (ID: DDI8GADFIP)
Drug Name			Metformin		Drug Info		Iothalamic acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiabetic Agents				Ionic Iodinated Contrast Media
Structure

Mechanism of Metformin-Iothalamic acid Interaction (Severity Level: Major)
Decreased renal excretion due to nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Metformin				Iothalamic acid
Mechanism		Primarily eliminated by renal excretion				Nephrotoxicity
Key Mechanism Factor 1
		Factor Name		Nephrotoxicity
		Factor Description		Drug-induced nephrotoxicity is a common and potentially serious complication of medication use. The kidneys are the primary organ for drug excretion, and when they are damaged can lead to decreased drug excretion.
Mechanism Description		Decreased renal excretion of Metformin caused by Iothalamic acid mediated nephrotoxicity

Recommended Action
Management		Biguanide therapy should be temporarily discontinued at the time of, or prior to, radiographic studies involving intravascular administration of iodinated contrast media, and not resumed until at least 48 hours after the procedure and renal function has been re-evaluated and determined to be normal.

References
1	Assan R, Heuclin C, Ganeval D, Bismuth C, George J, Girard JR "Metformin-induced lactic acidosis in the presence of acute renal failure." Diabetologia 13 (1977): 211-7. [PMID: 406158]
2	Product Information. Glucophage (metformin). Bristol-Myers Squibb, Princeton, NJ.
3	Stacul F, Adam A, Becker CR, et al. "Strategies to reduce the risk of contrast-induced nephropathy." Am J Cardiol 98(6S1) (2006): 59-77. [PMID: 16949381]