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Trends in metformin utilisation and dose appropriateness in Australia

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The study aimed to (1) determine the trends in the utilisation of metformin in Australia, (2) determine the appropriateness of metformin dosing in an Australian teaching hospital and (3) gather the opinions of prescribers on the relationship between metformin dose and renal function.

Methods

National prescription data between 1990 and 2012 were accessed. A retrospective audit (2008–2012) of metformin doses and patient renal function (20 % random sample of all in-patients prescribed metformin) was conducted at St Vincent’s Hospital (SVH), Sydney. Prescribers of metformin were interviewed (semi-structured; consultants at SVH) or surveyed (Australian endocrinologists) to gather their understanding of metformin dosing in relation to renal function.

Results

Metformin utilisation increased fivefold nationally between 1995 and 2012. Metformin tended to be under-dosed in SVH patients with normal renal function (83.5 %) and over-dosed in patients with impaired renal function (estimated glomerular filtration rate (eGFR) <30 mL/min, 50 %). Consultants indicated that metformin doses needed to be reduced in renal impairment. Most endocrinologists (61 %) were comfortable prescribing metformin down to eGFRs around 30 mL/min.

Conclusion

The use of metformin increased greatly over the period of the study. Metformin is prescribed frequently for patients with eGFR values below the minimal level approved in the product label (60 mL/min). While prescribers expressed their understanding of the need to reduce metformin doses in patients with renal impairment, we found that metformin doses were higher than appropriate in patients with impaired renal function. Metformin may be used safely when renal function is poor provided dosage is appropriately reduced.

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Notes

  1. Subsidised: government pays difference between patient co-payments and cost of drug. For metformin, this applies to concessionary patients namely those aged over 65 years and those with sickness benefits and from a low socio-economic background. Unsubsidised: government pays nothing, applies to non-concessionary patients

  2. Under copayment data began to be incorporated in Medicare data late in 2012 but was not included in the Medicare data accessed for this study.

  3. Administrations for which the corresponding orders spanned the annual cutoff (December 31) into the successive year were counted in the year in which the order was made.

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Acknowledgments

The authors would like to thank Ms. Agata Szylczak, Medical Records SVH, and Ms. Maxine Robinson, Secretary, Drug Utilisation Sub Committee of Pharmaceutical Benefits Advisory Committee, Pharmaceutical Benefits Scheme. The study was supported by the National Health and Medical Research Council Program under grants APP 568612 and APP 1054146 and Australian Research Council Linkage under grant LP0990670.

Author’s contributions

J Moon was responsible for data collection, data entry, data analysis and preparation of manuscript; SS Kumar for data entry, data analysis and preparation of manuscript; GG Graham for data analysis and preparation of manuscript; MT Baysari for data analysis and preparation of manuscript; KM Williams for data analysis and preparation of manuscript; W Chen for data collection and data analysis; A Viardot and JR Greenfield for clinical guidance and preparation of manuscript; and RO Day for clinical guidance, data analysis and preparation of manuscript.

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Authors and Affiliations

  1. Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Darlinghurst, New South Wales, 2010, Australia

    J. Moon, S. S. Kumar, G. G. Graham, M. T. Baysari, K. M. Williams & R. O. Day

  2. St Vincent’s Hospital Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia

    J. Moon & R. O. Day

  3. School of Medical Science, Faculty of Medicine, University of New South Wales, Sydney, Australia

    S. S. Kumar, G. G. Graham, K. M. Williams & R. O. Day

  4. Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Macquarie University, Sydney, Australia

    M. T. Baysari

  5. Diabetes and Metabolism Research Division, Garvan Institute of Medical Research, Sydney, Australia

    W. Chen, A. Viardot & J. R. Greenfield

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  1. J. Moon
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  2. S. S. Kumar
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Corresponding author

Correspondence to R. O. Day.

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Moon, J., Kumar, S.S., Graham, G.G. et al. Trends in metformin utilisation and dose appropriateness in Australia. Eur J Clin Pharmacol 72, 1489–1496 (2016). https://doi.org/10.1007/s00228-016-2117-y

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  • DOI: https://doi.org/10.1007/s00228-016-2117-y

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