Internal and Emergency Medicine

, Volume 3, Issue 4, pp 401–403 | Cite as

Older age and phenformin therapy: a dangerous association

  • Filippo Luca FimognariEmail author
  • Andrea Corsonello
  • Ruggero Pastorelli
  • Raffaele Antonelli Incalzi
CE - Letter to the Editor

The anti-diabetic drug phenformin was banned in many countries because of the high risk of lactic acidosis (LA), mostly arising in elderly with predisposing conditions [1]. To our knowledge, phenformin is still legal in Italy, Brazil, Uruguay, China, Poland, Greece and Portugal, and cases of LA are continuously reported worldwide [2, 3, 4, 5].

Phenformin-induced LA is an unpredictable complication that may occur even in people without predisposing diseases, causing death in 50% of cases [1]. In addition, LA is often misdiagnosed, and many cases may go unrecognized, particularly in older persons affected by various chronically symptomatic illnesses. As recently emphasized, the reported cases of phenformin-induced LA may thus represent only “the tip of an iceberg” [3].

Phenformin can always be replaced by metformin, a safe and useful drug. A recent meta-analysis showed that metformin does not cause LA more frequently than diabetes per se [6].

Age is an absolute contraindication to...


Metformin Glomerular Filtration Rate Lactic Acidosis Chinese Herbal Medicine Public Health System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The GIFA study is partially supported by a grant 94000402 from the Italian National Research Council, Roma, Italy.


  1. 1.
    Bailey CJ (1992) Biguanides and NIDDM. Diabetes Care 15:755–772PubMedCrossRefGoogle Scholar
  2. 2.
    Fimognari FL, Pastorelli R, Antonelli Incalzi R (2006) Phenformin-induced lactic acidosis in an older diabetic patient: a recurrent drama. Diabetes Care 29:950–951PubMedCrossRefGoogle Scholar
  3. 3.
    Ching CK, Lai CK, Poon WT et al (2008) Hazards posed by a banned drug-phenformin is still hanging around. Hong Kong Med J 14:50–54PubMedGoogle Scholar
  4. 4.
    Kumar A, Nugent K, Kalakunja A, Pirtle F (2003) Severe acidosis in a patient with type 2 diabetes mellitus, hypertension, and renal failure. Chest 123:1726–1729PubMedCrossRefGoogle Scholar
  5. 5.
    Chen ZS, Liy FF (2005) Observation of treatment effectiveness in ten cases of diabetic lactic acidosis [in Chinese]. Chin J Misdiagn 5:686–687Google Scholar
  6. 6.
    Salpeter S, Greyber E, Pasternak G, Salpeter E (2006) Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 25:CD002967Google Scholar
  7. 7.
    De Berardis G, Pellegrini F, Franciosi M et al (2004) Quality of care and outcomes in type 2 diabetic patients. A comparison between general practice and diabetes clinics. Diabetes Care 27:398–406PubMedCrossRefGoogle Scholar
  8. 8.
    Carosella L, Pahor M, Pedone C, Zuccalà G, Manto A, Carbonin P (1999) Pharmacosurveillance in hospitalized patients in Italy: study design of the Gruppo Italiano di Farmacovigilanza nell’ Anziano (GIFA). Pharmacol Res 40:287–295PubMedCrossRefGoogle Scholar
  9. 9.
    Corsonello A, Pedone C, Corica F et al (2005) Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus. J Gerontol A Biol Sci Med Sci 60:1147–1151PubMedGoogle Scholar
  10. 10.
    Fimognari FL, Corsonello A, Pastorelli R, Antonelli Incalzi R (2006) Metformin-induced pancreatitis: a possible adverse drug effect during acute renal failure. Diabetes Care 29:1183PubMedCrossRefGoogle Scholar
  11. 11.
    Sino American Health Products, Inc., Issues National Recall of herbal products due to the presence of the undeclared drugs glyburide and phenformin. US Food and Drug Administration website. Accessed 19 Feb 2000
  12. 12.
    Health Canada warns consumers not to take the Chinese medicine Shortclean due to potential health risk (article online) (2005). Available at: Accessed 23 Nov 2005

Copyright information

© SIMI 2008

Authors and Affiliations

  • Filippo Luca Fimognari
    • 1
    • 2
    Email author
  • Andrea Corsonello
    • 3
    • 4
  • Ruggero Pastorelli
    • 1
  • Raffaele Antonelli Incalzi
    • 2
    • 4
  1. 1.Unità Operativa di Medicina Interna, ASL Roma G, Ospedale Leopoldo Parodi-Delfino, Colleferro (Rome)RomeItaly
  2. 2.Cattedra di GeriatriaUniversità Campus BiomedicoRomeItaly
  3. 3.Unità Operativa di Medicina Geriatrica, Istituto Nazionale di Ricovero e Cura per Anziani (INRCA)CosenzaItaly
  4. 4.Fondazione San Raffaele-Cittadella della CaritàTarantoItaly

Personalised recommendations