Contrast media + Metformin-pioglitazone

MediHelp rates the interaction as major. Contrast media and Metformin-pioglitazone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Iodinated contrast can cause acute kidney injury, and metformin is eliminated unchanged by the kidneys. Reduced clearance leads to metformin accumulation and raises the risk of lactic acidosis.

MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Hold metformin at the time of or before the procedure in patients with reduced eGFR, liver disease, alcoholism, heart failure or intra-arterial contrast. Re-check renal function about 48 hours afterward and restart only if it is stable.

MediHelp also lists interactions of Metformin-pioglitazone with, for example, Diatrizoate meglumine / diatrizoate, Diatrizoate, Diazoxide. The full list is on the Metformin-pioglitazone page.