A patient with type 2 diabetes, eGFR 25 mL/min/1.73m², and HbA1c 9.2% requires intensification of therapy. Which oral antidiabetic should be avoided?
- A Linagliptin
- B Repaglinide
- C Metformin ✓
- D Gliquidone
Correct answer: C. Metformin
Explanation
Metformin is contraindicated when eGFR < 30 mL/min/1.73m² (and should be used with caution when eGFR 30–45) due to risk of lactic acidosis from impaired renal clearance. Linagliptin is the only DPP-4 inhibitor primarily excreted via bile (not kidneys), safe at any level of renal impairment. Repaglinide and gliquidone undergo predominantly hepatic elimination and are acceptable in CKD.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.