CONCLUSION:
Metformin does not appear to cause or exacerbate liver injury and, indeed, is often beneficial in patients with nonalcoholic fatty liver disease. Nonalcoholic fatty liver frequently presents with transaminase elevations but should not be considered a contraindication to metformin use. Literature evidence of liver disease being associated with metformin-associated metabolic acidosis is largely represented by case reports. Most such patients had cirrhosis and were also actively using alcohol. Patients with cirrhosis, particularly those with encephalopathy, may have arterial hypoxemia, which heightens the risk of developing lactic acidosis. For this reason, identifying patients with cirrhosis before initiating metformin seems prudent. Because cirrhosis can exist in the face of normal liver transaminases, however, and because metformin is not considered intrinsically hepatotoxic, withholding metformin from patients with abnormal transaminases or routinely monitoring transaminases before or during metformin treatment is not supported.
http://www.ncbi.nlm.nih.gov/pubmed/20452916
Metformin is not considered intrinsically hepatotoxic. In fact, metformin may be beneficial in patients with nonalcoholic fatty liver disease (1) and chronic hepatitis C (3). Metformin is only contraindicated in patients with advanced cirrhosis because it heightens the risk of developing lactic acidosis (4). However, given the increasing prevalence of type 2 diabetes and expanding indications for metformin (5), it is important that clinicians be alert to the occurrence of rare but potentially serious side effects of this drug, such as idiosyncratic hepatotoxicity.
http://care.diabetesjournals.org/content/35/3/e21.full
CONCLUSION:
Continuation of metformin after cirrhosis diagnosis reduced the risk of death by 57%. Metformin should therefore be continued in diabetic patients with cirrhosis if there is no specific contraindication.
http://www.ncbi.nlm.nih.gov/pubmed/24798175
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Glyburide and glipizide, second-generation oral sulfonylurea hypoglycemic agents. Prendergast BD.
