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The FDA provides specific guidelines based on estimated glomerular filtration rate (eGFR): Strictly prohibited for patients with eGFR below 30 mL/minute/1.73 m Not recommended for starting treatment in patients with eGFR between 30-45 mL/minute/1.73 m Requires careful monitoring when eGFR falls below 45 mL/minute/1.73 m Patients should avoid metformin if they have: Diabetic ketoacidosis Severe liver problems Acute or chronic metabolic acidosis History of lactic acidosis Conditions causing tissue hypoxia The medication is not recommended for patients 80 and older without normal kidney function [22]

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