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Unexpected outcome (positive or negative) including adverse drug reactions
Probable hepatotoxicity associated with the use of metformin in type 2 diabetes
  1. Taqi Hashmi
  1. Family Medicine Department, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
  1. Correspondence to Dr Taqi Hashmi MB BChir MA (Cantab) MRCGP, taqi{at}


This is a case report of a 44-year-old obese female who developed subclinical hepatic injury 4 weeks after starting metformin for type 2 diabetes. She had a rise in her alanine aminotransferase which peaked at 5 months (738 U/l) and rapidly declined within days of discontinuing her metformin. No other positive evidence of alternative causes for the hepatic injury was found. The likelihood of metformin-induced injury was 7 on the Naranjo scale of adverse drug reactions. A brief review of the 11 previously reported cases in the English medical literature is also made.

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  • Competing interests None.

  • Patient consent Obtained.

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