Prevalence of Pruritus with Use of Metformin and Other Oral Hypoglycemic Agents

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Lauren Sattele, BS
Courtney Linkous, BA
Laura Andrews, MD, MSCR
Chelsea Shope, MD, MSCR
Nicholas Strat, MSCR
Lara Wine Lee, MD, PhD


dermatology, pruritus, metformin, canagliflozin, diabetes mellitus, adverse event


Introduction: Metformin is being prescribed with increasing frequency for many dermatologic indications.1 This has resulted in anecdotal evidence correlating metformin use with pruritus, but the evidence is limited to case reports. 2,3 We aimed to investigate the association between metformin use and pruritus.

Methods: Using the FDA Adverse Event Reporting System (FAERS), we performed a retrospective review of patients taking metformin, canagliflozin, insulin lispro, and insulin glargine between January 1, 2012, and November 14, 2022. Data was analyzed using Chi square and Fisher’s exact testing, with Bonferroni adjusted column proportions.

Results: Prevalence of pruritus for patients taking metformin was 0.7%, canagliflozin 0.9%, insulin lispro 0.4%, and insulin glargine 0.6%. Canagliflozin was significantly more likely to cause pruritus than both insulin lispro and glargine (p-value<0.05). Reports of pruritus by metformin users was not significantly different than the other three oral hypoglycemics (p-value>0.05). 

Conclusion: Our results suggest that metformin is not significantly associated with pruritus and may be used for treatment of dermatologic conditions with little concern for this adverse event. Canagliflozin, however, was significantly likely to cause pruritus. General practitioners should consider counseling canagliflozin users on this significant adverse event. 


1. Badr D, Kurban M, Abbas O. Metformin in dermatology: an overview. J Eur Acad Dermatol Venereol. 2013;27(11):1329-1335. doi:10.1111/jdv.12116

2. Voore P, Odigwe C, Mirrakhimov AE, Rifai D, Iroegbu NA. DRESS Syndrome Following Metformin Administration: A Case Report and Review of the Literature. Am J Ther. 2016;23(6):e1970-e1973. doi:10.1097/MJT.0000000000000292

3. Díaz JM, Bruñén JMG, Cameo RB, González AM. Erythroderma and Chronic Lichenification Due to Metformin. Eur J Case Rep Intern Med. 2019;6(6):001119. Published 2019 May 29. doi:10.12890/2019_001119

4. Lima AL, Illing T, Schliemann S, Elsner P. Cutaneous Manifestations of Diabetes Mellitus: A Review. Am J Clin Dermatol. 2017;18(4):541-553. doi:10.1007/s40257-017-0275-z

5. Rådholm K, Figtree G, Perkovic V, et al. Canagliflozin and Heart Failure in Type 2 Diabetes Mellitus: Results From the CANVAS Program. Circulation. 2018;138(5):458-468. doi:10.1161/CIRCULATIONAHA.118.034222

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