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Metformin must not be used in patients with eGFR below 30ml/min/1.73m2 due to the risk of secondary lactic acidosis and must be used cautiously in patients with eGFR between 30 and 44ml/min/1.73m2, reducing the drug to a maximum of 1000mg/day
This robust therapeutic effect led to the FDAs approval of rilonacept in 2021 as the first drug for the treatment of recurrent pericarditis
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