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Contraindicated Combinations: Depending on the renal function, metformin must be discontinued 48 hrs before or from the time of IV administration of iodinated contrast media.
Combinations to be Used with Caution: Medicinal Products with Intrinsic Hyperglycaemic Activity [eg, Glucocorticoids and Tetracosactides (Systemic and Local Routes), β2-Agonists, Danazol, and Chlorpromazine at High Dosages of 100 mg Daily, Diuretics): More frequent blood glucose monitoring may be required, especially at the beginning of treatment. If necessary, adjust the metformin dosage during therapy with the respective medicinal product and upon its discontinuation.
Diuretics, especially loop diuretics, may increase the risk of lactic acidosis due to the potential to decrease renal function (further to the intrinsic hyperglycemic effect, see previously mentioned).
Angiotensin-Converting Enzyme (ACE) Inhibitors: May decrease the blood glucose levels. If necessary, adjust the metformin dosage during therapy with an ACE inhibitor and upon its discontinuation.
Interaction with Alcohol: The risk of lactic acidosis is increased in acute alcohol intoxication, particularly in case of fasting or malnutrition or hepatic insufficiency. It is recommended that consumption of alcohol and alcohol-containing medicinal product be avoided.
