Discontinue use if any severe cutaneous ARs eg, SJS, TEN, DRESS is suspected or hypersensitivity reactions occur. Interrupt therapy if metabolic acidosis develops; proteinuria, glycosuria, renal tubulopathy or Fanconi syndrome & unexplained cytopenia occurs. Not recommended in patients w/ short life expectancy eg, high-risk myelodysplastic syndromes. Patients w/ platelet counts <50,000/mm3
(50 x 109
/L); signs & symptoms of GI ulceration & haemorrhage; blood disorders; cardiac dysfunction. Monitor serum creatinine, CrCl, plasma cystatin C prior to initiation, wkly during 1st mth & mthly thereafter; serum transaminases, bilirubin & alkaline phosphatase prior to initiation, every 2 wk during 1st mth & mthly thereafter; serum ferritin mthly. Perform auditory & ophth testing prior to initiation & annually thereafter. Ensure adequate hydration & acid-base balance. Long-term use. Concomitant use w/ medicinal products depressing renal function; substances w/ known ulcerogenic potential eg, NSAIDs, corticosteroids or oral bisphosphonates; anticoagulants. May affect ability to drive & use machines. Not recommended in severe hepatic impairment (Child-Pugh class C). Pre-existing renal & chronic hepatic conditions; renal impairment. Women of childbearing potential should use effective contraception. Not to be used during pregnancy. Not recommended during lactation. Monitor body wt, height & sexual development prior to initiation & annually thereafter in childn. Elderly.