Discontinue use if diabetic ketoacidosis & necrotising perineum fasciitis/Fournier's gangrene is suspected or diagnosed. Not to be used in patients w/ type 1 diabetes. Consider additional glucose-lowering treatment if eGFR falls persistently <45 mL/min/1.73 m
2 in patients w/ type 2 DM. Vol-depletion risk due to acute disease eg, GI illness, history of hypotension; patients w/ low β-cell function reserve, conditions leading to restricted food intake or severe dehydration, reduced insulin doses, increased insulin requirements due to acute medical illness, surgery or alcohol abuse; UTI, pyelonephritis or urosepsis; cardiac failure (NYHA class IV); CKD w/o diabetes & albuminuria; +ve glucose urine test. Monitor vol status eg, physical exam, BP, haematocrit & electrolytes during treatment. Counsel patients on routine preventative foot care. Not to be taken by patients w/ galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Combination w/ sulphonylurea or insulin. Concomitant use w/ antihypertensives. May affect ability to drive & use machines. Not recommended in patients w/ GFR <25 mL/min. Hepatic impairment. Not recommended during 2nd & 3rd trimesters of pregnancy. Not to be used during lactation. Childn <18 yr. Elderly ≥65 yr.
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