Excessive intake or chronic ingestion of alcohol may elevate blood lactate concentrations or increase the risk of developing hypoglycemia, especially when alcohol is ingested without meals. Cimetidine inhibits renal tubular secretion and thus increasing plasma metformin concentration. Other cationic medications excreted by renal tubular transport, such as amiloride, calcium channel blockers, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim and vancomycin have the potential to increase metformin's plasma concentration or interfere with renal clearance; careful monitoring of blood glucose would be appropriate. Oral contraceptives, corticosteroids, diuretics, estrogens, isoniazid, nicotinic acid, phenothiazines, phenytoin, sympathomimetics and thyroid hormones may contribute to hyperglycaemia while clofibrate, monoamine oxidase inhibitors, probenecid, propranolol, rifabutin, rifampicin, salicylates, sulfonamides and sulphonylureas may cause hypoglycaemia.
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