Not to be used in type 1 diabetes or diabetic ketoacidosis. Discontinue use if pancreatitis & bullous pemphigoid are suspected. Temporarily discontinue use if dehydration occurs. Increased risk of lactic acidosis. Patients w/ acute & unstable heart failure. Periodically monitor vit B12 serum levels if vit B12 deficiency is suspected. Evaluate serum electrolytes & ketones, blood glucose, pH, lactate, pyruvate & metformin levels. Avoid excessive alcohol intake. Discontinue use prior to, during & until 28 hr after administration of iodinated contrast agent; during surgery. Assess GFR prior to treatment & at least annually thereafter. Concomitant use w/ sulphonylurea & insulin; antihypertensives, diuretics & NSAIDs; drugs causing lactic acidosis. May affect ability to drive & use machines. Not recommended in hepatic impairment. Not to be used during pregnancy. Lactation. Childn. Elderly ≥80 yr.
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