Diamet/Diamet SR Special Precautions

Metformin should not be used alone in insulin-dependent diabetes mellitus.
Metformin is not recommended in patients with severe impairment of thyroid function.
Metformin is known to be substantially excreted by the kidneys and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function.
Concomitant medication(s) that may affect renal function or result in significant haemodynamic change or may interfere with the disposition of metformin eg, cationic drugs that are eliminated by renal tubular secretion should be used with caution.
Cardiovascular collapse (shock) from whatever cause, acute congestive heart failure, acute myocardial infarction and other conditions characterised by hypoxaemia have been associated with lactic acidosis and may also cause prerenal azotemia. When such events occur in patients on metformin therapy, Diamet/Diamet SR should be promptly discontinued.
Metformin therapy should be temporarily suspended for any surgical procedure (except minor procedures not associated with restricted intake of food and fluids) and should not be restarted until the patient's oral intake has resumed and renal function has been evaluated as normal.
Alcohol is known to potentiate the effect of metformin on lactate metabolism.
Since impaired hepatic function has been associated with some cases of lactic acidosis, metformin should generally be avoided in patients with clinical or laboratory evidence of hepatic disease.
Use in pregnancy & lactation: Metformin is not recommended for use in pregnancy and lactation.
Use in children: Metformin is not recommended for use in patients <17 years.