Discontinue or interrupt treatment temporarily if ketoacidosis is suspected. Interrupt treatment temporarily in patients who develop vol depletion. Not for type 1 diabetes; diabetic ketoacidosis. Not recommended in diabetic patients w/ persistent eGFR <45 mL/min/1.73 m
2. Decreased BP; ketoacidosis, including diabetic ketoacidosis in patients w/ type 2 DM. Patients w/ very high blood glucose conc; on anti-hypertensive therapy w/ history of hypotension; w/ predisposing factors to ketoacidosis including pancreatic disorders (eg, type 1 diabetes, history of pancreatitis or pancreatic surgery), insulin dose reduction, reduced caloric intake or increased insulin requirements due to infections, illness or surgery & alcohol abuse. Evaluate renal function prior to initiation of treatment & periodically thereafter. Monitor vol status eg, physical exam, BP measurements, lab tests including haematocrit & electrolytes in case of vol-depleting conditions eg, GI illness. Risk of hypoglycemia in combination w/ insulin & insulin secretagogues eg, sulfonylureas. Severe renal impairment (eGFR <25 mL/min/1.73 m
2) or ESRD. Not to be used during pregnancy (2nd or 3rd trimester) & lactation. Ped & adolescents. Elderly.
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