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Some people using metformin develop lactic acidosis.which can be fatal. Get emergency medical help if you have even mild symptoms such as.

It may be harder to control your blood sugar when your body is stressed (such as due to fever.infection.injury.or surgery). Consult your doctor because increased stress may require a change in your treatment plan.medications.or blood sugar testing.

Lactic Acidosis. See boxed warning. (5.1) Vitamin B 12 Deficiency. Metformin may lower vitamin B 12 levels.Measure hematological parameters annually and vitamin B 12 at 2 to 3 year intervals and manage any abnormalities. (5.2) Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues. Increased risk of hypoglycemia when used in combination with insulin and/or an insulin secretagogue. Lower dose of insulin or insulin secretagogue may be required (5.3)

Nausea.vomiting.stomach upset.diarrhea.weakness.order glucophage 1 gm every am. available glucophage 500 mg tablets a metallic taste in the mouth may occur. If any of these effects persist or worsen.tell your doctor or pharmacist promptly. If stomach symptoms return later (after taking the same dose for several days or weeks).tell your doctor right away. Stomach symptoms that occur after the first days of your treatment may be signs of lactic acidosis.

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Minor side effects usually go away after your body gets used to taking the medicine for several weeksand may include mild diarrheanauseaor upset stomach.

Kidney diseaseyour kidney function may need to be checked before you take this medicine

Read the Patient Information Leaflet if available from your pharmacist before you start taking metformin and each time you get a refillIf you have any questionsconsult your doctor or pharmacist.

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Metformin and insulin may be used in combination therapy to achieve better blood glucose controlMetformin hydrochloride is given at the usual starting dose of 500 mg or 850 mg 2 or 3 times dailywhile insulin dosage is adjusted on the basis of blood glucose measurements.

Obtain eGFR before starting metformin eGFR 80 years unless normal renal function establishedInitial and maintenance dosing of metformin should be conservative in patients with advanced age due to the potential for decreased renal function in this population.

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