adverse effects of metformin

What is the most important information I should know about metformin?
• A small number of people who have taken metformin have developed a seriouscondition called lactic acidosis that has been fatal in up to 50% of cases adverse effects of metformin. Lactic acidosis has occurred most often in people whose kidneys were not workingproperly adverse effects of metformin. Liver problems may also increase the risk of developing lactic acidosis adverse effects of metformin. Stop taking metformin and call your doctor immediately if you experience a feelingof general discomfort or sickness; weakness; sore or aching muscles; troublebreathing, unusual drowsiness, dizziness or lightheadedness; unusual or unexplainedstomach upset (after the initial stomach upset that may occur at the start oftherapy with metformin); or the sudden development of a slow or irregular heartbeat adverse effects of metformin. These may be signs of lactic acidosis adverse effects of metformin.
• Avoid excessive alcohol intake while taking metformin adverse effects of metformin. Together, alcoholand metformin may increase the risk of lactic acidosis and hypoglycemia adverse effects of metformin.
• Metformin does not usually cause hypoglycemia (low blood sugar) adverse effects of metformin. Nevertheless,hypoglycemia may occur, as a result of skipped meals, excessive exercise, oralcohol consumption adverse effects of metformin. Know the signs and symptoms of low blood sugar, which includehunger, headache, drowsiness, weakness, dizziness, a fast heartbeat, sweating,tremor, and nausea adverse effects of metformin. Carry candy or glucose tablets to treat episodes of lowblood sugar adverse effects of metformin.

What is metformin?
• Metformin is used to regulate blood glucose (sugar) levels adverse effects of metformin. Metforminworks in three ways: first, it reduces the amount of glucose produced by yourliver; second, it reduces the amount of glucose absorbed from food through yourstomach; and third, it makes the insulin that your body produces work betterto reduce the amount of glucose already in your blood adverse effects of metformin.
• Metformin is used to treat non-insulin-dependent diabetes mellitus (NIDDMor Type II diabetes) adverse effects of metformin.
• Metformin may also be used for purposes other than those listed in thismedication guide adverse effects of metformin.

What should I discuss with my healthcare provider before taking metformin?
• Do not take metformin without first talking to your doctor if you
· have kidney disease;
· have liver disease;
· have congestive heart failure;
· have acute or chronic metabolic acidosis, including diabetic ketoacidosis;
· have had a heart attack or a stroke;
· have a serious infection, illness, or injury;
· need to have surgery;
· need to have x-rays or other procedures using injectable contrast agents;
· are dehydrated (have lost water from your body) due to diarrhea, vomiting,fever, heat stroke, decreased fluid intake, or any other cause;
· drink alcohol; or
· are 80 years of age or older and have not had your kidney functiontested adverse effects of metformin.
• You may not be able to take metformin, or you may require a dosage adjustmentor special monitoring during treatment if you have any of the conditions listedabove adverse effects of metformin.
• Metformin is in the FDA pregnancy category B adverse effects of metformin. This means that it is unlikelyto harm an unborn baby adverse effects of metformin. Usually, your doctor will want to prescribe insulinto control diabetes during pregnancy adverse effects of metformin. Do not take metformin without first talkingto your doctor if you are pregnant adverse effects of metformin.
• Metformin passes into breast milk and may affect a nursing baby adverse effects of metformin. Do nottake metformin without first talking to your doctor if you are breast-feedinga baby adverse effects of metformin.
• If you are over the age of 65 years, there may be an slight increasein the risk of developing lactic acidosis due to a natural decline in kidneyfunction with advancing age adverse effects of metformin. A lower dose or special monitoring may be necessaryduring your treatment adverse effects of metformin.

How should I take metformin?
• Take metformin exactly as directed by your doctor adverse effects of metformin. If you do not understandthese directions, ask your pharmacist, nurse, or doctor to explain the instructionsto you adverse effects of metformin.
• Take each dose with a full glass of water adverse effects of metformin.
• Take metformin with a meal to reduce nausea, diarrhea, and upset stomachthat may occur with metformin therapy adverse effects of metformin. These symptoms may be more likely tooccur during the first few weeks of therapy adverse effects of metformin.
• A decrease in vitamin B12 may also occur during metformin therapy adverse effects of metformin. Yourdoctor may want to monitor your blood levels of vitamin B12 and you may needto take B12 supplements adverse effects of metformin. A vitamin B12 deficiency may rarely cause anemia adverse effects of metformin.
• Your doctor may want to monitor your blood sugar control and other factorswith regularly scheduled blood tests adverse effects of metformin.
• Occasionally, inactive ingredients in the metformin extended-release(Glucophage XR) tablets may pass through your body undissolved and appear inthe stool as a soft mass adverse effects of metformin. This is not harmful, and the medication has been absorbedby your body adverse effects of metformin.
• Store metformin at room temperature away from moisture and heat adverse effects of metformin.

What happens if I miss a dose?
• Take the missed dose as soon as you remember adverse effects of metformin. However, if it is almosttime for your next dose, skip the missed dose and only take your next regularlyscheduled dose adverse effects of metformin. Do not take a double dose adverse effects of metformin.

What happens if I overdose?
• Seek emergency medical attention adverse effects of metformin.
• An overdose of metformin is likely to cause lactic acidosis adverse effects of metformin. Symptomsof lactic acidosis include a feeling of general discomfort or sickness; weakness;sore or aching muscles; trouble breathing; unusual drowsiness, dizziness orlightheadedness; unusual or unexplained stomach upset (after the initial stomachupset that may occur at the start of therapy with metformin); and the suddendevelopment of a slow or irregular heartbeat adverse effects of metformin.

What should I avoid while taking metformin?
• Avoid excessive alcohol intake while taking metformin adverse effects of metformin. Together, alcoholand metformin may increase the risk of lactic acidosis and hypoglycemia adverse effects of metformin.
• Follow your diet, medication, and exercise routines very closely adverse effects of metformin. Changingany of these things can effect your blood sugar levels adverse effects of metformin.
• Tell your doctor or other health care provider that you are taking thismedication if you need to have surgery or x-ray procedures that require injectionof contrast agents adverse effects of metformin. Treatment with metformin may need to be stopped for a shortperiod of time adverse effects of metformin.
• Tell your doctor that you are taking metformin if you become ill, ifyou have a heart attack; if you have a stroke; if you develop congestive heartfailure; if you experience diarrhea, vomiting, fever, or dehydration from anycause; or if you decrease the amount of food or liquid in your normal diet adverse effects of metformin. You may need to stop your treatment with metformin for a short amount of timeuntil you are feeling better adverse effects of metformin.

What are the possible side effects of metformin?
• Stop taking metformin and seek emergency medical attention if you experiencean allergic reaction (difficulty breathing; closing of your throat; swellingof your lips, tongue, or face; or hives) adverse effects of metformin.
• A small number of people who have taken metformin have developed a seriouscondition called lactic acidosis that has been fatal in up to 50% of cases adverse effects of metformin. Lactic acidosis has occurred most often in people whose kidneys were not workingproperly adverse effects of metformin. Liver problems may also increase the risk of developing lactic acidosis adverse effects of metformin. Stop taking metformin and call your doctor immediately if you experience a feelingof general discomfort or sickness; weakness; sore or aching muscles; troublebreathing, unusual drowsiness, dizziness or lightheadedness; unusual or unexplainedstomach upset (after the initial stomach upset that may occur at the start oftherapy with metformin); or the sudden development of a slow or irregular heartbeat adverse effects of metformin. These may be signs of lactic acidosis adverse effects of metformin.
• Other, less serious side effects may be more likely to occur adverse effects of metformin. Continueto take metformin and talk to your doctor if you experience
· nausea, vomiting, abdominal pain, or diarrhea at the start of therapy;
· abdominal bloating or increased gas production; or
· decreased appetite or changes in taste (metallic taste in your mouth) adverse effects of metformin.
• Side effects other than those listed here may also occur adverse effects of metformin. Talk to yourdoctor about any side effect that seems unusual or that is especially bothersome adverse effects of metformin.

What other drugs will affect metformin?
• Before taking this medication, tell your doctor if you are taking anyof the following medications:
· a diuretic (water pill) such as furosemide (Lasix), bumetanide (Bumex),ethacrynic acid (Edecrin), torsemide (Demadex), amiloride (Midamor), triamterene(Dyazide, Maxzide, Dyrenium), spironolactone (Aldactone), hydrochlorothiazide(HydroDiuril), chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide(Lozol), metolazone (Zaroxolyn, Mykrox), and others;
· a phenothiazine such as chlorpromazine (Thorazine), prochlorperazine(Compazine), promethazine (Phenergan), and others
· an estrogen (Premarin, Prempro, Ogen, and others) or birth controlpill (Ovral, Lo-Ovral, Ortho-Novum, Triphasil, Levlen, Tri-Levlen, Alesse, andothers)
· a calcium channel blocker such as nifedipine (Adalat, Procardia), verapamil(Calan, Verelan, Isoptin), diltiazem (Cardizem, Dilacor XR), felodipine (Plendil),bepridil (Vascor), amlodipine (Norvasc), and others;
· a steroid medication such as prednisone (Deltasone), methylprednisolone(Medrol), dexamethasone (Decadron), and others;
· a thyroid medication (Synthroid, Levoxyl, Levothroid, and others),
· digoxin (Lanoxin, Lanoxicaps);
· procainamide (Pronestyl);
· quinidine (Cardioquin, others);
· cimetidine (Tagamet, Tagamet HB) or ranitidine (Zantac, Zantac 75);
· morphine (Astramorph, MS Contin, Roxanol, and others);
· trimethoprim (Proloprim, Trimpex, Septra, Bactrim);
· phenytoin (Dilantin);
· isoniazid (Nydrazid); or
· nicotinic acid or niacin (Nicobid, Nicolar, others) adverse effects of metformin.
• You may not be able to take metformin, or you may require a dosage adjustmentor special monitoring if you are taking any of the medicines listed above adverse effects of metformin.
• Drugs other than those listed here may also interact with metformin oraffect your condition adverse effects of metformin. Talk to your doctor and pharmacist before taking anyprescription or over-the-counter medicines adverse effects of metformin.

Where can I get more information?
• Your pharmacist has more information about metformin written for healthprofessionals that you may read adverse effects of metformin.

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