metformin and b12 problems

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 metformin and b12 problems. Lactic acidosis has occurred most often in people whose kidneys were not workingproperly metformin and b12 problems. Liver problems may also increase the risk of developing lactic acidosis metformin and b12 problems. 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 metformin and b12 problems. These may be signs of lactic acidosis metformin and b12 problems.
• Avoid excessive alcohol intake while taking metformin metformin and b12 problems. Together, alcoholand metformin may increase the risk of lactic acidosis and hypoglycemia metformin and b12 problems.
• Metformin does not usually cause hypoglycemia (low blood sugar) metformin and b12 problems. Nevertheless,hypoglycemia may occur, as a result of skipped meals, excessive exercise, oralcohol consumption metformin and b12 problems. Know the signs and symptoms of low blood sugar, which includehunger, headache, drowsiness, weakness, dizziness, a fast heartbeat, sweating,tremor, and nausea metformin and b12 problems. Carry candy or glucose tablets to treat episodes of lowblood sugar metformin and b12 problems.

What is metformin?
• Metformin is used to regulate blood glucose (sugar) levels metformin and b12 problems. 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 metformin and b12 problems.
• Metformin is used to treat non-insulin-dependent diabetes mellitus (NIDDMor Type II diabetes) metformin and b12 problems.
• Metformin may also be used for purposes other than those listed in thismedication guide metformin and b12 problems.

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 metformin and b12 problems.
• 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 metformin and b12 problems.
• Metformin is in the FDA pregnancy category B metformin and b12 problems. This means that it is unlikelyto harm an unborn baby metformin and b12 problems. Usually, your doctor will want to prescribe insulinto control diabetes during pregnancy metformin and b12 problems. Do not take metformin without first talkingto your doctor if you are pregnant metformin and b12 problems.
• Metformin passes into breast milk and may affect a nursing baby metformin and b12 problems. Do nottake metformin without first talking to your doctor if you are breast-feedinga baby metformin and b12 problems.
• 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 metformin and b12 problems. A lower dose or special monitoring may be necessaryduring your treatment metformin and b12 problems.

How should I take metformin?
• Take metformin exactly as directed by your doctor metformin and b12 problems. If you do not understandthese directions, ask your pharmacist, nurse, or doctor to explain the instructionsto you metformin and b12 problems.
• Take each dose with a full glass of water metformin and b12 problems.
• Take metformin with a meal to reduce nausea, diarrhea, and upset stomachthat may occur with metformin therapy metformin and b12 problems. These symptoms may be more likely tooccur during the first few weeks of therapy metformin and b12 problems.
• A decrease in vitamin B12 may also occur during metformin therapy metformin and b12 problems. Yourdoctor may want to monitor your blood levels of vitamin B12 and you may needto take B12 supplements metformin and b12 problems. A vitamin B12 deficiency may rarely cause anemia metformin and b12 problems.
• Your doctor may want to monitor your blood sugar control and other factorswith regularly scheduled blood tests metformin and b12 problems.
• 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 metformin and b12 problems. This is not harmful, and the medication has been absorbedby your body metformin and b12 problems.
• Store metformin at room temperature away from moisture and heat metformin and b12 problems.

What happens if I miss a dose?
• Take the missed dose as soon as you remember metformin and b12 problems. However, if it is almosttime for your next dose, skip the missed dose and only take your next regularlyscheduled dose metformin and b12 problems. Do not take a double dose metformin and b12 problems.

What happens if I overdose?
• Seek emergency medical attention metformin and b12 problems.
• An overdose of metformin is likely to cause lactic acidosis metformin and b12 problems. 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 metformin and b12 problems.

What should I avoid while taking metformin?
• Avoid excessive alcohol intake while taking metformin metformin and b12 problems. Together, alcoholand metformin may increase the risk of lactic acidosis and hypoglycemia metformin and b12 problems.
• Follow your diet, medication, and exercise routines very closely metformin and b12 problems. Changingany of these things can effect your blood sugar levels metformin and b12 problems.
• 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 metformin and b12 problems. Treatment with metformin may need to be stopped for a shortperiod of time metformin and b12 problems.
• 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 metformin and b12 problems. You may need to stop your treatment with metformin for a short amount of timeuntil you are feeling better metformin and b12 problems.

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) metformin and b12 problems.
• 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 metformin and b12 problems. Lactic acidosis has occurred most often in people whose kidneys were not workingproperly metformin and b12 problems. Liver problems may also increase the risk of developing lactic acidosis metformin and b12 problems. 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 metformin and b12 problems. These may be signs of lactic acidosis metformin and b12 problems.
• Other, less serious side effects may be more likely to occur metformin and b12 problems. 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) metformin and b12 problems.
• Side effects other than those listed here may also occur metformin and b12 problems. Talk to yourdoctor about any side effect that seems unusual or that is especially bothersome metformin and b12 problems.

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) metformin and b12 problems.
• 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 metformin and b12 problems.
• Drugs other than those listed here may also interact with metformin oraffect your condition metformin and b12 problems. Talk to your doctor and pharmacist before taking anyprescription or over-the-counter medicines metformin and b12 problems.

Where can I get more information?
• Your pharmacist has more information about metformin written for healthprofessionals that you may read metformin and b12 problems.

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