metformin effects interactions remain theoretical

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

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

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

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

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

What happens if I overdose?
• Seek emergency medical attention metformin effects interactions remain theoretical.
• An overdose of metformin is likely to cause lactic acidosis metformin effects interactions remain theoretical. 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 effects interactions remain theoretical.

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

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

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

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

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