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Indications:

Metformin is an oral diabetes medicine that helps control blood sugar levels. Metformin is for people with type 2 (non-insulin-dependent) diabetes. Metformin is sometimes used in combination with insulin or other medications, but it is not for treating type 1 diabetes.

Contraindications:

Do not use this medication if you are allergic to metformin, if you have kidney disease or kidney failure, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Before taking metformin, tell your doctor if you are allergic to any drugs, or if you have: liver disease; or a history of heart disease. If you have any of these conditions, you may need a dose adjustment or special tests to safely take metformin.

Adverse reactions:

Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. Stop using metformin and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects: feeling short of breath, even with mild exertion; swelling or rapid weight gain; or fever, chills, body aches, flu symptoms. Less serious side effects may include: headache or muscle pain; weakness; or mild nausesa, vomiting, diarrhea, gas, stomach pain.

Interactions:

You may be more likely to have hyperglycemia (high blood sugar) if you are taking metformin with other drugs that raise blood sugar. Drugs that can raise blood sugar include: isoniazid; diuretics (water pills); steroids (prednisone and others); phenothiazines (Compazine and others); thyroid medicine (Synthroid and others); birth control pills and other hormones; seizure medicines (Dilantin and others); and diet pills, or medicines to treat asthma, colds or allergies. You may be more likely to have hypoglycemia (low blood sugar) if you are taking metformin with other drugs that lower blood sugar. Drugs that can lower blood sugar include: some nonsteroidal anti-inflammatory drugs (NSAIDs); aspirin or other salicylates (including Pepto-Bismol); sulfa drugs (Bactrim and others); a monoamine oxidase inhibitor (MAOI); beta-blockers (Tenormin and others); or probenecid (Benemid). Some medications may interact with metformin. Tell your doctor if you are using any of the following drugs: furosemide (Lasix); nifedipine (Adalat, Procardia); cimetidine (Tagamet) or ranitidine (Zantac); amiloride (Midamor) or triamterene (Dyrenium); digoxin (Lanoxin); morphine (MS Contin, Kadian, Oramorph); procainamide (Procan, Pronestyl, Procanbid); quinidine (Cardioquin, Quinidex, Quinaglute); trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra); or vancomycin (Vancocin, Lyphocin). This list is not complete and there may be other drugs that can interact with metformin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugsprescribed by other doctors. Do not start using a new medication without telling your doctor.

Warnings:

Do not use metformin if you have kidney disease, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Before taking metformin, tell your doctor if you have liver disease or a history of heart disease. Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin. Be sure the doctor knows ahead of time that you are using metformin. Know the signs of low blood sugar (hypoglycemia) and how to recognize them, including hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma (severe hypoglycemia can be fatal). Always keep a source of sugar available in case you have symptoms of low blood sugar. Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. You may be more likely to develop lactic acidosis if you have congestive heart failure. Older adults may also have a higher risk of developing lactic acidosis. Talk with your doctor about your individual risk. FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether metformin passes into breast milk or if it could harm a nursing baby. Do not take metformin without first talking to your doctor if you are breast-feeding a baby. Metformin should not be given to a child younger than 10 years old. Extended-release metformin (Glucophage XR) should not be given to a child younger than 17 years old. Avoid drinking alcohol while taking metformin. Alcohol lowers blood sugar and may increase the risk of lactic acidosis while you are taking this medicine.

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