Besides the gastrointestinal side effects and low risk of lactic acidosis, long-term therapy with metformin can reversibly reduce intestinal absorption of vitamin B12 and folate, but rarely leads to macrocytic anemia. Metformin therapy should be discontinued in any situation that may cause a rapid change in renal clearance, such as acute illness requiring hospitalization or prior to intravenous radiologic contrast studies. Metformin can be restarted once renal function has stabilized.

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