Side effectscontraindications

Metformin is generally well tolerated and safe. Gastrointestinal side effects (diarrhea, flatulence, abdominal discomfort, anorexia, nausea, and metallic taste) predominate and are commonly dose-related. Dose reduction, administration with food, or an extended-release formulation can improve drug tolerance. Over 50% of individuals tolerate the maximum daily dose of metformin, but 5-10% of people need to discontinue the drug altogether.65

Lactic acidosis is a rare, but potentially fatal, adverse complication, with an estimated incidence of 0.03 cases per 1000 patient-years. Most cases of lactic acidosis occur in a setting in which metformin therapy is continued inappropriately: during an acute or chronic medical condition that may alter the pharmacokinetics or renal clearance of metformin (renal impairment (plasma creatinine >1.5mgdL_ 1 in men; >1.4mgdL_ 1 in women)); or, in circumstances when hypoxia or reduced peripheral perfusion may occur (liver disease, cardiac or respiratory conditions, or a history of previous lactic acidosis).

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