Forherdin Special Precautions

Lactic Acidosis: Lactic acidosis is a rare, but serious (high mortality in the absence of prompt treatment), metabolic complication that can occur due to metformin accumulation. Reported cases of lactic acidosis in patients on metformin have occurred primarily in diabetic patients with significant renal failure. The incidence of lactic acidosis can and should be reduced by assessing also other associated risk factors such as poorly controlled diabetes, ketosis, prolonged fasting, excessive alcohol intake, hepatic insufficiency, and any condition associated with hypoxia.
Renal function: As metformin is excreted by the kidney, creatinine clearance (this can be estimated from serum creatinine levels by using the Cockcroft-Gault formula) should be determined before initiating treatment and regularly thereafter: At least annually in patients with normal renal function; at least two to four times a year in patients with creatinine clearance at the lower limit of normal and in elderly subjects.
Surgery: Metformin must be discontinued 48 hours before elective major surgery. Therapy may be restarted no earlier than 48 hours following surgery or resumption of oral nutrition and only if normal renal function has been established.
Other Precautions: Avoid consumption of alcoholic beverages.
Patients have to inform their doctor of any other treatment they are receiving and of any infectious diseases such as influenza, respiratory tract infection, or urinary tract infection.
All patients should continue their diet with a regular distribution of carbohydrate intake during the day.
Overweight patients should continue their energy restricted diet.
The usual laboratory tests for diabetes monitoring should be performed regularly.
Metformin alone does not cause hypoglycemia but caution is advised when it is used in combination with insulin or other oral antidiabetics (e.g., sulfonylureas or meglitinides).
Use in Children and Adolescents: The diagnosis of type 2 diabetes mellitus should be confirmed before treatment with metformin is initiated.