TEQUIN gatifloxacin and serious hypoglycemia and hyperglycemia. Bristol-Myers Squibb Canada May 12, 2006. Because of the extensive protein binding of GLUCOTROL, is unlikely to be of benefit. Glipizide belongs to the class of drugs known as sulfonylureas. Glucotrol XL is not for people with type 1 diabetes or people with diabetic ketoacidosis. detrol
Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. USFood and Drug Administration FDA.
Gastrointestinal disturbances are the most common reactions. Gastrointestinal complaints were reported with the following approximate incidence: nausea and diarrhea, 1 in 70; constipation and gastralgia, 1 in 100. They appear to be dose-related and may disappear on division or reduction of dosage. Cholestatic jaundice may occur rarely with sulfonylureas: glipizide should be discontinued if this occurs. Patients should be closely monitored for a minimum of 24 to 48 hours since hypoglycemia may recur after apparent clinical recovery. FITZGERALD MG, GADDIE R, MALINS JM, O'SULLIVANDJ. It may also be used with other medications. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems.
About FAERS: The FDA Adverse Event Reporting System FAERS is used by FDA for activities such as looking for new safety concerns that might be related to a marketed product, evaluating a manufacturer's compliance to reporting regulations and responding to outside requests for information. Reporting of adverse events is a voluntary process, and not every report is sent to FDA and entered into FAERS. GLUCOTROL XL affects you. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment. How should I take Glucotrol XL glipizide?
Use Glucotrol XL extended-release tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions. It may be harder to control your blood sugar during times of stress, such as fever, infection, injury, or surgery. Talk with your doctor about how to control your blood sugar levels if any of these occur. Do not change the dose of your medicine without checking with your doctor. If you experience a sudden onset of cold sweat, dizziness, fatigue, shakiness, rapid heartbeat, nausea, vision changes, confusion, personality change, nervousness, or hunger, contact your doctor. It may be necessary to check your blood sugar levels more often. Your doctor may want to adjust the dose of your diabetes medicine. Read the Patient Information Leaflet if available from your pharmacist before you start taking glipizide and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Take glipizide 30 minutes before a meal. If you take glipizide once daily, take it 30 minutes before breakfast. Cmax, -4% and 0%, respectively. Therefore, GLUCOTROL should be administered at least 4 hours prior to colesevelam to ensure that colesevelam does not reduce the absorption of glipizide. Do not crush, chew, or break an extended-release tablet. Swallow it whole. XL is co-administered with miconazole. Inert ingredients are: colloidal silicon dioxide; lactose; microcrystalline cellulose; starch; stearic acid. Your pharmacist can provide more information about glipizide. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. Use glipizide regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. The mean volume of distribution was approximately 10 liters after single intravenous doses in patients with type 2 diabetes mellitus.
Patients should be informed of the potential risks and advantages of Glipizide and of alternative modes of therapy. There is no well documented experience with Glipizide overdosage. Short-term administration of Glucotrol may be sufficient during periods of transient loss of control in patients usually controlled well on diet. If you also take colesevelam, avoid taking it within 4 hours after you take glipizide. Absher JR, Black DW. Tranylcypromine withdrawal delirium. These doses are both approximately 4 times the maximum recommended human daily MRHD dose of 2000 mg of the metformin component of Glipizide and Metformin HCl Tablets based on body surface area comparisons. No evidence of carcinogenicity with metformin alone was found in either male or female mice. Similarly, there was no tumorigenic potential observed with metformin alone in male rats. GLUCOTROL XL every day to help keep your blood sugar level under good control. There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Glipizide and Metformin HCl Tablets or any other antidiabetic drug. Metformin hydrochloride is an oral antihyperglycemic drug used in the management of type 2 diabetes. See window for lot number and expiration date. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Alcohol is known to potentiate the effect of metformin on lactate metabolism. Patients, therefore, should be warned against excessive alcohol intake, acute or chronic, while receiving Glipizide and Metformin HCl Tablets. Glipizide and Metformin HCl Tablets combines Glipizide and Metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action, to improve glycemic control in patients with type 2 diabetes. curacne
As with other sulfonylurea-class hypoglycemics, many stable non-insulin-dependent diabetic patients receiving insulin may be safely placed on Glipizide Tablets. Get medical help right away if you take too much acetaminophen even if you feel well. Glipizide is an oral diabetes medicine that helps control blood sugar levels. This medication helps your pancreas produce insulin. There were no differences in the pharmacokinetics of glipizide after single dose administration to older diabetic subjects compared to younger healthy subjects. Seek medical attention if you think any of your asthma medications are not working as well as usual. An increased need for medication could be an early sign of a serious asthma attack. If you use a peak flow meter at home, call your doctor if your numbers are lower than normal. If you think you may be pregnant, contact your doctor. It is not known if this medicine is found in breast milk. evista canada drugs evista
If you experience pale skin, blurred vision, loss of consciousness, increased thirst, increased urination, fatigue, or fast, deep breathing, check your blood sugar, stop using your antibiotic and contact your doctor right away. Included as part of the PRECAUTIONS section. Use Serevent Diskus regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Glucotrol XL extended-release tablets may cause drowsiness, dizziness, blurred vision, or light-headedness. These effects may be worse if you take it with alcohol or certain medicines. Use Glucotrol XL extended-release tablets with caution. Asthma is often treated with a combination of different drugs. If you use Serevent Diskus to treat asthma, you must use it together with another asthma control medication. Use all of your medications as directed by your doctor. Talk with your doctor if your medications do not seem to work as well in treating or preventing attacks. Do not change your doses or medication schedule without advice from your doctor. Find patient medical information for Glipizide Oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. When can I stop taking Glucotrol? The metabolism of Glucotrol is extensive and occurs mainly in the liver. The primary metabolites are inactive hydroxylation products and polar conjugates and are excreted mainly in the urine. Less than 10% unchanged Glucotrol is found in the urine. mail order now travatan mastercard
When I was first diagnosed I was put on Metformin and Glipizide. Anyway, when my BG's started coming down I started having lows. In the meantime, remember: If you do try any of these, it's important that you share this information with your health-care provider. Treatment of patients with glucose-6-phosphate dehydrogenase G6PD deficiency with sulfonylurea agents can lead to hemolytic anemia. Because Glipizide and Metformin HCl Tablets belongs to the class of sulfonylurea agents, caution should be used in patients with G6PD deficiency and a non-sulfonylurea alternative should be considered. In postmarketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency. Colesevelam can decrease the absorption of glipizide. If you are taking colesevelam, take glipizide at least 4 hours before taking colesevelam. Blood and urine glucose should be monitored periodically. Measurement of may be useful. order micronase payment usa micronase
Colesevelam can reduce the maximum plasma concentration and total exposure of glipizide when the two are coadministered. Certain drugs tend to produce hyperglycemia and may lead to loss of blood glucose control. These drugs include thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. When such drugs are administered to a patient receiving Glipizide and Metformin HCl Tablets, the patient should be closely observed for loss of blood glucose control. When such drugs are withdrawn from a patient receiving Glipizide and Metformin HCl Tablets, the patient should be observed closely for hypoglycemia. Metformin is negligibly bound to plasma proteins and is, therefore, less likely to interact with highly protein-bound drugs such as salicylates, sulfonamides, chloramphenicol, and probenecid as compared to sulfonylureas, which are extensively bound to serum proteins. All sulfonylurea drugs are capable of producing severe hypoglycemia. Proper patient selection, dosage, and instructions are important to avoid hypoglycemic episodes. Renal or hepatic insufficiency may cause elevated blood levels of glipizide and the latter may also diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemic reactions. Elderly, debilitated or malnourished patients, and those with adrenal or pituitary insufficiency, are particularly susceptible to the hypoglycemic action of glucose-lowering drugs. Hypoglycemia may be difficult to recognize in the elderly, and in people who are taking beta-adrenergic blocking drugs. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose-lowering drug is used. Protein binding was studied in serum from volunteers who received either oral or intravenous glipizide and found to be 98% to 99% 1 hour after either route of administration. The apparent volume of distribution of glipizide after intravenous administration was 11 liters, indicative of localization within the extracellular fluid compartment. In mice, no glipizide or metabolites were detectable autoradiographically in the brain or spinal cord of males or females, nor in the fetuses of pregnant females. In another study, however, very small amounts of radioactivity were detected in the fetuses of rats given labeled drug. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Know the signs of low blood sugar hypoglycemia and how to recognize them: headache, hunger, weakness, sweating, tremors, irritability, or trouble concentrating. Glipizide and Metformin HCl Tablets therapy due to GI adverse events. Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Therefore, hemodialysis may be useful for removal of accumulated drug from patients in whom metformin overdosage is suspected.
Precose metformin Glucophage miglitol Glyset pioglitazone Actos or rosiglitazone Avandia. If you are already taking another anti-diabetic drug such as chlorpropamide follow your doctor's directions carefully for stopping the old drug and starting glipizide. Furosemide increased the metformin plasma and blood C max by 22% and blood AUC by 15%, without any significant change in metformin renal clearance. When administered with metformin, the C max and AUC of furosemide were 31% and 12% smaller, respectively, than when administered alone, and the terminal half-life was decreased by 32%, without any significant change in furosemide renal clearance. No information is available about the interaction of metformin and furosemide when coadministered chronically. Glipizide extended-release Glucotrol XL should be taken with breakfast. This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time. Lewis-Hall F. Dear Healthcare Provider letter. Metformin is negligibly bound to plasma proteins and is, therefore, less likely to interact with highly protein-bound drugs such as salicylates, sulfonamides, chloramphenicol, and probenecid, as compared to the sulfonylureas, which are extensively bound to serum proteins. The mean relative bioavailability of glipizide in 21 males with type 2 diabetes mellitus after administration of 20 mg Glucotrol XL, compared to immediate release Glucotrol 10 mg given twice daily was 90% at steady-state. Steady-state plasma concentrations were achieved by at least the fifth day of dosing with Glucotrol XL in 21 males with type 2 diabetes mellitus and patients younger than 65 years. Do I need a prescription for salmeterol? It is unknown if this medication passes into milk. However, similar drugs pass into milk. Consult your doctor before breast-feeding. Q3. Why is it important to control type 2 diabetes? WARNING: A small number of people who have taken metformin hydrochloride have developed a serious condition called lactic acidosis. Tell your doctor if you have severe kidney problems. sefc.info dutasteride
Hemodialysis has often resulted in reversal of symptoms and recovery. SIADH electrolyte imbalance hyponatremia. Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals. These things can affect your glucose levels and your dose needs may also change. Do not change your medication dose or schedule without your doctor's advice. Studies characterizing the pharmacokinetics of glipizide in pediatric patients have not been performed. Salmeterol can increase the risk of asthma-related hospitalization in children and teenagers. It is very important that children using Serevent for asthma use it together with another long-term asthma control medication. The patient's ability to concentrate and react may be impaired as a result of hypoglycemia. Early warning symptoms of hypoglycemia may be different or less pronounced in patients with autonomic neuropathy, the elderly, and in patients who are taking beta-adrenergic blocking medications or other sympatholytic agents. Along with its benefits, this medication may rarely cause abnormal drug-seeking behavior . This risk may be increased if you have abused alcohol or drugs in the past. Take this medication exactly as prescribed to lessen the risk of addiction. Proper diet, regular exercise, and regular blood sugar testing are important for best results with Glucotrol XL extended-release tablets. Follow the diet and exercise program given to you by your health care provider. It has been shown that Glipizide therapy was effective in controlling blood sugar without deleterious changes in the plasma lipoprotein profiles of patients treated for NIDDM. Hypoglycemia was reported in approximately 10% of cases, but no causal association with metformin hydrochloride has been established. Clark's view is essentially the same. Alternative" implies that you ditch one treatment in favor of another. purchase bisoprolol manufacturer
Advise patients with diabetes to inform their healthcare provider if they are pregnant, contemplating pregnancy, breastfeeding, or contemplating breastfeeding. Q7. Can Glipizide and Metformin HCl Tablets cause side effects? Patients should be counseled against excessive alcohol intake, either acute or chronic, while receiving Glipizide and Metformin HCl Tablets. See printed below. Limited data from controlled pharmacokinetic studies of metformin in healthy elderly subjects suggest that total plasma clearance is decreased, the half-life is prolonged, and Cmax is increased, when compared to healthy young subjects. It may increase the risk of death from heart disease. Talk with your doctor about the benefits and risks of this or other therapies to treat your condition. It is not known if Glucotrol XL is safe and effective in children under 18 years of age. No information is available on race differences in the pharmacokinetics of glipizide. google sominex
There is no well documented experience with Glucotrol overdosage. When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well. Re-evaluate eGFR 48 hours after the imaging procedure, and restart Glipizide and Metformin HCl Tablets if renal function is stable. Store Serevent Diskus at room temperature away from moisture, heat, and sunlight. If hypoglycemia should occur in such patients, it may be prolonged and appropriate management should be instituted. It has been shown that glipizide therapy was effective in controlling blood sugar without deleterious changes in the plasma lipoprotein profiles of patients treated for NIDDM. Because GLUCOTROL belongs to the class of sulfonylurea agents, caution should be used in patients with and a non-sulfonylurea alternative should be considered. In post-marketing reports, has also been reported in patients who did not have known G6PD deficiency. Primary failure: Inadequate lowering of blood glucose at the maximum recommended dose. Glucotrol may cause low blood sugar levels. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your heart beat faster; make your vision change; give you a headache, chills, or tremors; or make you hungrier. It is a good idea to carry a reliable source of glucose eg, tablets or gel to treat low blood sugar. If this is not available, you should eat or drink a quick source of sugar like table sugar, honey, candy, orange juice, or non-diet soda. This will raise your blood sugar level quickly. Tell your doctor right away if this happens. To prevent low blood sugar, eat meals at the same time each day and do not skip meals. If you experience a sudden onset of cold sweat, dizziness, fatigue, shakiness, rapid heartbeat, nausea, vision changes, confusion, personality change, nervousness, or hunger, contact your doctor. It may be necessary to measure your blood sugar levels more often. Your doctor may need to adjust the dose of your diabetes medicine. The full effects of this interaction may take several weeks to appear and may last for several weeks after you stop taking your other medicine. Treatment of patients with glucose 6-phosphate dehydrogenase G6PD deficiency with sulfonylurea agents can lead to hemolytic anemia. Because Glipizide belongs to the class of sulfonylurea agents, caution should be used in patients with G6PD deficiency and a non-sulfonylurea alternative should be considered. In post-marketing reports, hemolytic anemia has also been reported in patients who did not have known G6PD deficiency. The effectiveness of any oral hypoglycemic drug, including Glipizide, in lowering blood glucose to a desired level decreases in many patients over a period of time, which may be due to progression of the severity of the diabetes or to diminished responsiveness to the drug. This phenomenon is known as secondary failure, to distinguish it from primary failure in which the drug is ineffective in an individual patient when first given. Glipizide primarily lowers blood glucose by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. Sulfonylureas bind to the sulfonylurea receptor in the pancreatic beta-cell plasma membrane, leading to closure of the ATP-sensitive potassium channel, thereby stimulating the release of insulin. What should I discuss with my healthcare provider before taking Glucotrol XL glipizide? FDA pregnancy category C. It is not known whether Serevent will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. XYZ. However, lifestyle changes like diet and exercise seem to slow the loss of beta cell function by improving insulin sensitivity. Other drugs may also stabilize beta cells. feldene
There have been post-marketing cases of metformin-associated lactic acidosis, including fatal cases. These cases had a subtle onset and were accompanied by nonspecific symptoms such as malaise, myalgias, abdominal pain, respiratory distress, or increased somnolence; however, hypotension and resistant bradyarrhythmias have occurred with severe acidosis. The administration of oral hypoglycemic drugs has been reported to be associated with increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin. This warning is based on the study conducted by the University Group Diabetes Program UGDP a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. The study involved 823 patients who were randomly assigned to 1 of 4 treatment groups Diabetes 19 Suppl. Gastrointestinal absorption of Glipizide in man is uniform, rapid, and essentially complete. Peak plasma concentrations occur 1 to 3 hours after a single oral dose. The half-life of elimination ranges from 2 to 4 hours in normal subjects, whether given intravenously or orally. The metabolic and excretory patterns are similar with the two routes of administration, indicating that first-pass metabolism is not significant. Glipizide does not accumulate in plasma on repeated oral administration. It has been reported that total absorption and disposition of an oral dose was unaffected by food in normal volunteers, but absorption was delayed by about 40 minutes. Thus, Glipizide was more effective when administered about 30 minutes before, rather than with, a test meal in diabetic patients. Protein binding was studied in serum from volunteers who received either oral or intravenous Glipizide and found to be 98 to 99% one hour after either route of administration. The apparent volume of distribution of Glipizide after intravenous administration was 11 liters, indicative of localization within the extracellular fluid compartment. In mice, no Glipizide or metabolites were detectable autoradiographically in the brain or spinal cord of males or females, nor in the fetuses of pregnant females. In another study, however, very small amounts of radioactivity were detected in the fetuses of rats given labelled drug. This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use and wear protective clothing when outdoors. Alcohol lowers blood glucose levels and disrupts the product of glucose in the liver. Check with your health care provider before you start, stop, or change the dose of any medicine.
During the insulin withdrawal period, the patient should test urine samples for sugar and at least three times daily. Patients should be instructed to contact the prescriber immediately if these tests are abnormal. In some cases, especially when patient has been receiving greater than 40 units of insulin daily, it may be advisable to consider hospitalization during the transition period. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Some forms of glipizide are made with a shell that is not absorbed or melted in the body. Part of the tablet shell may appear in your stool. This is a normal side effect and will not make the medication less effective. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your heart beat faster; make your vision change; give you a headache, chills, or tremors; or make you more hungry. It is a good idea to carry a reliable source of glucose eg, tablets or gel to treat low blood sugar. If this is not available, you should eat or drink a quick source of sugar like table sugar, honey, candy, orange juice, or non-diet soda. This will raise your blood sugar level quickly. Tell your doctor right away if this happens. To prevent low blood sugar, eat meals at the same time each day and do not skip meals. As with other sulfonylurea-class hypoglycemics, many stable non-insulin-dependent diabetic patients receiving insulin may be safely placed on Glucotrol. When transferring patients from insulin to Glucotrol, the following general guidelines should be considered: For patients whose daily insulin requirement is 20 units or less, insulin may be discontinued and Glucotrol therapy may begin at usual dosages. Several days should elapse between Glucotrol titration steps. For patients whose daily insulin requirement is greater than 20 units, the insulin dose should be reduced by 50% and Glucotrol therapy may begin at usual dosages. Subsequent reductions in insulin dosage should depend on individual patient response. Several days should elapse between Glucotrol titration steps. It has gotten worse over the past year. The pattern of laboratory test abnormalities observed with glipizide was similar to that for other sulfonylureas. Occasional mild to moderate elevations of SGOT, LDH, alkaline phosphatase, BUN, and creatinine were noted. One case of jaundice was reported. The relationship of these abnormalities to glipizide is uncertain, and they have rarely been associated with clinical symptoms. The cause of the interaction is not known. When these two medicines are taken together, your body may produce more insulin than expected. Your body may not respond properly to low blood sugar levels. Glipizide and Metformin HCl Tablets. Cerner Multum, Inc. "UK Summary of Product Characteristics. What happens if I miss a dose Glucotrol? ALT, LDH, alkaline phosphatase, and creatinine have been noted. acheter abilify
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Blood sugar control persists in some patients for up to 24 hours after a single dose of glipizide, even though plasma levels have declined to a small fraction of peak levels by that time see below. If you have any questions or problems, you should talk to your doctor or other healthcare provider about type 2 diabetes as well as Glipizide and Metformin HCl Tablets and its side effects. There is also a leaflet package insert written for health professionals that your pharmacist can let you read. Tell your doctor if your pain persists or worsens. Doses can be adjusted with caution taking into account the degree of hepatic, renal, or cardiac function, and the concomitant disease or other drug therapy.
Glucotrol should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. Maintenance dosing should be conservative to avoid hypoglycemic reactions. If you have signs or symptoms of low blood sugar, eat or drink something with sugar in it right away. If you do not feel better or your blood sugar level does not go up, call your healthcare provider or go to the nearest emergency room.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. Patients with hepatic impairment have developed cases of metformin-associated lactic acidosis. This may be due to impaired lactate clearance resulting in higher lactate blood levels. Therefore, avoid use of Glipizide and Metformin HCl Tablets in patients with clinical or laboratory evidence of hepatic disease. Short-term administration of GLUCOTROL may be sufficient during periods of transient loss of control in patients usually controlled well on diet.
What Is Glipizide and How Does It Work? GLUCOTROL in man is uniform, rapid, and essentially complete. There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Glipizide or any other anti-diabetic drug. The risks of lactic acidosis associated with metformin therapy, its symptoms, and conditions that predispose to its development, as noted in the and sections, should be explained to patients. Patients should be advised to discontinue Glipizide and Metformin HCl Tablets immediately and promptly notify their health practitioner if unexplained hyperventilation, myalgia, malaise, unusual somnolence, or other nonspecific symptoms occur. Once a patient is stabilized on any dose level of Glipizide and Metformin HCl Tablets, gastrointestinal symptoms, which are common during initiation of metformin therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.