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Funding decision: Recommended with restrictions. Manufacturer advises caution in chronic stable heart failure monitor cardiac function, and concomitant use of drugs that can acutely impair renal function; interrupt treatment if dehydration occurs, and avoid in conditions that can acutely worsen renal function, or cause tissue hypoxia. Gastrointestinal side-effects are most frequent during treatment initiation and usually resolve spontaneously.

Dose adjustments In children: Manufacturer advises consider dose reduction in moderate impairment. Can be used in pregnancy for both pre-existing and gestational diabetes. Adult initiated by a specialist Initially mg once daily for 1 week, dose to be taken with breakfast, then mg twice daily for 1 week, dose to be taken with breakfast and evening meal, then 1. In adults: Manufacturer advises reduce dose in moderate impairment—consult product literature.

May be used during breast-feeding in women with pre-existing diabetes. A slow increase in dose may improve tolerability. See Prescribing in renal impairment. Patients and their carers should be counselled on the signs and symptoms of vitamin B 12 deficiency and advised to seek medical advice if these occur. Adult Initially mg once daily for at least 1 glucophage 750 price, dose to be taken with breakfast, then mg twice daily for at least 1 week, dose to be taken with breakfast and evening meal, then mg 3 times a day, dose to be taken with breakfast, lunch and evening meal; maximum 2 g per day.

See also Prescribing in the elderly. If control still not achieved then change to standard release tablets. Child 10—17 years specialist use only Initially mg once daily, dose to be adjusted according to response at intervals of at least 1 week, maximum daily dose to be given in 2—3 divided doses; maximum 2 g per day. Adult Initially mg once daily, then increased if necessary up to 2 g once daily, dose increased gradually, every 10—15 days, dose to be taken with evening meal, alternatively increased to 1 g twice daily, dose to be taken with meals, alternative dose only to be used if control not achieved with once daily dose regimen.

Women with gestational diabetes should discontinue treatment after giving birth. Healthcare professionals are advised to check serum-vitamin B 12 levels if deficiency is suspected and consider periodic monitoring in patients with risk factors for deficiency. Determine renal function before treatment and at least annually at least twice a year in patients with additional risk factors for renal impairment, or if deterioration suspected. Abdominal pain; appetite decreased; diarrhoea; gastrointestinal disorder; nausea; taste altered; vitamin B12 deficiency; vomiting.

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