Invokamet

Increased risk for metformin-associated lactic acidosis in renal or hepatic impairment, concomitant use of certain drugs (eg, carbonic anhydrase inhibitors), ≥65yrs of age, undergoing radiological contrast study, surgery and other procedures, hypoxic states, and excessive alcohol intake; discontinue if lactic acidosis is suspected. Discontinue at time of, or prior to intravascular iodinated contrast imaging in patients with eGFR <60mL/min/1.73m², history of hepatic impairment, alcoholism, heart failure, or will be given intra-arterial contrast; reevaluate eGFR 48hrs after procedure and restart therapy if renally stable. Assess renal function prior to starting and as clinically indicated. Prior to initiation, assess and correct volume status in those with renal impairment, elderly, or on loop diuretics; monitor during therapy. Precipitating conditions for diabetic ketoacidosis (eg, under-insulinization, acute febrile illness, reduced caloric intake, ketogenic diet, surgery, volume depletion, and alcohol abuse). Assess for ketoacidosis in presence of signs/symptoms of metabolic acidosis, regardless of blood glucose levels; discontinue if suspected; evaluate and treat if confirmed. Monitor for resolution of ketoacidosis before restarting. Withhold (at least 3 days), if possible, prior to major surgery or procedures associated with prolonged fasting. Increased risk for lower limb amputations. Consider risk factors that may predispose to amputations prior to initiation (eg, prior amputation, peripheral vascular disease, neuropathy, diabetic foot ulcers). Monitor for foot infection (including osteomyelitis), new pain or tenderness, sores or ulcers in lower limbs; discontinue if occur. Necrotizing fasciitis of the perineum (Fournier's gangrene); discontinue and treat immediately if suspected; use alternative antidiabetic. Discontinue if hypersensitivity reactions occur. Consider risk factors for bone fractures before initiation. Monitor for genital mycotic infections, UTIs (including urosepsis, pyelonephritis), hematology (esp. serum Vit. B₁₂); treat if needed. Hepatic impairment: not recommended. Pregnancy (during 2^nd & 3^rd trimesters), nursing mothers: not recommended.