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General information about glyburide

People who have a condition known as glucose-6-phosphate dehydrogenase G6PD deficiency and who take Glucovance may develop hemolytic anemia fast breakdown of red blood cells. G6PD deficiency usually runs in families. Tell your doctor if you or any members of your family have been diagnosed with G6PD deficiency before you start taking Glucovance. The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members. Q13. What does my doctor need to know to decrease my risk of lactic acidosis? Weight gain was seen with the addition of rosiglitazone to glyburide and metformin, similar to that reported for thiazolidinedione therapy alone. cheap novolog sale

Most of these side effects are minor

If Alka-Seltzer effervescent tablets has a strong vinegar-like smell upon opening, or if Alka-Seltzer effervescent tablets does not fizz when placed in water, it means the medicine is breaking down. Throw the medicine away safely and out of the reach of children; contact your pharmacist and replace. Glyburide: Metabolites are 4-transhydroxy derivative major and 3-cis-hydroxy derivative, but they are not thought to contribute to the hypoglycemic activity of glyburide. These may be transient and may disappear despite continued use of glyburide; if skin reactions persist, the drug should be discontinued.

Glyburide side effects

Such interaction between metformin and oral cimetidine has been observed in normal healthy volunteers in both single- and multiple-dose metformin-cimetidine drug interaction studies, with a 60% increase in peak metformin plasma and whole blood concentrations and a 40% increase in plasma and whole blood metformin AUC. There was no change in elimination half-life in the single-dose study. Metformin had no effect on cimetidine pharmacokinetics. The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members. Primary and secondary failure also should be explained.

Glyburide adult dosage

Can I take glyburide and metformin with other medications? The safety and efficacy of Glucovance were evaluated in an active-controlled, double-blind, 26-week randomized trial involving a total of 167 pediatric patients ranging from 9-16 years of age with type 2 diabetes. Glucovance was not shown statistically to be superior to either metformin or glyburide with respect to reducing HbA 1c from baseline see Table 5. No unexpected safety findings were associated with Glucovance in this trial. Single-dose studies with Diaβeta in normal subjects demonstrate significant absorption within one hour, peak drug levels at about four hours, and low but detectable levels at twenty-four hours. Mean serum levels of glyburide, as reflected by areas under the serum concentration-time curve, increase in proportion to corresponding increases in dose. Multiple-dose studies with Diaβeta in diabetic patients demonstrate drug level concentration-time curves similar to single-dose studies, indicating no build-up of drug in tissue depots. The decrease of glyburide in the serum of normal healthy individuals is biphasic, the terminal half-life being about 10 hours. In single-dose studies in fasting normal subjects, the degree and duration of blood glucose lowering is proportional to the dose administered and to the area under the drug level concentration-time curve. The blood glucose lowering effect persists for 24 hours following single morning doses in non-fasting diabetic patients. Under conditions of repeated administration in diabetic patients, however, there is no reliable correlation between blood drug levels and levels. A one-year study of diabetic patients treated with Diaβeta showed no reliable correlation between administered dose and serum drug level.



What are the symptoms of lactic acidosis?

While megaloblastic anemia has rarely been seen with metformin therapy, if this is suspected, Vitamin B 12 deficiency should be excluded. Serious stomach ulcers or bleeding can occur with the use of Alka-Seltzer effervescent tablets. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Alka-Seltzer effervescent tablets with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling. Glyburide Tablets should be added gradually to the dosing regimen of patients who have not responded to the maximum dose of metformin monotherapy after four weeks see and . Refer to metformin package insert. See window for lot number and expiration date. In elderly patients, debilitated or malnourished patients, and patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions see section. In a steady-state study in diabetic patients receiving Glynase PresTab Tablets 6 mg once daily or Glynase PresTab Tablets 3 mg twice daily, no difference was seen between the two dosage regimens in average 24-hour glyburide concentrations following two weeks of dosing. The once-daily and twice-daily regimens provided equivalent glucose control as measured by fasting plasma glucose levels, 4-hour postprandial glucose AUC values, and 24-hour glucose AUC values. Insulin AUC response over the 24-hour period was not different for the two regimens. There were differences in insulin response between the regimens for the breakfast and supper 4-hour postprandial periods, but these did not translate into differences in glucose control. You may get a small at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes. Mean serum levels of glyburide, as reflected by areas under the serum concentration-time curve, increase in proportion to corresponding increases in dose. Multiple dose studies with glyburide in diabetic patients demonstrate drug level concentration-time curves similar to single dose studies, indicating no buildup of drug in tissue depots. Diaβeta has been shown to affect the maturation of the long bones and in rat pups when given in doses 6250 times the maximum recommended human dose. These effects, which were seen during the period of lactation and not during organogenesis, are a shortening of the bones with effects to various structures of the long bones, especially in humerus and femur. These may be transient and may disappear despite continued use of Diaβeta. Q14. Can I take Glyburide and Metformin hydrochloride tablets withother medications? GLUCOVANCE therapy, the drug should be promptly discontinued. All hypoglycemic events were managed by the patients and only one patient discontinued for hypoglycemia see PRECAUTIONS, General, Addition of Thiazolidinediones to Glyburide and Metformin Therapy. Attach a tube to the needle to fill it with blood. Q7. Can Glucovance cause side effects?



TEVA PHARMACEUTICALS USA, INC

Glyburide is mainly metabolized by CYP 2C9 and to a lesser extent by CYP 3A4. There is a potential for drug-drug interaction when glyburide is coadministered with inducers or inhibitors of CYP 2C9, which should be taken into account when considering concomitant therapy. Do not share this medication with others. Less frequently, symptoms of hypoglycemia low blood sugar such as lightheadedness, dizziness, shakiness, or hunger may occur. The risk of hypoglycemic symptoms increases when meals are skipped, too much alcohol is consumed, or heavy exercise occurs without enough food. Following the advice of your doctor can help you to avoid these symptoms. You may be asked to stop eating and drinking for 8 hours before having this blood test. Glyburide and metformin combines two antihyperglycemic agents with complementary mechanisms of action, to improve glycemic control in patients with type 2 diabetes. 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 glyburide. They tend to be dose-related and may disappear when dosage is reduced. GLUCOVANCE with rosiglitazone and 184 received GLUCOVANCE with placebo. Find the cause of low blood sugar hypoglycemia. Q14. Can I take Glucovance with other medications? Prolonged severe hypoglycemia 4 to 10 days has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. It is not recommended that glyburide and metformin be used during pregnancy. This represents an exposure of about 2 and 6 times the MRHD dose of 2000 mg of the metformin component of glyburide and metformin based on body surface area comparisons for rats and rabbits, respectively. Determination of fetal concentrations demonstrated a partial placental barrier to metformin. Why do I need to take glyburide and metformin? cipro



What conditions does glyburide treat

Dia” and “ß” on one side and plain on the other side. The mechanism for this interaction is not known. Together, they are efficient in helping you achieve better glucose control. Tell your doctor if you plan to become pregnant or have become pregnant. As with other oral glucose-control medications, you should not take glyburide and metformin during pregnancy. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal. Recent information strongly suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities. Most experts recommend that insulin be used during pregnancy to maintain blood glucose as close to normal as possible. Because animal reproduction studies are not always predictive of human response, Glyburide and Metformin hydrochloride should not be used during pregnancy unless clearly needed. See below. Glucovance is capable of producing hypoglycemia or hypoglycemic symptoms, therefore, proper patient selection, dosing, and instructions are important to avoid potential hypoglycemic episodes. The risk of hypoglycemia is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents or ethanol. Renal or hepatic insufficiency may cause elevated drug levels of both glyburide and metformin hydrochloride, and the hepatic insufficiency may also diminish gluconeogenic capacity, both of which increase the risk of hypoglycemic reactions. Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects. Hypoglycemia may be difficult to recognize in the elderly and people who are taking beta-adrenergic blocking drugs. Glyburide and Metformin hydrochloride tablets USP contain 2 oral antihyperglycemic drugs used in the management of type 2 diabetes, glyburide, USP and metformin hydrochloride, USP. PEG 6000, Propylene Glycol, Iron Oxide Yellow and Iron Oxide Red. purchase erythromycin online reviews erythromycin



What other drugs will affect glyburide

Intravascular contrast studies with iodinated materials can lead to acute alteration of renal function and have been associated with lactic acidosis in patients receiving metformin see . Therefore, in patients in whom any such study is planned, Glucovance should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been reevaluated and found to be normal. Glyburide and Metformin hydrochloride tablets combines Glyburide and Metformin hydrochloride, 2 antihyperglycemic agents with complementary mechanisms of action, to improve glycemic control in patients with type 2 diabetes. For patients not adequately controlled on Glucovance, a thiazolidinedione can be added to Glucovance therapy. When a thiazolidinedione is added to Glucovance therapy, the current dose of Glucovance can be continued and the thiazolidinedione initiated at its recommended starting dose. For patients needing additional glycemic control, the dose of the thiazolidinedione can be increased based on its recommended titration schedule. The increased glycemic control attainable with Glucovance plus a thiazolidinedione may increase the potential for hypoglycemia at any time of day. In patients who develop hypoglycemia when receiving Glucovance and a thiazolidinedione, consideration should be given to reducing the dose of the glyburide component of Glucovance. As clinically warranted, adjustment of the dosages of the other components of the antidiabetic regimen should also be considered. Patients should be retitrated when transferred from MICRONASE or Diabeta or other oral hypoglycemic agents. Reproduction studies were performed in rats and rabbits at doses up to 500 times the MRHD dose of 20 mg of the glyburide component of glyburide and metformin based on body surface area comparisons and revealed no evidence of impaired fertility or harm to the fetus due to glyburide. Certain individuals those with inadequate Vitamin B 12 or calcium intake or absorption appear to be predisposed to developing subnormal Vitamin B 12 levels. In these patients, routine serum Vitamin B 12 measurements at two- to three-year intervals may be useful. There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with glyburide and metformin or any other antidiabetic drug. Glyburide and Metformin Hydrochloride Tablets USP are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. For patients not adequately controlled on glyburide and metformin hydrochloride tablets, a thiazolidinedione can be added to glyburide and metformin hydrochloride tablets therapy. When a thiazolidinedione is added to glyburide and metformin hydrochloride tablets therapy, the current dose of glyburide and metformin hydrochloride tablets can be continued and the thiazolidinedione initiated at its recommended starting dose. For patients needing additional glycemic control, the dose of the thiazolidinedione can be increased based on its recommended titration schedule. The increased glycemic control attainable with glyburide and metformin hydrochloride tablets plus a thiazolidinedione may increase the potential for hypoglycemia at any time of day. In patients who develop hypoglycemia when receiving glyburide and metformin hydrochloride tablets and a thiazolidinedione, consideration should be given to reducing the dose of the glyburide component of glyburide and metformin hydrochloride tablets. As clinically warranted, adjustment of the dosages of the other components of the antidiabetic regimen should also be considered. store pantoprazole hygien



Glyburide warnings

When colesevelam is coadministered with glyburide, maximum plasma concentration and total exposure to glyburide is reduced. Therefore, glyburide and metformin hydrochloride tablets should be administered at least 4 hours prior to colesevelam. HbA in patients randomized to glyburide or metformin therapy. This information is not specific medical advice and does not replace information you receive from your health care provider. Properly functioning kidneys are needed to help prevent lactic acidosis. Most people with kidney problems should not take glyburide and metformin see questions 9 through 13. Some Type II diabetic patients being treated with insulin may respond satisfactorily to Glynase PresTab. This represents an exposure of about 2 and 6 times the MRHD dose of 2000 mg of the metformin component of Glucovance based on body surface area comparisons for rats and rabbits, respectively. Determination of fetal concentrations demonstrated a partial placental barrier to metformin. Some patients who are initially responsive to oral hypoglycemic drugs, including glyburide, may become unresponsive or poorly responsive over time. Alternatively, Glyburide Tablets may be effective in some patients who have become unresponsive to one or more other sulfonylurea drugs. Feig DS, Kraemer JM, Moskovitz DN et al. The transfer of glyburide into breast milk. Clin Pharmacol Ther. Octreotide may lower your blood sugar. 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. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known.



Glyburide dosing information

No studies have been performed specifically examining the safety and efficacy of switching to Glucovance therapy in patients taking concomitant glyburide or other sulfonylurea plus metformin. Changes in glycemic control may occur in such patients, with either hyperglycemia or hypoglycemia possible. Any change in therapy of type 2 diabetes should be undertaken with care and appropriate monitoring. What if I become pregnant while taking glyburide and metformin? Certain individuals those with inadequate vitamin B 12 or calcium intake or absorption appear to be predisposed to developing subnormal vitamin B 12 levels. In these patients, routine serum vitamin B 12 measurements at 2- to 3-year intervals may be useful. Fischbach FT, Dunning MB III, eds. 2009. Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins. Although rare, if lactic acidosis does occur, it can be fatal in up to half the cases. C-peptide test must be done at the same time as a blood glucose test. What does my doctor need to know to decrease my risk of lactic acidosis? Q1. Why do I need to take GLUCOVANCE? The following adverse reactionos have been identified during post-approval use. Because these reactions are reported voluntarily from a population of uncertain size; it is generally not possible to reliably estimate their frequency or establish a casual relationship to drug exposure. Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness; back pain; chest pain or discomfort; confusion; dizziness or light-headedness; fainting; fast or difficult breathing; feeling of being unusually cold; fever, chills, or persistent sore throat; general feeling of being unwell; low blood sugar symptoms eg, anxiety, dizziness, fast heartbeat, headache, tremors, unusual sweating; muscle pain or weakness; severe or persistent blurred vision or other vision problems; slow or irregular heartbeat; symptoms of liver problems eg, dark urine, loss of appetite, pale stools, stomach pain, yellowing of the eyes or skin; unusual bruising or bleeding; unusual drowsiness; unusual or persistent nausea, or stomach or back pain or discomfort; unusual tiredness or weakness. synthroid buy online shopping



What are the possible side effects of glyburide

Where can I get more information about glyburide and metformin? No. 1 aluminum lake. Tell your doctor or dentist that you take Alka-Seltzer effervescent tablets before you receive any medical or dental care, emergency care, or surgery. All sulfonylureas including Glynase PresTab are capable of producing severe hypoglycemia. Proper patient selection and dosage and instructions are important to avoid hypoglycemic episodes. Renal or hepatic insufficiency may cause elevated drug levels of glyburide 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. The risk of hypoglycemia may be increased with combination therapy. WARNINGS and PRECAUTIONS. 2. Known hypersensitivity to metformin hydrochloride or glyburide. 3. Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin. 4. Concomitant administration of bosentan. When transferring patients from oral hypoglycemic agents other than chlorpropamide, to Diaβeta, no transition period and no initial priming dose is necessary. When transferring patients from chlorpropamide, particular care should be exercised during the first two weeks because the prolonged retention of chlorpropamide in the body and subsequent overlapping drug effects may provoke hypoglycemia. ikni.info loratadine



List of glyburide side effects

These situations can lead to severe dehydration, and it may be necessary to stop taking glyburide and metformin temporarily. 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. You should let your doctor know if you are going to have any surgery or specialized x-ray procedures that require injection of contrast agents. Glyburide and metformin therapy will need to be stopped temporarily in such instances. What if I become pregnant while taking Glyburide and Metformin hydrochloride tablets? In addition to its blood glucose lowering actions, Diaβeta produces a mild by enhancement of renal free water clearance. Clinical experience to date indicates an extremely low incidence of disulfiram-like reactions in patients while taking Diaβeta. 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 Glyburide and Metformin hydrochloride, the patient should be closely observed for loss of blood glucose control. When such drugs are withdrawn from a patient receiving Glyburide and Metformin hydrochloride, 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. No overall differences in effectiveness or safety were observed between these patients and younger patients, and other reported clinical experience has not identified differences in response between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. demadex



Before taking glyburide

Metformin decreases liver uptake of lactate increasing lactate blood levels which may increase the risk of lactic acidosis, especially in patients at risk. Carry an ID card at all times that says you have diabetes. Check your blood sugar levels as directed by your doctor. Treatment of patients with glucose-6-phosphate dehydrogenase G6PD deficiency with sulfonylurea agents can lead to hemolytic anemia. People who have a condition known as glucose-6-phosphate dehydrogenase G6PD deficiency and who take Glyburide and Metformin Hydrochloride Tablets may develop hemolytic anemia fast breakdown of red blood cells. G6PD deficiency usually runs in families. Tell your doctor if you or any members of your family have been diagnosed with G6PD deficiency before you start taking Glyburide and Metformin hydrochloride tablets. Octreotide may cause dizziness, drowsiness, or vision changes. These effects may be worse if you take it with alcohol or certain medicines. Use octreotide with caution.



Important information

GLUCOVANCE, similar to that reported for thiazolidinedione therapy alone. With known hypersensitivity to the drug or any of its excipients. Weight gain was seen with the addition of rosiglitazone to Glucovance, similar to that reported for thiazolidinedione therapy alone. Symptoms may include chest pain; diarrhea; dizziness; flushing; irregular heartbeat; severe stomach pain or tenderness; trouble breathing; unusual tiredness or weakness; weight loss; yellowing of the skin or eyes. The risk of hypoglycemia is increased when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents or ethanol. Renal or hepatic insufficiency may cause elevated drug levels of both Glyburide and Metformin hydrochloride, and the hepatic insufficiency may also diminish gluconeogenic capacity, both of which increase the risk of hypoglycemic reactions. Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects. Hypoglycemia may be difficult to recognize in the elderly and people who are taking beta-adrenergic blocking drugs. purchase diclofenac forum



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Use of glyburide


Commonly used brand names: Glucovance

SIADH electrolyte imbalance hyponatremia a certain nervous system problem autonomic neuropathy. Changes in the lipid profile associated with Glyburide and Metformin hydrochloride treatment were similar to those seen with glyburide, metformin, and placebo. In patients with decreased renal function based on creatinine clearance the plasma and blood half-life of metformin is prolonged and the renal clearance is decreased in proportion to the decrease in creatinine clearance see Table 1; also, see WARNINGS. Therapeutic response to Glyburide Tablets should be monitored by frequent urine glucose tests and periodic blood glucose tests. Measurement of glycosylated hemoglobin levels may be helpful in some patients. purchase fluconazole shop uk

What is glyburide

Glucovance, like all blood sugar-lowering medications, can cause side effects in some patients. Most of these side effects are minor. However, there are also serious, but rare, side effects related to Glucovance see Q9-Q13. N-dimethylimidodicarbonimidic diamide monohydrochloride is not chemically or pharmacologically related to sulfonylureas, thiazolidinediones, or a-glucosidase inhibitors. It is a white to off-white crystalline compound with a molecular formula of C 4 H 12 ClN 5 monohydrochloride and a molecular weight of 165. Periodic fasting blood glucose FBG and HbA 1c measurements should be performed to monitor therapeutic response. asacol

Concomitant administration of bosentan

Concomitant medications that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin, such as cationic drugs that are eliminated by renal tubular secretion see PRECAUTIONS, Drug Interactions should be used with caution. For institutional use only. Similarly, in controlled clinical studies in patients with type 2 diabetes, the antihyperglycemic effect of metformin was comparable in males and females. If you have any questions about Alka-Seltzer effervescent tablets, please talk with your doctor, pharmacist, or other health care provider.

How should i store glyburide

In rare cases, the vein may become swollen after the blood sample is taken. If you develop unusual or unexpected stomach problems, or if you develop stomach problems later during treatment, contact your doctor at once. This may be a sign of lactic acidosis. There was no evidence of a mutagenic potential of metformin alone in the following in vitro tests: Ames test S. typhimurium gene mutation test mouse lymphoma cells or chromosomal aberrations test human lymphocytes. Results in the in vivo mouse micronucleus test were also negative.

C-peptide levels will be low because the pancreas cannot make any insulin in response to the glucagon. In people with type 2 diabetes, C-peptide levels will be higher than the first blood test because the pancreas is making more insulin in response to the glucagon. Nifedipine appears to enhance the absorption of metformin. Little is known about how other herbs might help control diabetes. and bilberry have been studied in animal experiments, but have yet to undergo large, controlled human studies. The reputation of two other herbs, gymnome and jambul, rests on anecdotal evidence alone. The metformin in this combination medicine may rarely cause a serious and sometimes fatal condition called lactic acidosis. Most of these cases have occurred in diabetic patients who also have certain kidney problems. The risk of lactic acidosis may be greater if you have liver problems, kidney problems, or heart failure. The risk may also be greater in patients who are elderly or drink alcohol.

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