Not recommended to initiate treatment in patients w/ eGFR <15 mL/min/1.3 m
2; patients w/ severe hepatic impairment. Assess patients for ketoacidosis immediately if nonspecific symptoms eg, nausea, vomiting, anorexia, abdominal pain, excessive thirst, difficulty breathing, confusion, unusual fatigue or sleepiness occur, regardless of blood glucose level. Stop treatment immediately if diabetic ketoacidosis is suspected or diagnosed. Patients at higher risk of diabetic ketoacidosis include patients w/ low β cell function reserve (eg, type 2 diabetes patients w/ low C peptide or latent autoimmune diabetes in adults or patients w/ history of pancreatitis), conditions that lead to restricted food intake or severe dehydration, for whom insulin doses are reduced & w/ increased insulin requirements due to acute medical illness, surgery or alcohol abuse. Not to be used for patients w/ type 1 diabetes. Evaluate patients w/ pain, tenderness, erythema, or swelling in genital or perineal area, w/ fever or malaise for necrotising fasciitis. Discontinue & institute prompt treatment if Fournier's gangrene is suspected. Consider temporary interruption of treatment when treating pyelonephritis or urosepsis. Cardiac failure, NYHA class IV. CKD in patients w/o diabetes who do not have albuminuria; w/ polycystic kidney disease, glomerulonephritis w/ flares, ongoing or recent requirements of cytotoxic, immunosuppressive or other immunomodulating renal therapy, or who received organ transplant. Lower limb amputations. +ve glucose in urine. Contains lactose; not to be taken by patients w/ galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Not recommended during 2nd or 3rd trimester of pregnancy. Not to be used while breast-feeding. Childn <18 yr. Elderly ≥65 yr.
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