Metfor XR Special Precautions

Monitor renal function regularly in elderly patients particularly those >80 years of age.
Cardiovascular collapse (shock); acute congestive heart failure, myocardial infarction and other conditions characterized by hypoxemia.
Temporarily suspend therapy for any surgical procedure (except minor procedures not associated with restricted intake of food and fluids).
Excessive alcohol intake since it is known to potentiate the effect of metformin on lactate metabolism.
Patients with impaired hepatic function.
Annually measure hematologic parameters. Any apparent abnormalities should be appropriately investigated and managed.
Hypoglycemia may occur when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents (such as sulfonylureas and insulin) or ethanol.
Elderly, debilitated, or malnourished patients, those with adrenal insufficiency, and in people who are taking adrenergic blocking agents.
Exposure to stress such as fever, trauma, infection, or surgery may cause temporary loss of glycemic control.