Discontinue if ketoacidosis, necrotizing fasciitis is suspected; at the time of surgery under general, spinal or epidural anaesth & may be restarted no earlier than 48 hr following surgery or resumption of oral nutrition. Consider temporary discontinuation for at least 3 days prior to surgery for patients who undergo scheduled surgery; in clinical situations known to predispose to ketoacidosis; in present conditions that alter renal function; until fluid loss is corrected in conditions that may lead to fluid loss; in patients w/ complicated UTI. Temporarily discontinue metformin if dehydration (severe diarrhea or vomiting, fever or reduced fluid intake) occurs. Discontinue metformin in suspected symptoms of lactic acidosis; prior to iodinated contrast media administration or at the time of imaging procedure & not restarted until at least 48 hr provided that renal function has been re-evaluated & stable. Not to be used in patients w/ type 1 diabetes. Patients w/ very low carbohydrate diet, acute illness, pancreatic disorders suggesting insulin deficiency (eg, type 1 diabetes, history of pancreatitis or pancreatic surgery), insulin dose reduction (including insulin pump failure), alcohol abuse, severe dehydration, & history of ketoacidosis; heart failure; known CV disease, on antihypertensive therapy w/ history of hypotension or ≥75 yr for whom an empagliflozin-induced drop in BP could pose a risk. Assess patients for ketoacidosis immediately if symptoms occur regardless of blood glucose level; GFR before treatment & regularly (at least annually) thereafter. Monitor ketones; cardiac & renal function (every 3-6 mth in patients at increased risk of renal impairment progression & elderly) in patients w/ stable chronic heart failure; vol status (eg, physical exam, BP measurements, lab tests including haematocrit) & electrolytes; serum vit B
12 levels in case of suspicion of deficiency (eg, anaemia or neuropathy). Evaluate treated patients for necrotizing fasciitis w/ pain or tenderness, erythema, genital or perineal swelling, fever, malaise. Concomitant use w/ medicinal products that can acutely impair renal function eg, antihypertensives, diuretics & NSAIDs; medicinal products that can cause lactic acidosis. Avoid use during pregnancy. Discontinue breastfeeding during treatment. Not recommended in childn <18 yr & elderly ≥85 yr. Elderly ≥75 yr (increased risk of vol depletion).