Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Metformin. 

Alcohol intake: Anyone taking metformin should avoid excessive alcohol intake.

Blood sugar control: If you have fever, trauma, infection, or surgery, you may have a temporary loss of blood sugar control. At such times, your doctor may think it is necessary to stop metformin and temporarily inject insulin. Metformin may be started again after the problem is resolved.

Blood sugar monitoring: Monitor your blood sugar regularly at intervals as discussed with your doctor or diabetes educator.

Diabetes complications: The use of metformin (or any other medication used for diabetes) will not prevent the development of complications particular to diabetes mellitus (e.g., Kidney Disease, nerve disease, eye disease).

Diet: Metformin is a treatment to be taken in combination with a proper diet. Metformin is not a substitute for proper diet.

Dye or contrast agents: If you are going to have an X-ray procedure that uses dye or a contrast agent, you may need to stop taking Metformin for a short time. Contact your doctor for instructions.

Kidney problems:  Kidney disease or reduced kidney function causes Metformin to build up in the body, causing side effects. If you have kidney problems, your doctor should closely monitor your condition while you are taking metformin, as it may affect kidney function.

Lactic acidosis: Lactic acidosis is a rare but serious problem that occurs due to metformin accumulation (i.e., the body doesn't get rid of it fast enough) during treatment. If you have severe kidney disease you are at higher risk of developing lactic acidosis. Since alcohol may increase the risk of lactic acidosis, do not drink a lot of alcohol over the short- or long-term while taking Metformin. When it does occur (very rarely), it is fatal in 50% of cases. There have been no reports of lactic acidosis in Canada when metformin was used as directed. If you experience symptoms of lactic acidosis (e.g., weakness, tiredness, drowsiness, unusual muscle pain, trouble breathing, stomach pain with nausea, vomiting or diarrhea, feeling cold, dizziness, light-headedness, or slow or irregular heartbeat), stop taking Metformin and get immediate medical attention.

Liver function: Decreased liver function has been linked to lactic acidosis. Metformin is not recommended for people with severely reduced liver function. If you have moderately reduced liver function, discuss with your doctor how Metformin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Metformin, and whether any special monitoring is needed.

Low blood sugar: Under usual circumstances, low blood sugar does not occur for people who take only metformin. Low blood sugar could occur when not enough food is eaten, especially when strenuous exercise is undertaken at the same time or when large amounts of alcohol have been consumed.

Reduced response: Over a period of time, you may become progressively less responsive to a particular treatment for diabetes because your diabetes worsens. If metformin fails to lower blood sugar to target levels, talk to your doctor. Your doctor may want to stop metformin or recommend another medication.

Surgery: Metformin should be stopped temporarily for surgery (except for minor surgery where food and fluid intake is not restricted). You will be restarted on Metformin once you are eating and drinking and your kidney function has been tested and is normal. Talk to your doctor for specific instructions.

Vitamin B12 levels: Metformin may decrease vitamin B12 levels. Your doctor will monitor your B12 levels with blood tests while you are taking Metformin.

Pregnancy: Metformin should not be used during pregnancy. If you become pregnant while taking Metformin, contact your doctor immediately.

Breast-feeding: Metformin is believed to pass into breast milk. Metformin should not be used if you are breast-feeding.

Children: The safety and effectiveness of Metformin have not been established for children.

Seniors: Kidney function often decreases with age. As a result, seniors may be more likely to experience side effects of Metformin.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Actos (Pioglitazone).

Bladder: Taking Actos (Pioglitazone) may increase the risk of developing bladder cancer. If you have risk factors for bladder cancer, such as age, smoking, or someone in your family has had bladder cancer you may be more likely to develop this disease. Do not use Actos (Pioglitazone) if you have or have had bladder cancer.

If you experience symptoms such as blood or red colour in your urine, an urgent need to urinate, pain while urinating, or pain in the back or lower abdomen, talk to your doctor right away.

Fractures: Actos (Pioglitazone) has been associated with an increased incidence of bone fracture for female patients. You and your doctor should consider the risk of fractures. Talk to your doctor if you have any concerns.

Heart failure: Actos (Pioglitazone) can cause fluid buildup in the body, which may lead to Congestive Heart Failure. Actos (Pioglitazone) should not be used by anyone who has any degree of heart failure, or anyone who is at risk of heart failure (including people with swelling due to fluid buildup). If you develop fluid buildup or swelling, shortness of breath, fatigue, or excessive weight gain while taking Actos (Pioglitazone), you should consult your doctor immediately.

Liver: Although liver problems have not been observed with Actos (Pioglitazone), another similar medication has caused liver problems in a small number of people. You should report any signs of liver problems (abdominal or stomach pain, dark urine, loss of appetite, nausea or vomiting, unusual tiredness or weakness, or yellow eyes or skin) to your doctor at once.

Use with other diabetes medications: Actos (Pioglitazone) should not be used with insulin. It should not be used in combination (i.e., triple therapy) with both metformin and a sulfonylurea (e.g., glyburide, glicazide); however, it may be used with either metformin or a sulfonylurea.

Vision: Actos (Pioglitazone) may cause fluid to build up in the eye (macular edema) causing vision changes. If you experience any change to your vision, contact your doctor.

Pregnancy: Actos (Pioglitazone) has not been studied for use by pregnant women. Actos (Pioglitazone) should not be used during pregnancy. In general, blood sugar should be controlled during pregnancy by using insulin injections. If you become pregnant while taking Actos (Pioglitazone), contact your doctor immediately.

Breast-feeding: It is not known if Actos (Pioglitazone) passes into breast milk. If you are a breast-feeding mother and are taking Actos (Pioglitazone), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Actos (Pioglitazone) have not been established for children.