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Due to these drugs causing hyperglycaemia, the mechanism being uncertain at present

≠ doses of insulin are often required for adequate glycaemic control


METFORMIN ALCOHOL Enhanced effect of metformin and ≠ risk of lactic acidosis. May mask signs and symptoms of hypoglycaemia

Alcohol is known to potentiate the effect of metformin on lactate metabolism. Inhibits glucose production and release, from many sources including the liver and release

Watch for and warn patients about symptoms of hypoglycaemia. The onset of lactic acidosis is often subtle with symptoms of malaise, myalgia, respiratory distress and ≠ nonspecific abdominal distress. There may be hypothermia and resistant bradyarrhythmias ➣ For signs and symptoms of hypoglycaemia, see Clinical Features of Some Adverse Drug Interactions, Hypoglycaemia


METFORMIN NSAIDs Possibility of ≠ plasma levels of metformin if there is renal impairment due to NSAIDs. Phenylbutazone is likely to ↓ renal elimination of metformin and ≠ plasma levels.