Should not be used in patients w/ type 1 diabetes. Discontinue treatment if ketoacidosis is suspected; consider monitoring & temporary discontinuation in clinical situations predisposing to ketoacidosis (eg, prolonged fasting due to acute illness or surgery); if necrotizing fascitiis is suspected; in cases of recurrent UTI. Patients on very low carbohydrate diet, w/ acute illness, pancreatic disorders suggesting insulin deficiency, insulin dose reduction, alcohol abuse, severe dehydration & w/ history of ketoacidosis. Temporarily discontinue use in case of dehydration. Increased risk of lactic acidosis. Discontinue metformin prior to or at the time of the imaging procedure & not restarted until at least 48 hr after. Evaluate for necrotizing fasciitis in patients w/ pain or tenderness, erythema, swelling in the genital or perineal area, fever, malaise. Assess GFR before treatment initiation & regularly thereafter. Regularly monitor of cardiac & renal function in patients w/ stable chronic heart failure. Contraindicated in patients w/ acute & unstable heart failure. Carefully monitor vol status & electrolytes in case of conditions that may lead to fluid loss (eg, GI illness). Consider temporary treatment interruption until fluid loss is corrected & in patients w/ complicated UTI. Discontinue treatment at the time of surgery under general, spinal or epidural anaesth & not restarted until at least 48 hr, provided that renal function has been re-evaluated & found to be stable. Elevated haematocrit. Positive test for glucose in the urine. Regularly examine the feet & counsel all diabetic patients on routine preventative footcare. Perform routine serum vit B12
measurement at 2- to 3-yr intervals. Pregnancy. Discontinue breast feeding during treatment. Not recommended for use in childn < 18 yr. Elderly ≥85 yr; increased risk of vol depletion in elderly ≥75 yr.