Discontinue use if diabetic ketoacidosis & necrotising perineum fasciitis/Fournier's gangrene is suspected or diagnosed. Not to be used in patients w/ type 1 diabetes. Not recommended in diabetic patients w/ persistent eGFR <45 mL/min/1.73 m2
. Consider additional glucose-lowering treatment if eGFR falls persistently <45 mL/min/1.73 m2
in patients w/ heart failure & type 2 DM. Vol-depletion risk due to acute disease eg, GI illness, history of hypotension; patients w/ low β-cell function reserve, conditions leading to restricted food intake or severe dehydration, reduced insulin doses, increased insulin requirements due to acute medical illness, surgery or alcohol abuse; UTI, pyelonephritis or urosepsis; cardiac failure (NYHA class IV). Positive glucose urine test. Evaluate renal function prior to initiation & periodically thereafter. Monitor vol status eg, physical exam, BP, haematocrit & electrolytes during treatment. Counsel patients on routine preventative foot care. Galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Risk of hypoglycaemia in combination w/ sulphonylurea or insulin. Concomitant use w/ antihypertensives. May affect ability to drive & use machines. Severe renal impairment (eGFR <30 mL/min/1.73 m2
) or end-stage renal disease. Hepatic impairment. Not recommended during 2nd & 3rd trimesters of pregnancy. Not to be used during lactation. Elderly ≥65 yr. Childn <18 yr.