Not to be used for type 1 DM. Discontinue use if diabetic ketoacidosis & necrotising perineum fasciitis (Fournier's gangrene) is suspected & if eGFR persistently <45 mL/min/1.73 m2
or CrCl persistently <45 mL/min. Not to be initiated in patients w/ eGFR <60 mL/min/1.73 m2
or CrCl <60 mL/min. Vol depletion risk in patients on diuretics, antihypertensives or w/ history of hypotension. Patients w/ low β-cell function reserve, conditions that lead to restricted food intake or severe dehydration, increased/decreased insulin dose due to acute medical illness, surgery or alcohol abuse; events which may precede amputation eg, lower-extremity skin ulcer, infection, osteomyelitis or gangrene; increased risk of genital mycotic infections; UTI; cardiac failure (NYHA class I-IV). False +ve result for glucose test. Interference w/ 1,5-anhydroglucitol assay. Concomitant use w/ insulin & insulin secretagogues. Monitor renal function prior to & during treatment. Monitor vol status & electrolytes during therapy. Counsel patients on routine preventative foot care. Galactose intolerance, total lactase deficiency, glucose-galactose malabsorption. May affect ability to drive & use machines. Not to be used in severe renal impairment, ESRD or receiving dialysis. Not recommended in severe hepatic impairment. Not to be used during pregnancy & lactation. Childn <18 yr. Elderly ≥65 yr.