Not recommended for the treatment of diabetes when eGFR <45 mL/min/1.73 m2
; severe renal impairment (eGFR <30 mL/min/1.73 m2
) or end-stage renal disease. Consider temporary interruption or discontinuation of treatment if signs & symptoms of ketoacidosis develops. Consider temporary interruption of treatment for patients who develop vol depletion; when treating pyelonephritis or urosepsis. Evaluate renal function prior to initiation of treatment & periodically thereafter. Patients w/ predisposing factors to ketoacidosis (eg, low β-cell function reserve from pancreatic disorders, insulin dose reduction, reduced caloric intake or increased insulin requirements due to infections, illness or surgery & alcohol abuse). Concomitant use w/ medications known to cause hypoglycemia eg, insulin & insulin secretagogues. Not recommended in monitoring glycemic control w/ 1,5-AG assay. Increased risk of UTI. Pregnancy (2nd & 3rd trimester) & lactation. Ped & adolescent.