Discontinue treatment if hypersensitivity reactions occur. Prior to initiation of therapy, consider factors in patient history that may predispose to the need for amputations (eg, history of prior amputation, peripheral vascular disease, neuropathy & diabetic foot ulcers). Monitor patients for signs & symptoms of infection (including osteomyelitis), new pain or tenderness, sores or ulcers involving the lower limbs & discontinue treatment if these occurs. Symptomatic hypotension may occur after initiating therapy in patients w/ impaired renal function, elderly, on either diuretics or drugs that interfere w/ the renin-angiotensin-aldosterone system, or w/ low systolic BP. Not for treatment of patient w/ type 1 DM. Discontinue use if ketoacidosis is suspected. Consider factors in patient history that may predispose to ketoacidosis including pancreatic insulin deficiency from any cause, caloric restriction & alcohol abuse; that may predispose patients to acute kidney injury including hypovolemia, chronic renal insufficiency, CHF & concomitant medications (diuretics, ACE inhibitors, ARBs, NSAIDs) prior to initiation of therapy. Increased serum creatinine & decreased eGFR on intiation of therapy; risk of bone fracture; LDL-C. Not recommended in patients w/ eGFR <45 mL/min/1.73 m2
. Evaluate for signs & symptoms of UTI. Evaluate prior to initiating therapy & periodically monitor renal function. Concomitant use w/ insulin & insulin secretagogues. Discontinue treatment if necrotizing fasciitis occurs & closely monitor blood glucose levels. History of genital mycotic infections especially in uncircumcised males. Pregnancy (2nd & 3rd trimester) & lactation. Ped patients <18 yr. Monitoring glycemic control w/ urine glucose test & 1,5-AG assay is not recommended.