Not for use in type 1 diabetes or diabetic ketoacidosis. History of pancreatitis. Assess renal function prior to initiation of therapy & at least annually thereafter. Hypoglycemia in combination w/ sulfonylurea or insulin. Discontinue if hypersensitivity reactions, & bullous pemphigoid occurs. Risk of lactic acidosis in patients w/ CHF requiring pharmacologic management, particularly those w/ unstable or acute CHF at risk of hypoperfusion & hypoxemia (promptly discontinue if these occurs); renal dysfunction; withhold use in the presence of any condition associated w/ hypoxemia, dehydration or sepsis; hepatic disease. Avoid excessive alcohol intake. Temporarily suspend therapy for any surgical procedure. Suspect lactic acidosis in any diabetic patient w/ metabolic acidosis lacking evidence of ketoacidosis (ketonuria & ketonemia). Elderly, debilitated or malnourished patients, & those w/ adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects, Concomitant use w/ drugs that may affect renal function or metformin disposition eg, cationic drugs. Temporarily discontinue intravascular contrast studies w/ iodinated materials at the time of or prior to the procedure, & withhold for 48 hr subsequent to the procedure & reinstitute after renal function has been reevaluated in patients w/ eGFR ≥30 to <60 mL/min/1.73 m2
history of hepatic impairment, alcoholism, or heart failure or patients who will be administered intra-arterial iodinated contrast. Promptly discontinue therapy if CV collapse, acute CHF, acute MI & other conditions characterized by hypoxemia have been associated w/ lactic acidosis & cause prerenal azotemia. Impaired hepatic function. Decreased vit B12
levels. Withhold Janumet & temporarily administer insulin if loss of control of blood glucose occurs. Pregnancy & lactation. Childn <18 yr. Elderly.