Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic impairment, and mitochondrial diseases [see Warnings and Precautions (5.1)]
Additionally, inserting the needle at a 90-degree angle straight down (not at a slant) and choosing a different injection site each weekrotating between upper arms, thighs, and abdomenprevents repeated tissue irritation in the same location
Clinical trials indicate that participants lost an average of 20.9% of their body weight
Symptoms may include infrequent bowel movements, hard stools, bloating, or difficulty passing stool