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The frequency of side effects of the drug is estimated as follows: very often (≥1/10); often (≥1/100, <1/10), infrequently (≥1/1000, <1/100), rarely (≥1/10000, <1/1000), very rarely (≤1/10000).
From the side of metabolism: very rarely – lactic acidosis. With prolonged use of metformin, there may be a decrease in the absorption of vitamin B12. When detecting megaloblastic anemia, it is necessary to take into account the possibility of such an etiology.
From the nervous system: often – a violation of taste.
From the digestive system: very often – nausea, vomiting, diarrhea, abdominal pain, lack of appetite. They most often occur during the initial period of treatment and in most cases spontaneously pass. To prevent symptoms, it is recommended to take metformin 2 or 3 times / day during or after meals. A slow increase in the dose may improve gastrointestinal tolerance.
From the liver and biliary tract: very rarely – impaired liver function and hepatitis; after discontinuation of metformin, these adverse events completely disappear.
From the skin and subcutaneous tissues: very rarely – skin reactions such as erythema, itching, rash.
Published data, post-marketing data, as well as controlled clinical studies in a limited pediatric population in the age group of 10-16 years show that side effects in children are similar in nature and severity to those in adult patients.
Contraindications to use
hypersensitivity to metformin or to any auxiliary substance; diabetic ketoacidosis, diabetic precoma, coma; renal insufficiency or impaired renal function (CC less than 45 ml/min); acute conditions occurring with the risk of developing renal dysfunction: dehydration (with diarrhea, vomiting), severe infectious diseases, shock; clinical manifestations of acute or chronic diseases that can lead to the development of tissue hypoxia (including acute heart failure, chronic heart failure with unstable hemodynamic parameters, respiratory failure, acute myocardial infarction); extensive surgical operations and injuries (when insulin therapy is indicated); liver failure, liver dysfunction; chronic alcoholism, acute alcohol poisoning; pregnancy; lactic acidosis (including in anamnesis); use for a period of less than 48 hours before and for 48 hours after radioisotope or X-ray examinations with the introduction of an iodine-containing contrast agent; compliance with a hypocaloric diet (<1000 kcal / day).
With caution: in patients over 60 years of age who perform heavy physical work (which is associated with an increased risk of developing lactic acidosis); in patients with renal insufficiency (CC 45-59 ml / min); during breastfeeding.