Discontinue use if ketoacidosis, necrotizing fasciitis of the perineum (Fournier's gangrene) are suspected. Not to be used in type 1 diabetes or diabetic ketoacidosis. Patients w/ very low carbohydrate diet, acute illness, pancreatic disorders suggesting insulin deficiency, insulin dose reduction, alcohol abuse, severe dehydration & history of ketoacidosis. Vol-depletion risk in patients w/ CV disease, on antihypertensive therapy w/ history of hypotension; conditions leading to fluid loss eg, GI illness; complicated UTI eg, pyelonephritis or urosepsis. Assess renal function prior to & periodically during treatment. Monitor ketones in situations predisposing ketoacidosis eg, prolonged fasting due to acute illness or surgery. Counsel patients on routine preventive foot care. Positive test for glucose in urine. Not to be taken by patients w/ galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. May affect ability to drive & use machines. Not recommended to be initiated in renal impairment (eGFR <20 mL/min/1.73 m
2) & severe hepatic impairment. Hepatic injury. Not recommended during 2nd & 3rd trimesters of pregnancy. Not to be used during lactation. Childn <10 yr w/ type 2 DM; <18 yr w/ heart failure & CKD. Elderly ≥75 yr.
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