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Metformin MUST NOT BE USED in the following cases: Hypersensitivity to metformin or to any of the excipients.
Any type of acute metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis).
Diabetic pre-coma.
Severe renal failure (CrCl below 30 mL/min or eGFR below 30 mL/min/1.73 m2).
Acute conditions with the potential to alter renal function such as dehydration, severe infection, or shock.
Disease (especially acute disease or worsening of chronic disease) which may cause tissue hypoxia such as unstable congestive heart failure, respiratory failure, recent myocardial infarction or shock.
Hepatic insufficiency, acute alcohol intoxication, alcoholism.
750 mg: Metformin must be discontinued 48 hours prior to elective major surgical interventions and may not be reinstituted until 48 hours afterwards, and only after renal function has been re-evaluated and has not deteriorated further.
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