Take orally with meals (e.g., breakfast and/or dinner), usually once or twice daily, to reduce gastrointestinal side effects. Swallow whole, do not crush or chew extended-release tablets.

Metformin primarily decreases hepatic glucose production (gluconeogenesis), decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. It activates AMP-activated protein kinase (AMPK).

• •Severe renal impairment (eGFR <30 mL/min/1.73m²).
• •Metabolic acidosis, including diabetic ketoacidosis, with or without coma.
• •Hypersensitivity to metformin hydrochloride or any component of the formulation.
• •Acute or chronic conditions which may cause tissue hypoxia (e.g., cardiac failure, respiratory failure, recent myocardial infarction, shock).
• •Hepatic impairment, acute alcohol intoxication.

Store below 30°C (86°F) in a dry place, away from light and moisture. Keep out of reach of children. Do not freeze.

Overdose can lead to lactic acidosis, characterized by symptoms such as severe gastrointestinal upset, lethargy, muscle pain, hyperventilation, and hypotension. Treatment is supportive, primarily involving hemodialysis to remove metformin from the blood and correct acidosis.

**Pregnancy**: FDA Pregnancy Category B. Generally considered safe for use in pregnancy for gestational diabetes or pre-existing type 2 diabetes if benefits outweigh potential risks. Use under strict medical supervision. **Lactation**: Low levels of metformin are excreted into breast milk. Generally considered compatible with breastfeeding with careful monitoring of the infant for adverse effects like hypoglycemia. Consult a doctor.