Rosiglitazone/Metformin Rx

Symptomatic HF or acute coronary syndromes: not recommended; discontinue if occurs. CHF: NYHA Class I or II: increased risk of cardiovascular events (monitor); discontinue or reduce dose if develops. Edema. Monitor for signs/symptoms of heart failure. Increased risk of metformin-associated lactic acidosis in renal or hepatic impairment, concomitant use of certain drugs (eg, cationic drugs), ≥65yrs of age, undergoing radiological contrast study, surgery and other procedures, hypoxic states, and excessive alcohol intake; discontinue if lactic acidosis occurs. Discontinue at time of, or prior to intravascular iodinated contrast imaging in patients with eGFR 30–60mL/min/1.73m2, history of hepatic impairment, alcoholism, heart failure, or will be given intra-arterial contrast; reevaluate eGFR 48hrs after procedure and restart therapy if renally stable. Suspend therapy if dehydration occurs or before surgery. Assess renal function prior to starting and periodically thereafter; more frequently in elderly or if eGFR <60mL/min/1.73m². Hepatic impairment: not recommended. Do not initiate in active liver disease or if ALT >2.5xULN. Monitor LFTs at baseline, then periodically. Follow up and monitor closely if ALT is mildly elevated (≤2.5xULN); discontinue if ALT >3xULN or jaundice occurs. Elderly, debilitated, uncompensated strenuous exercise, malnourished or deficient caloric intake, adrenal or pituitary insufficiency, or alcohol intoxication: increased risk of hypoglycemia. Monitor hematology (esp. serum Vit. B₁₂ in susceptible patients). Premenopausal women with anovulatory: ovulation may occur. Reevaluate if menstrual dysfunction occurs. Pregnancy (Cat.C), nursing mothers: not recommended; consider using insulin instead.