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The risks of lactic acidosis associated with metformin therapyits symptomsand conditions that predispose to its developmentas noted in the WARNINGS and PRECAUTIONS sectionsshould be explained to patientsPatients should be advised to discontinue Glucovance immediately and promptly notify their health practitioner if unexplained hyperventilationmyalgiamalaiseunusual somnolenceor other nonspecific symptoms occurOnce a patient is stabilized on any dose level of Glucovancegastrointestinal symptomswhich are common during initiation of metformin therapyare unlikely to be drug relatedLater occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

For each of the known and possible risk factors for metformin-associated lactic acidosisrecommendations to reduce the risk of and manage metformin-associated lactic acidosis are provided below:

Instruct patients to inform their doctor that they are taking Glucovance prior to any surgical or radiological procedureas temporary discontinuation of Glucovance may be required until renal function has been confirmed to be normalsee PRECAUTIONS

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