Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Pms Metformin. 

Alcohol intake: Anyone taking metformin should avoid excessive alcohol intake.

Blood sugar control: If you have fever, trauma, infection, or surgery, you may have a temporary loss of blood sugar control. At such times, your doctor may think it is necessary to stop metformin and temporarily inject insulin. Metformin may be started again after the problem is resolved.

Blood sugar monitoring: Monitor your blood sugar regularly at intervals as discussed with your doctor or diabetes educator.

Diabetes complications: The use of metformin (or any other medication used for diabetes) will not prevent the development of complications particular to diabetes mellitus (e.g., Kidney Disease, nerve disease, eye disease).

Diet: Metformin is a treatment to be taken in combination with a proper diet. Metformin is not a substitute for proper diet.

Dye or contrast agents: If you are going to have an X-ray procedure that uses dye or a contrast agent, you may need to stop taking Pms Metformin for a short time. Contact your doctor for instructions.

Kidney problems:  Kidney disease or reduced kidney function causes Pms Metformin to build up in the body, causing side effects. If you have kidney problems, your doctor should closely monitor your condition while you are taking metformin, as it may affect kidney function.

Lactic acidosis: Lactic acidosis is a rare but serious problem that occurs due to metformin accumulation (i.e., the body doesn't get rid of it fast enough) during treatment. If you have severe kidney disease you are at higher risk of developing lactic acidosis. Since alcohol may increase the risk of lactic acidosis, do not drink a lot of alcohol over the short- or long-term while taking Pms Metformin. When it does occur (very rarely), it is fatal in 50% of cases. There have been no reports of lactic acidosis in Canada when metformin was used as directed. If you experience symptoms of lactic acidosis (e.g., weakness, tiredness, drowsiness, unusual muscle pain, trouble breathing, stomach pain with nausea, vomiting or diarrhea, feeling cold, dizziness, light-headedness, or slow or irregular heartbeat), stop taking Pms Metformin and get immediate medical attention.

Liver function: Decreased liver function has been linked to lactic acidosis. Pms Metformin is not recommended for people with severely reduced liver function. If you have moderately reduced liver function, discuss with your doctor how Pms Metformin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Pms Metformin, and whether any special monitoring is needed.

Low blood sugar: Under usual circumstances, low blood sugar does not occur for people who take only metformin. Low blood sugar could occur when not enough food is eaten, especially when strenuous exercise is undertaken at the same time or when large amounts of alcohol have been consumed.

Reduced response: Over a period of time, you may become progressively less responsive to a particular treatment for diabetes because your diabetes worsens. If metformin fails to lower blood sugar to target levels, talk to your doctor. Your doctor may want to stop metformin or recommend another medication.

Surgery: Pms Metformin should be stopped temporarily for surgery (except for minor surgery where food and fluid intake is not restricted). You will be restarted on Pms Metformin once you are eating and drinking and your kidney function has been tested and is normal. Talk to your doctor for specific instructions.

Vitamin B12 levels: Pms Metformin may decrease vitamin B12 levels. Your doctor will monitor your B12 levels with blood tests while you are taking Pms Metformin.

Pregnancy: Pms Metformin should not be used during pregnancy. If you become pregnant while taking Pms Metformin, contact your doctor immediately.

Breast-feeding: Metformin is believed to pass into breast milk. Pms Metformin should not be used if you are breast-feeding.

Children: The safety and effectiveness of Pms Metformin have not been established for children.

Seniors: Kidney function often decreases with age. As a result, seniors may be more likely to experience side effects of Pms Metformin.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Contrave.

Accidental ingestion: If you are dependent on narcotics and you ingest Contrave, you could experience severe symptoms of withdrawal including confusion, nausea, shakiness, sweating, anxiety, visual hallucinations, vomiting, or diarrhea. Avoid taking narcotic medications while you are taking naltrexone-bupropion.

Diabetes: Weight loss often causes decreased blood glucose. As a result, using naltrexone-bupropion may cause episodes of low blood sugar when taken by people with diabetes who are taking certain oral medications to control blood sugar. You may find it necessary to monitor your blood sugar more frequently while using Contrave.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Bupropion may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how Contrave affects you.

Heart disease: Bupropion can increase blood pressure and heart rate. It is not known whether it is safe for use by people with a recent history of Heart Attack or unstable heart disease. If you have had a heart attack within the past 6 months, have an irregular heartbeat, high blood pressure, Congestive Heart Failure or a recent Stroke, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Galactose intolerance/glucose malabsorption: Contrave contains lactose. If you have lactose or galactose intolerance you should not take Contrave.

Glaucoma: Contrave may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking Contrave.

Identical medications: Wellbutrin®, Zyban® and several other medications contain bupropion. Revia® and Relistor® contain naltrexone. If you are taking naltrexone-bupropion, do not take any other product containing bupropion or naltrexone, as the risk of side effects increases with an increased dosage.

Interference with opiate-containing mediations: Because Contrave works by blocking the effects of opiates, it will reduce the effectiveness of narcotic pain relievers. It may also interfere with other medications that contain opiates such as certain cough and cold medications, antidiarrheal medications, and some analgesics (pain medications). Trying to overcome the blocking effects of naltrexone by taking larger doses of narcotics may result in severe side effects of the narcotic. Talk to your doctor or pharmacist about non-opiate containing alternatives.

Kidney function:  Kidney Disease or reduced kidney function may cause Contrave to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed. Contrave is not recommended for people with end-stage kidney disease.

Liver function: Liver disease or reduced liver function may cause Contrave to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed. Naltrexone-bupropion is not recommended for people with severely decreased liver function.

Naltrexone-bupropion has been reported to cause decreased liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Lupus: There may be an association between taking naltrexone – bupropion and the autoimmune conditions systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). If you develop any skin rash (particularly on the face), fatigue, joint pain, or swelling, contact your doctor as soon as possible.

Mental health: Bupropion may trigger mania and make behaviour and thought disturbances worse for people who have mental health conditions. It may also cause symptoms of psychosis and mania to develop for people who have not had these symptoms before. If you experience symptoms such as hallucinations, mania (feeling unusually over-excited or uninhibited), or delusional thinking, or notice them in a family member who is taking Contrave, contact your doctor as soon as possible. If you have mental health concerns, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Seizure risk: Bupropion may increase the risk of seizures. If you are at risk of seizures, discuss with your doctor how Contrave may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Contrave, and whether any special monitoring is needed.

Things that increase the risk of seizures include:

• addiction to cocaine, stimulants, or opiates (such as morphine)
• diabetes treated with oral medications or insulin
• excessive alcohol use
• history of head trauma or seizures (including Epilepsy)
• severe liver problems
• tumours of the brain or spinal cord
• use of other medications that make seizures more likely (e.g., antipsychotics, antidepressants, lithium, theophylline, steroids)
• use of over-the-counter stimulants or appetite suppressants

Serotonin toxicity: Severe reactions are possible when naltrexone - bupropion is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, medications used to treat depression. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are possible.

Suicidal or agitated behaviour, or other behaviour changes: People taking Contrave may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking Contrave. If you experience these side effects or notice them in a family member who is taking Contrave, contact your doctor immediately. Your doctor will monitor you for emotional and behavioural changes while you are taking bupropion.

Pregnancy: Weight loss does not benefit a woman during pregnancy and may cause harm to the developing baby. Use of either of these medications may also cause harm to the developing baby. For these reasons, Contrave should not be used during pregnancy. If you become pregnant while taking Contrave, contact your doctor immediately.

Breast-feeding: Both naltrexone and bupropion pass into breast milk. If you are breast-feeding and are taking Contrave, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Contrave have not been established for children.

Seniors: Seniors may be at an increased risk of side effects due to age-related decreased kidney or liver function.