Indications: diabetes mellitus

Cautions: monitor liver function; manufacturer advises avoid in severe heart failure—no information available; discontinue if symptoms of acute pancreatitis (persistent, severe abdominal pain).

Liver toxicity: Rare reports of liver dysfunction; monitor liver function before treatment and every 3 months for first year and periodically thereafter; advise patients to seek prompt medical attention if symptoms such as nausea, vomiting, abdominal pain, fatigue, and dark urine develop; discontinue if jaundice or other signs of liver dysfunction occur.

Contra-indications: Ketoacidosis

Hepatic impairment: Avoid

Renal impairment: Reduce dose to 50 mg once daily if eGFR less than 50 ml/minute/1.73 m2

Pregnancy: avoid—toxicity in animal studies

Breast-feeding: avoid—present in milk in animal studies.

Side Effects: nausea, peripheral oedema, headache, tremor, asthenia, dizziness; less commonly constipation, hypoglycaemia, arthralgia; rarely hepatic dysfunction. very rarely nasopharyngitis, upper respiratory tract infection; also reported pancreatitis, exfoliative and bullous skin reactions.

Dose: ADULT over 18 years, monotherapy, 50 mg twice daily

ADULT over 18 years, dual therapy in combination with metformin or pioglitazone, 50 mg twice daily; dual therapy in combination with a sulfonylurea, 50 mg daily in the morning.

ADULT over 18 years, triple therapy in combination with metformin and a sulfonylurea, 50 mg twice daily.

ADULT over 18 years, in combination with insulin (with or without metformin), 50 mg twice daily.

Dose of concomitant sulfonylurea or insulin may need to be reduced.