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You may experience blurred vision.dizziness.or drowsiness due to extremely low or high blood sugar. Do not drive.use machinery.or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely.

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Use Of Concomitant Medications That May Affect Renal Function Or Metformin Disposition.

Some people develop lactic acidosis while taking metformin. Early symptoms may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms such as. muscle pain or weakness.numb or cold feeling in your arms and legs.trouble breathing.stomach pain.nausea with or uneven heart rate.dizziness.or feeling very weak or tired.

Order actoplus met was no evidence of mutagenic potential of metformin in the following in vitro tests. Ames test (S. typhimurium).gene mutation test (order actoplus met lymphoma cells).or chromosomal aberrations test (human lymphocytes). Results in the in vivo mouse micronucleus test were also negative.

Pioglitazone hydrochloride was not mutagenic in a battery of genetic toxicology studies.including the Ames bacterial assay.a mammalian cell forward gene mutation assay (CHO/HPRT and AS52/XPRT).an in vitro cytogenetics assay using CHL unscheduled DNA synthesis assay.and an in vivo micronucleus assay.

Patients receiving ACTOPLUS MET in combination with insulin or other antidiabetic medications (particularly insulin secretagogues such as sulfonylureas) may be at risk order actoplus met hypoglycemia. A reduction in the dose of the concomitant antidiabetic medication may be necessary to reduce the risk of hypoglycemia [see DOSAGE AND ADMINISTRATION ]. Hypoglycemia can also occur when caloric intake is deficient or when strenuous exercise is not compensated by caloric supplement. Elderly.debilitated.or malnourished patients.and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects. Hypoglycemia may be difficult to recognize in the elderly.and in people who are taking beta-adrenergic blocking drugs.

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