diarrhoea, nausea - occasionally accompanied by a metallic taste - these side effects are not uncommon after commencement of metformin therapy - these side effects may resolve with time
if treatment is started with a small initial dose (e.g. metformin 500mg od) and dosage is increased gradually then gastrointestinal effects are less likely
there have been malabsorption syndromes reported associated with metformin treatment
lactic acidosis may occur with metformin use although Salpeter et al concluded that the use of metformin in type 2 diabetes does not increase the risk for fatal or non-fatal lactic acidosis or increase in blood lactate concentrations compared with placebo or other hypoglycaemic treatments (1)
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