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When using glyburide/metformin, it's crucial to be aware of the potential risks and necessary precautions. Below are important safety instructions and warnings to consider:

• Lactic Acidosis Risk: This medication can lead to a rare but serious condition known as lactic acidosis, which involves an excessive buildup of acid in the body. This risk is heightened in older adults, those with kidney or liver issues, dehydration, heart failure, heavy alcohol consumption, or those undergoing surgery or certain imaging procedures involving contrast dye. Symptoms include extreme fatigue, dizziness, severe drowsiness, chills, bluish or cold skin, muscle pain, rapid or difficult breathing, irregular heartbeat, or abdominal pain with nausea, vomiting, or diarrhea. Immediate medical attention is necessary if these symptoms occur.

• Low Blood Sugar (Hypoglycemia): Glyburide/metformin can cause dangerously low blood sugar levels. Symptoms of hypoglycemia include shakiness, nervousness, rapid heartbeat, sweating, confusion, and extreme hunger. It is important to know how to manage low blood sugar and when to seek emergency help. Keep fast-acting sugars on hand to quickly elevate blood sugar levels if needed. Factors increasing this risk include missing meals, alcohol consumption, intense physical activity, and taking other blood sugar-lowering medications.

• Heart Problems Risk: There is potential for serious heart problems, as similar medications have been associated with an increased risk of heart-related death. If you experience symptoms of a heart attack, such as chest pain, sweating, nausea, dizziness, or signs of heart failure like difficulty breathing, fatigue, swelling, or sudden weight gain, seek immediate medical assistance.

• Hemolytic Anemia Risk: Some patients have developed hemolytic anemia, which involves a decrease in red blood cells, after taking medications similar to glyburide. This is particularly a concern for those with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Symptoms include weakness, fatigue, and dizziness.

• Low Vitamin B12 Levels: Long-term use of metformin may lead to decreased vitamin B12 levels, potentially causing anemia. Regular monitoring of vitamin B12 levels is advised, and supplementation may be necessary. Symptoms include fatigue, dizziness, muscle issues, or tingling/numbness in extremities.

Contraindications:

• Severe kidney problems
• Acute or chronic acidosis, including diabetic ketoacidosis
• Concurrent use with bosentan (Tracleer)

Consult your healthcare provider if any of these conditions or risk factors apply to you before starting this medication. Always inform your healthcare team about your complete medical history and any other medications you are taking to ensure safe and effective treatment.

Common side effects:

• Nausea
• Diarrhea
• Headaches
• Dizziness
• Stomach discomfort
• Skin irritation
• Redness
• Itching

Less common but important to monitor:

• Low blood sugar (hypoglycemia)

Serious side effects:

• Severe allergic reactions
• Lactic acidosis
• High blood sugar symptoms

Interactions with high risk of serious adverse effects and should be avoided:

• Bosentan

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Acarbose
• Aspirin
• Balofloxacin
• Besifloxacin
• Bupropion
• Capmatinib
• Chloroquine
• Ciprofloxacin
• Darolutamide
• Dasabuvir
• Desmopressin
• Disopyramide
• Dofetilide
• Dolutegravir
• Dulaglutide
• Enasidenib
• Enoxacin
• Entacapone
• Fleroxacin
• Flumequine
• Gatifloxacin
• Gemifloxacin
• Hydroxychloroquine
• Ioversol
• Lanreotide
• Leflunomide
• Letermovir
• Levofloxacin
• Lixisenatide
• Lomefloxacin
• Metreleptin
• Moxifloxacin
• Nadifloxacin
• Norfloxacin
• Octreotide
• Ofloxacin
• Ombitasvir
• Paritaprevir
• Pasireotide
• Pazufloxacin
• Pefloxacin
• Pioglitazone
• Porfimer
• Prulifloxacin
• Ritonavir
• Rufloxacin
• Simeprevir
• Sitagliptin
• Sparfloxacin
• Tafenoquine
• Teriflunomide
• Thioctic Acid
• Tosufloxacin
• Vandetanib

Interactions with low risk that usually do not require a change in therapy:

• Beta-blocker medications (including metoprolol, Propranolol, glaucoma eye drops such as Timolol)