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This medication, containing metformin and dapagliflozin, is associated with several important safety concerns. It is essential to be aware of these and discuss any questions or concerns with your healthcare provider. Below are the key warnings and precautions:

• Lactic Acidosis Risk: Metformin can lead to lactic acidosis, a serious condition with symptoms such as unusual tiredness, dizziness, severe drowsiness, chills, blue/cold skin, muscle pain, and stomach pain with nausea, vomiting, or diarrhea. Higher risk factors include age over 65, kidney or liver disease, dehydration, heart failure, heavy alcohol use, surgery, and use of iodinated contrast in imaging procedures. Immediate medical attention is crucial if symptoms appear.

• Ketoacidosis Caution: Dapagliflozin may cause diabetic ketoacidosis (DKA), a potentially dangerous condition due to high ketone levels. Symptoms include trouble breathing, vomiting, belly pain, dry skin and mouth, fatigue, and fruity-smelling breath. Risk increases with reduced calorie intake, post-surgery, sudden fever, pancreas problems, reduced insulin dosage, and excessive alcohol intake. Seek urgent medical care if these symptoms occur.

• Dehydration and Low Blood Pressure: Dapagliflozin can cause increased urination leading to dehydration, low blood pressure, or kidney issues. Watch for dizziness, confusion, chest pain, or reduced urination. Higher risks are associated with older age, kidney problems, use of loop diuretics, or low sodium diets. Consult your provider for monitoring and management strategies.

• Genital and Urinary Infections: There's an increased risk of genital and urinary tract infections, including yeast infections. Individuals with a history of frequent infections are at higher risk. Symptoms include genital itching, painful urination, cloudy urine, or back pain. Serious infections require immediate medical attention.

• Vitamin B12 Deficiency: Long-term metformin use can lower vitamin B12 levels, potentially leading to anemia. Regular monitoring of B12 levels is recommended, with supplementation as needed. Report symptoms like low energy, dizziness, muscle problems, or tingling in extremities.

• Serious Skin Infections: Rarely, dapagliflozin users might develop necrotizing fasciitis, a severe skin infection. Swelling, redness, and tenderness around the genitals are warning signs. Immediate medical intervention and cessation of the medication are necessary.

• Hypoglycemia with Other Diabetes Medications: There is a risk of low blood sugar when taken with insulin or sulfonylureas. Symptoms include shakiness, anxiety, confusion, sweating, rapid heartbeat, and hunger. It's important to know how to manage low blood sugar and discuss risk factors with your healthcare provider.

Contraindications: This medication should not be used by individuals with severe kidney issues or those experiencing acute or long-term high acid levels in the body, such as in diabetic ketoacidosis. Always consult your healthcare provider before initiating this medication if these conditions apply.

When using this medication, some common side effects may arise. These include headaches, diarrhea, nausea, vomiting, a runny nose, and sore throat. Generally mild, these symptoms often resolve on their own, but should they persist or worsen, contacting a healthcare provider is advisable. An empty tablet shell may also be noticed in your stool, which is harmless and indicates the body has absorbed the medication.

In some cases, users may experience redness, itching, or other symptoms associated with genital yeast infections, as well as urinary tract infections, such as pain during urination. If these occur, it's important to seek medical advice. Other possible side effects include constipation, back pain, dizziness, increased urination, and cough. While these are generally not severe, they should be discussed with a healthcare provider if they cause concern.

More serious side effects, although rare, require immediate medical attention. Symptoms such as confusion, extreme fatigue, unusual heartbeat, or rapid breathing could signal lactic acidosis, while trouble breathing, vomiting, and fruity-smelling breath may indicate high ketone levels. Kidney problems, dehydration, and severe genital infections can also occur, presenting with symptoms like reduced urination, dizziness, or redness and swelling in the affected area. Additionally, severe allergic reactions, characterized by hives or swelling of the face and throat, necessitate urgent care. Maintaining hydration and monitoring for these rare but serious symptoms can help manage risks associated with this medication.

Certain medications can impact your blood sugar levels, making them more challenging to manage. Always consult with your doctor or pharmacist before starting, stopping, or altering any medication to understand how it might affect your blood sugar. Regularly monitor your blood sugar as instructed and report your findings to your doctor. If you notice any signs of high or low blood sugar, inform your doctor immediately. Adjustments to your diabetes medications, exercise regimen, or diet may be necessary.

Beta-blockers, such as metoprolol, propranolol, and even glaucoma eye drops like timolol, can mask the typical rapid or pounding heartbeat that signals low blood sugar (hypoglycemia). However, they do not affect other low blood sugar symptoms, such as dizziness, hunger, or sweating.

Additionally, this medication might interfere with certain laboratory tests, like urine glucose tests, potentially leading to incorrect results. Ensure that all healthcare personnel and your doctors are aware that you are taking this medication.