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Th onst lactic acidosis otn is subtl, and accompanid only by nonspciic symptoms such as malais, myalgias, spiatoy distss, incasing somnolnc, and nonspciic abdominal distss. Th may b associatd hypothmia, hypotnsion, and sistant badyahythmias with mmakd acidosis. Patints should b ducatd tpomptly pot ths symptoms should thy occu. I psnt, ACTOPLUS MT should b withdawn until lactic acidosis is uld out. Sum lctolyts, ktons, blood glucos, blood pH, lactat lvls, and blood mtomin lvls may b usul. Onc a patint is stabilizd on any dos lvl mtomin, gastointstinal symptoms, which a common duing initiation thapy, a unlikly tcu. Lat occunc gastointstinal symptoms could b du tlactic acidosis oth sious disas.

Tabl 12: Wight Changs (kg) om Baslin Duing Doubl-Blind Clinical Tial with ACTOPLUS MT in Patints with Inadquat Glycmic Contol on Dit and xcis.

Tabl 3: Advs vnts ( ? 5% ACTOPLUS MT) potd by Patints with Inadquat Glycmic Contol on Dit and xcis in a 24-Wk Doubl-Blind Clinical Tial ACTOPLUS MT Administd Twic Daily.

Cationic dugs (.g., amiloid, digoxin, mophin, pocainamid, quinidin, quinin, anitidin, tiamtn, timthopim, vancomycin) that a liminatd by nal tubula sction thotically hav th potntial intaction with mtomin by compting common nal tubula tanspot systms. Although such intactions main thotical (xcpt cimtidin), caul patint monitoing and dos adjustmnt ACTOPLUS MT and/th inting dug is commndd in patints wha taking cationic mdications that a xctd via th poximal nal tubula sctoy systm [s CLINICAL PHAMACOLOGY ].

Lvls asting vnous plasma lactat abov th upp limit nomal but lss than 5 mmol/L in patints taking mtomin dnot ncssaily indicat impnding lactic acidosis and may b xplainabl by oth mchanisms, such as pooly contolld diabts obsity, vigoous physical activity, tchnical poblms in sampl handling [s Monitoing nal unction ].

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