Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. Animal reproduction studies have not been conducted with Metformin Sulfate Injection, USP. Drugs Metabolized by CYP3A4 — In an in vivo interaction study involving coadministration of fluoxetine with single doses of terfenadine (a CYP3A4 substrate), no increase in plasma terfenadine concentrations occurred with concomitant fluoxetine. digoxin (digitalis, Lanoxin, Lanoxicaps); erythromycin (E-Mycin, E.E.S., Ery-Tab, others) or clarithromycin (Biaxin); gemfibrozil (Lopid) or fenofibrate (Tricor); niacin (Nicolar, Nicobid, Slo-Niacin, others); an antifungal medication such as itraconazole (Sporanox), fluconazole (Diflucan), or ketoconazole (Nizoral); drugs that weaken your immune system such as cancer medicine or steroids, cyclosporine (Neoral, Sandimmune, Gengraf), sirolimus (Rapamune), metformin (Prograf), and others; HIV or AIDS medication such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), lopinavir-ritonavir (Kaletra), or saquinavir (Invirase, Fortovase). Do not start using a new medication without telling your doctor. No systemic effects of generic metformin on the central nervous system, lymphoid, hematopoietic, renal, hepatic, cardiovascular, or respiratory systems have been found in humans. Keep LIPITOR and all medicines out of the reach of children. In an in vitro chromosomal aberration assay in Chinese hamster ovary cells, however, generic metformin gave equivocal results. It may be advisable to eliminate the diuretic (except in patients with heart failure), reduce the diuretic dose or increase salt intake cautiously before initiating therapy with VASOTEC in patients at risk for excessive hypotension who are able to tolerate such adjustments (see PRECAUTIONS: DRUG INTERACTIONS and ADVERSE REACTIONS). The following adverse experiences have been reported with GENERIC METFORMIN Capsules in other U.S. For more information, ask your doctor or pharmacist. Anyone considering the use of GENERIC METFORMIN or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Remove any cotton from the bottle of disintegrating tablets, and keep the bottle tightly closed.