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An accumulation of lactate to dangerous levels ( lactic acidosis ) can occur when metformin is taken by patients with other conditions resulting metabolic acidosis (liver disease, heart failure, sepsis, alcohol abuse), or kidney disease (as indicated by elevated creatinine levels) because metformin is eliminated by renal excretion) (He & Wondisford, 2015

Handle under appropriate laboratory conditions and avoid repeated freezethaw cycles of the reconstituted solution

These changes may cause disordered sympathetic and parasympathetic activity (158, 360) as well as PEM and cognitive dysfunction (363)

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abyssinicus did not result in any deaths but did show a significant decrease in platelet count and mild acute liver injury (692)