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Initiation of rosiglitazone maleate/metformin hydrochloride in patients with established NYHA Class III or IV heart failure is contraindicated. Combined use of glimepiride with insulin or metformin may increase the potential for hypoglycemia. Because the risk of metformin accumulation and lactic acidosis increases with the degree of renal function impairment, assess renal function before starting therapy and at least annually thereafter. With concomitant Amaryl and metformin therapy, the risk of hypoglycemia associated with Amaryl therapy continues and may be increased. Use of metformin and rosiglitazone can increase the risk of serious side effects in these patients.
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