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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. Metformin and rosiglitazone should be used carefully as age increases and older adults may need a lower dose of metformin and rosiglitazone. Amaryl may be used concomitantly with metformin when diet, exercise, and Amaryl or metformin alone do not result in adequate glycemic control. , x-rays, CT scans, and MRIs) that use intravenous contrast media—Use of metformin and rosiglitazone should be discontinued before you have one of these procedures. However, it also can occur if you delay or miss a meal or snack, drink alcohol, exercise more than usual, cannot eat because of nausea or vomiting, take certain medicines, or take metformin and rosiglitazone with another type of diabetes medicine.

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