Anabolic steroids , eg testosterone, nandrolone, stanozolol ace inhibitors , eg captopril these can cause unpredictable drops in blood sugar azole antifungals such as itraconazole or ketoconazole beta-blockers , eg propranolol ciclosporin clopidogrel should be avoided where possible in people taking repaglinide; blood sugar levels should be carefully monitored if it is essential disopyramide gemfibrozil gemfibrozil, used for lowering cholesterol levels, must not be taken in combination with repaglinide as this may cause severe or prolonged low blood sugar macrolide antibiotics such as clarithromycin maoi antidepressants , eg phenelzine non-steroidal anti-inflammatory drugs nsaids , eg ibuprofen, diclofenac other antidiabetic medicines , eg metformin octreotide large doses of salicylates, eg aspirin small pain relieving doses do not normally have this effect trimethoprim or co-trimoxazole should be avoided where possible in people taking repaglinide; blood sugar levels should be carefully monitored if trimethoprim is needed to treat an infection .

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metformin, one of the medicines in janumet xr, can cause a rare but serious condition called lactic acidosis a buildup of an acid in the blood that can cause death.

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the trend toward greater metformin use over the past decade is positive, as metformin remains the antidiabetes medication associated with the highest efficacy, the best cardiovascular profile, and the fewest unwanted side effects 2,4,18 .

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