<p><strong>Use in pediatric patients</strong>: The safety and effectiveness of this combination in pediatric patients have not been established. Therefore, this combination is not recommended for use in children below 18 years of age.<br />
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<strong>Use in geriatric patients</strong>: As Metformin is excreted via the kidney, and elderly patients have a tendency to decreased renal function, elderly patients taking this combination should have their renal function monitored regularly. This combination should only be used in elderly patients with normal renal function.<br />
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<strong>Patients with renal impairment</strong>: This combination should not be used in patients with renal failure or renal dysfunction, e.g. serum creatinine levels &gt; 1.5 mg/dl (&gt;135 micro mol/L) in males and &gt; 1.4 mg/dl (&gt;110 micro mol/L) in females.<br />
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<strong>Patients with hepatic impairment</strong>: This combination is not recommended in patients with hepatic impairment including patients with a pre-treatment ALT or AST &gt;3 X the upper limit of normal.</p>