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There was no evidence of mutagenic potential of glyburide alone in the following in vitro testsSalmonella microsome testAmes testand in the DNA damage/alkaline elution assay.

This is not a complete list of possible side effectsIf you notice other effects not listed abovecontact your doctor or pharmacist.

If metformin-associated lactic acidosis is suspectedimmediately discontinue Glucovance and institute general supportive measures in a hospital settingPrompt hemodialysis is recommendedsee PRECAUTIONS

The risks of lactic acidosis associated with metformin therapyits symptomsand conditions that predispose to its developmentas noted in the WARNINGS and PRECAUTIONS sectionsshould be explained to patientsPatients should be advised to discontinue Glucovance immediately and promptly notify their health practitioner if unexplained hyperventilationmyalgiamalaiseunusual somnolenceor other nonspecific symptoms occurOnce a patient is stabilized on any dose level of Glucovancegastrointestinal symptomswhich are common during initiation of metformin therapyare unlikely to be drug relatedLater occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

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