Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. One of the most commonly used drugs in the world, generic metformin is the first medicine prescribed for nearly anyone with Type 2. Metformin is cheap because it’s available as a generic. The top brand name in the United States is Glucophage, but few people need the brand name. Like many great medicines, metformin started as a plant medicine. It was extracted from the French lilac plant (Galega officinalis). French lilac is a weed; people noticed that eating it made animals sick. When they investigated, they found that metformin was almost a wonder drug. Metformin signals the liver to keep extra sugar in storage. Insulin sends the same vital message, but in Type 2 diabetes, the liver doesn’t listen to insulin. Metformin locks down the liver and so keeps glucose levels down. 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