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How does Avandamet cause lactic acidosis?

Metformin, one of the two main active ingredients in Avandamet, has been associated with lactic acidosis, which is a harmful buildup of lactic acid (a normal product of muscle metabolism) in the body. Lactic acidosis occurs when the cells of the body produce acid faster than it can be metabolized. Thus, the liver cannot convert this lactate buildup into glucose in a normal way.
Lactic acidosis is associated with liver and kidney damage and this condition can be fatal. Get immediate medical attention if you have any symptoms of lactic acidosis, including: diarrhea, difficulty breathing, dizziness, extreme weakness or fatigue, shallow breathing, loss of appetite, muscle cramps, numb or cold feeling in your arms and legs, slow or erratic heartbeat, stomach pain, unusual drowsiness, and vomiting. Your risk of developing lactic acidosis is increased if you take too much Avandamet or if you drink alcohol while taking this drug. Other health conditions (particularly pre-existing liver or kidney disease) may also increase your risk.

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