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After initiation of rosiglitazone maleate/metformin hydrochloride, and after dose increases, observe patients carefully for signs and symptoms of heart failure (including excessive, rapid weight gain, dyspnea, and/or edema). Should secondary failure occur with Amaryl or metformin monotherapy, combined therapy with Amaryl and metformin or Amaryl and insulin may result in a response. Because the risk of metformin accumulation and lactic acidosis increases with the degree of renal function impairment, assess renal function before starting therapy and at least annually thereafter. With concomitant Amaryl and metformin therapy, the risk of hypoglycemia associated with Amaryl therapy continues and may be increased. Metformin reduces the absorption of sugar, reduces the release of stored sugar from the liver, and helps your body's cells use sugar better.

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