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Danese S, Vermeire S, Zhou W, et al

2013:437576 Szukiewicz D, Szewczyk G, Pyzlak M, Stangret A, Bachanek M, Trojanowski S, Alkhalayla H, Wejman J (2018) Anti-inflammatory action of metformin with respect to CX3CL1/CX3CR1 signaling in human placental circulation in normal-glucose versus high-glucose environments

Dose adjustment considerations: If gastrointestinal symptoms are severe or persistent despite these measures, contact your prescribing clinician to discuss: Slowing the dose escalation schedule Temporarily reducing the dose Taking a brief treatment pause (though this may affect weight loss progress) Switching to an alternative weight management medication if symptoms are intolerable The STEP trials demonstrated that slower dose titration can reduce the incidence and severity of gastrointestinal adverse effects

and Xia, J