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Contact your prescriber if: (1) you vomit more than twice in one week, (2) nausea prevents you from eating or drinking adequately for more than 48 hours, (3) symptoms worsen instead of improving after 8 weeks at a stable dose, or (4) you develop new symptoms like severe abdominal pain, bloody vomit, or signs of dehydration

The advice is to investigate and treat the vitamin B12 deficiency in the normal way, following clinical guidelines, and to continue the metformin

Breakouts: Purging: Occurs in acne-prone areas, lasts 46 weeks, and improves with continued use