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Too much lactic acid: confusion, feeling weak, fast or slow heartbeat, rapid breathing, no appetite, nausea, vomiting, stomach pain High ketone levels in the blood: trouble breathing, vomiting, belly pain, dry skin and mouth, feeling very tired, fruity-smelling breath Serious kidney problems: confusion, weakness, tiredness, urinating less than usual Dehydration (dangerously low body fluids): dizziness, lightheadedness, confusion, dark-colored urine Serious genital infection: pain, swelling, or redness in the genital area, fever, weakness Effects of other drugs, drug classes and over-the-counter products on Xigduo XR The following medications may interact with Xigduo XR: Carbonic anhydrase inhibitors may increase the risk of lactic acidosis Consider more frequent monitoring Drugs that reduce metformin clearance (such as ranolazine, vandetanib dolutegravir, and cimetidine) may increase the accumulation of metformin

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Both diarrhoea and constipation have been reported in retatrutide Phase 2 clinical trials