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For instance, metformin, is generally well-tolerated but can cause gastrointestinal side effects (e.g., nausea, diarrhea) and, in rare cases, lactic acidosis, particularly in patients with renal impairment [118]

Hepatology 63 , 14301441 (2016)

Individuals who significantly restrict their caloric intake, whether intentionally or as a result of nausea, are at greater risk of prolonged fatigue due to insufficient macronutrient and micronutrient intake

For example, hemorrhage and intravascular coagulation can develop, potentially leading to hemorrhagic or ischemic stroke