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Important precautions Lactic acidosis Metformin can cause a rare but serious build-up of acid in the blood

Victoza (liraglutide): A daily injectable option that may work better for those who prefer smaller, more frequent doses

Dry mouth Drowsiness and fatigue Dizziness Constipation Weight gain Irregular heartbeat or palpitations Severe dizziness or fainting Eye pain or vision changes (risk of glaucoma) Signs of liver dysfunction (yellowing skin, dark urine) Thoughts of self-harm or worsening depression Studies suggest that amitriptyline may also impact sexual function, particularly in men, with some patients experiencing reduced libido or erectile dysfunction

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Budget, insurance considerations, and access planning should assume years of continued use, not months