Administration advice :
-Take orally with meals
-Gastrointestinal tolerability may be improved by a slow increase in dosage; doses above 2000 mg per day may be better tolerated given 3 times a day with meals
-Extended-release product: Take with evening meal; swallow whole; do not crush, cut, dissolve, or chew
-If patients have not responded to therapy after 3 to 4 months, consider intensifying treatment as outlined in accepted diabetes management algorithms and diabetes standards of care.
-Not for use in patients with type 1 diabetes or diabetic ketoacidosis.
-Temporarily stop treatment prior to radiologic studies utilizing iodinated contrast materials and for surgical procedures when restricted food or fluid intake is expected; may resume once adequate renal function is confirmed.
Renal: Assess renal function baseline, repeat at least annually and more often as clinically indicated.
Hematologic: Measure hematologic parameters annually; periodically asses Vitamin B-12 levels, especially in patients peripheral neuropathy or anemia.
-Monitor glycemic control
Patient advice :
-Tablet shells may appear in feces, and this should not cause alarm.
-Inform patients about the risk of lactic acidosis, conditions that might predispose them to its occurrence, and symptoms to watch for and report.
-Patients should understand the signs and symptoms, risks, and treatment of low blood sugar, especially if using this drug in combination with insulin or other drugs that may lower blood sugar.
-Advise patient that this drug may need to be temporarily stopped if undergoing radiologic studies with intravascular iodinated contrast materials or surgical procedures that will limit food or fluid intake.
-Advise patients on the risks of excessive alcohol intake.
-Tell patients that while gastrointestinal symptoms might be common when initiating treatment, gastrointestinal problems after initiation should be reported.
Supplemental N-acetylcysteine showed promise in one case study  and the first pilot study to investigate this claim (double blind) used 900mg of N-acetylcysteine daily for four weeks before doubling the dose for another four weeks (1,800mg) and increasing it further (2,700mg) over the course of 12 weeks;  it was found that, in subjects with autism and stable medication, that N-acetylcysteine was able to reduce irritability (As assessed by the Aberrant Behavior Checklist  ) after 12 weeks but failed to influence any other parameter on the ABC rating scale or any parameter on either the SRS or RBS scales.  This was replicated later on subjects with autism on stable risperidone therapy, where 1,200mg daily for eight weeks reduced irritability on the ABC scale and no other parameter.