By using the LYRICA Co-Pay Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions: The Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as “La Reforma de Salud”]). The Card is not valid for prescriptions that are eligible to be reimbursed by private indemnity or HMO insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs. Eligible patients will pay as little as $25 with a savings of up to $140 per prescription fill, for up to 12 offers per year. To qualify for this offer, the patient’s out-of-pocket expense must be a minimum of $25 per prescription. Depending on individual’s co-pay, savings may be up to $140 per prescription. You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. The Card will be accepted only at participating pharmacies. This Card is not health insurance. Offer good only in the US and Puerto Rico. The Card is limited to 1 per person during this offering period and is not transferable. Pfizer reserves the right to rescind, revoke, or amend the program without notice. For expiration date, please refer to the Co-Pay Savings Card.
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Lactate uptake by the liver is diminished with metformin administration because lactate is a substrate for hepatic gluconeogenesis , a process that metformin inhibits. In healthy individuals, this slight excess is cleared by other mechanisms (including uptake by unimpaired kidneys), and no significant elevation in blood levels of lactate occurs.  Given impaired kidney function, clearance of metformin and lactate is reduced, increasing levels of both, and possibly causing lactic acid buildup. Because metformin decreases liver uptake of lactate, any condition that may precipitate lactic acidosis is a contraindication. Common causes include alcoholism (due to depletion of NAD+ stores), heart failure and respiratory disease (due to inadequate tissue oxygenation); the most common cause is kidney disease.