Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. Realizing that this is an old thread that got revived, if anyone is interested, Metformin can be purchased without a prescription in Thailand and the Philippines. I'm pretty sure there would likely be other countries in Asia that also sell it OTC, but I haven't checked. Metformin is inexpensive and in some areas it’s even free but it does require a prescription in the US. My pharmacy fills a 90 day prescription free but other pharmacies do charge. Still, it’s generally considered an inexpensive drug. 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