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Off-label use mirrors diabetes dosing: taken with the first bite of carbohydrate-containing meals, titrated from a low dose (e.g. 25 mg) up to 50–100 mg per meal as GI tolerance allows. A prescription drug, not an approved longevity regimen.

With meals · with food

Oral tablet with meals

Off-label longevity use mirrors diabetes dosing (commonly 500–1500 mg/day of extended-release with meals) under a clinician. Not an approved longevity regimen, and unnecessary in well-controlled non-diabetics without a clear rationale.

With meals · with food

Extended-release tablet

• Inflammatory bowel disease / intestinal obstruction
• Cirrhosis
• Diabetic ketoacidosis

• Insulin / sulfonylureas
• Digestive enzymes / intestinal adsorbents

• Severe renal impairment (eGFR < 30)
• Acute metabolic acidosis
• Conditions predisposing to lactic acidosis (severe hypoxia, decompensated heart failure)

• Iodinated contrast
• Alcohol (excessive)