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The clinically important interactions are with insulin and sulfonylureas (high hypoglycemia risk), oral contraceptives (notable absorption change requiring backup contraception), warfarin (INR monitoring needed), levothyroxine (timing matters), and antibiotics that require precise blood levels

More severe side effects are possible, though rare

Metformin promotes neuronal differentiation and neurite outgrowth through AMPK activation in human bone marrow-mesenchymal stem cells