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Be aware that prolonged use can lead to rebound congestion

For example, multiple studies have demonstrated that metformin can inhibit the growth of thyroid cells and different types of thyroid cancer cells, and metformin therapy has been associated with a decrease in the levels of serum thyroid-stimulating hormone (TSH) (7)

Briefly, metabolites from 3 10 6 cells were extracted on ice with 0.8 ml pre-cold 80% methanol (80 C), and cell rupture was achieved by a Bullet Blender Storm 24 (Next Advance, Troy, NY) with metal beads, followed by five freeze-thaw out cycles

If GI symptoms are still significant, the documented approach is to hold the current dose longer rather than escalate on schedule