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Table 2 General dose reduction guidelines

From: Metformin and longevity (METAL): a window of opportunity study investigating the biological effects of metformin in localised prostate cancer

Grade I Continue study treatment at same dose; monitor and treat as clinically indicated.
Grade II Continue study treatment at same dose; monitor and treat as clinically indicated.
Grade III Step 1. Interrupt study drug until toxicity reduced to ≤Grade 1.
Step 2. Restart study treatment at same dose or lower dose at discretion of investigator
Grade IV Step 1. Interrupt study drug until toxicity reduced to ≤Grade 2.
Step 2. Restart study treatment at lower dose level.