Clove (Syzygium aromaticum)

Syzygium aromaticum
Evidence Level
Limited
5 Clinical Trials
6 Documented Benefits
2/5 Evidence Score

Clove is the dried, unopened flower bud of the Syzygium aromaticum tree, a common kitchen spice. The bud holds about 15 to 17% essential oil, and that oil is mostly eugenol (about 75 to 88%). Supplements use a different part of the chemistry: water-soluble clove bud extracts rich in polyphenols such as gallic and ellagic acids, quercetin and the ellagitannin eugeniin. Human research by mouth is small and comes almost entirely from one extract maker: a 16-man placebo-controlled crossover during an alcohol challenge, an 84-day trial against synthetic glutathione with no placebo, and two uncontrolled studies of blood sugar and antioxidant enzymes. A large review of spices for blood sugar found too few clove trials to analyze. Clove oil is a separate product and is not for swallowing: small amounts swallowed by young children have caused liver failure, seizures and coma.

Studied Dose 250 mg once a day of a clove bud polyphenol extract (Clovinol) in every human study: around a single alcohol challenge, for 30 days in two uncontrolled studies, and for 84 days in an active-controlled trial. No controlled trial has tested whole clove spice or clove oil by mouth.
Active Compound Clove bud polyphenols (gallic acid, ellagic acid, quercetin and eugeniin) in water-soluble extracts; clove oil is mainly eugenol with acetyl eugenol and beta-caryophyllene.

Benefits

Oxidative stress markers during an alcohol challenge

In a placebo-controlled crossover of 16 men who drank alcohol at 1 g/kg body weight, one 250 mg capsule of clove bud polyphenol extract lowered markers of oxidative stress and lipid peroxidation and raised glutathione and superoxide dismutase compared with placebo. The study was small, run by the extract maker, and measured blood markers over 12 hours.

C-reactive protein and IL-6 after drinking

In the same 16-man crossover, C-reactive protein and IL-6, two blood markers of inflammation, were lower after the clove bud extract than after placebo, and the hangover severity score was 55% lower. These are short-term markers from one maker-run study; they do not show protection of the liver or make heavy drinking safer.

Blood sugar and lipid markers compared with synthetic glutathione

In 70 adults with metabolic syndrome, 84 days of a clove bud extract (250 mg/day) improved fasting and post-meal glucose, HbA1c, insulin and blood lipids, while synthetic glutathione showed no significant effect on glucose or lipids. There was no placebo arm, and the extract maker co-authored the study.

Post-meal blood sugar in healthy volunteers

In 13 young adults taking 250 mg of a clove bud extract after lunch for 30 days, 2-hour post-meal glucose fell about 13 to 17 mg/dL from baseline. The study had no control group or blinding and was funded by the maker. A review of spices for blood sugar in type 2 diabetes found too few clove studies to analyze.

Antioxidant enzymes over 30 days

Healthy office workers who took 250 mg a day of a de-flavored clove bud extract for 30 days, in capsules or foods, showed higher catalase, superoxide dismutase, glutathione peroxidase and glutathione and lower lipid peroxidation. No control group is described, and the extract maker ran the study.

Fat storage and blood sugar in lab and animal studies

In mice on a high-fat diet, 0.5% clove bud extract for 9 weeks lowered weight gain, body fat, blood lipids, glucose and insulin. In diabetic mice, a clove extract with most of its eugenol removed lowered blood glucose and HbA1c. These are animal and cell findings that have not been confirmed in people.

Mechanism of action

1

Polyphenols and eugenol act differently

Clove bud contains two distinct groups of compounds. In lab tests, the clove compound eugeniin blocked glycogen phosphorylase, an enzyme that releases stored glucose from the liver, and cut glucose output from liver cells, while eugenol had no effect. The supplement extracts studied in people are standardized for polyphenols, not eugenol.

2

Fat-building genes in animal tissue

In mice on a high-fat diet, clove bud extract reduced liver and fat-tissue levels of proteins that drive fat formation, including SREBP-1, fatty acid synthase, CD36 and PPAR-gamma, and blocked fat-cell formation in a cell line. These are animal and cell findings.

3

Eugenol and acetyl eugenol slow platelet clumping in the lab

In human platelets in the test tube, eugenol and acetyl eugenol from clove oil inhibited aggregation triggered by arachidonate, adrenaline and collagen, partly by lowering thromboxane formation. No study has measured this effect in people taking clove supplements, but it is the basis for bleeding cautions.

Clinical trials

1
Clove Bud Polyphenol Extract and an Alcohol Challenge: Placebo-Controlled Crossover
PubMed

Randomized, double-blind, placebo-controlled crossover; one 250 mg capsule of a clove bud polyphenol extract (Clovinol) or placebo with alcohol at 1 g/kg body weight, reversed after a 2-week washout; blood sampled over 12 hours. Four of the five authors are from the extract maker (Akay). (Mammen et al. 2018, J Med Food)

16 male social drinkers.

Compared with placebo, blood acetaldehyde cleared faster, markers of oxidative stress, lipid peroxidation, C-reactive protein and IL-6 were lower, glutathione and superoxide dismutase were higher, and the hangover severity score was 55% lower. A small maker-run study of blood markers over one drinking session; it does not show liver protection or make drinking safer.

2
Clove Bud Polyphenol Extract vs an Active Comparator for 84 Days (no placebo)
PubMed

Randomized, double-blind, active-controlled trial of a clove bud polyphenol extract (Clovinol) versus synthetic glutathione, each 250 mg/day for 84 days, with no placebo arm. Outcomes included plasma glutathione, Nrf2 and antioxidant enzymes, glucose and lipid markers, and inflammatory markers; the abstract reports higher plasma glutathione, Nrf2, antioxidant enzymes and GSH/GSSG ratio and lower IL-1beta, TNF-alpha and neutrophil/lymphocyte ratio with the clove extract. Not PubMed-indexed; read from its published abstract only. Two authors from the extract maker. (Thomas et al. 2022, J Funct Foods)

70 adults with metabolic syndrome.

The abstract reports that the clove extract arm improved fasting and post-meal glucose, HbA1c, HOMA-IR, insulin and blood lipids, while the comparator showed no significant effect on glucose or lipids. Between-arm statistics were not available to us. With no placebo arm, the trial cannot show how much of the change beats no treatment. No significant side effects or blood-test changes were reported.

3
Clove Bud Polyphenol Extract and Post-Meal Blood Sugar: Open-Label Pilot (no control group)
PubMed

Open-label, unblinded pilot with no control group; 250 mg of a water-soluble clove bud polyphenol extract after lunch daily for 30 days, glucose measured by glucometer before and 2 hours after lunch. Funded by the extract maker (Akay). (Mohan et al. 2019, BMC Complement Altern Med)

13 adults aged 25 to 35 (10 men, 3 women): 7 with pre-meal glucose up to 100 mg/dL and 6 with 101 to 125 mg/dL.

Post-meal glucose fell from baseline by about 13 mg/dL and 17 mg/dL in the two groups by day 12 and stayed lower through day 30. Pre-meal glucose fell only in the higher-glucose group (about 13 mg/dL at days 24 and 30). Without a comparison group, changes in diet or routine cannot be ruled out.

4
De-Flavored Clove Bud Extract in Capsules and Foods: 30-Day Study (no control group)
PubMed

Product development paper with a 30-day intake study of a clove bud polyphenol extract (Clovinol) at 250 mg a day in capsules or added to foods and drinks; the abstract describes no placebo or control group. Outcomes were blood antioxidant enzymes (catalase, superoxide dismutase, glutathione peroxidase), glutathione and lipid peroxidation. Authors from the extract maker. (Johannah et al. 2015, Food Funct)

Healthy adult office workers; number not given in the abstract.

Average levels of the first four markers rose about 33%, 66%, 56% and 167%, and the membrane damage marker fell about 81%, measured before and after intake with no comparison group. These are blood markers, not health outcomes.

5
Safety of a Clove Bud Polyphenol Extract (Rat and Bacterial Study)
PubMed

Acute (5 g/kg) and 90-day (0.25, 0.5 and 1 g/kg a day) oral toxicity tests in Wistar rats plus Ames mutagenicity tests of a clove bud polyphenol extract (Clovinol); co-authored by the extract maker. (Vijayasteltar et al. 2016, Toxicol Rep)

Wistar rats and Salmonella typhimurium test strains; no people.

No toxicologically significant changes in behavior, weight, blood tests, urine or organ tissue versus untreated rats; the no-observed-adverse-effect level was 1000 mg/kg a day, the highest dose tested. No mutagenic activity was found. These results apply to this polyphenol extract, not to clove oil, which is mostly eugenol.

Side effects and drug interactions

Common Potential side effects

Clove oil is not a food supplement and should never be swallowed or given to children. The EMA notes that 5 to 10 mL swallowed by children under 2 caused life-threatening poisoning, and case reports describe infants with liver failure after swallowing less than 8 mL and 10 mL, as well as coma, seizures, very low blood sugar and clotting failure. Keep clove oil out of children's reach and get emergency care after any ingestion.
The EMA accepted clove oil only for short-term use on teeth and in the mouth, not for internal use, did not recommend it under 18 years or in pregnancy and breastfeeding, and found the data on eugenol and genetic damage equivocal.
Eugenol, the main compound in clove oil, has an acceptable daily intake of up to 2.5 mg per kg body weight set by the WHO and FAO food additives committee (JECFA).
Clove can cause allergic reactions, and people allergic to Peru balsam may react to it. Concentrated clove oil can irritate the mouth and skin.
In the 84-day trial of a clove bud polyphenol extract at 250 mg/day, no significant side effects or blood-test changes were reported; human safety data for clove extracts are limited to these small studies and a 90-day rat study.

Important Drug interactions

Anticoagulant and antiplatelet drugs (such as warfarin): eugenol and acetyl eugenol from clove inhibit platelet clumping in lab tests, and clove is listed among herbs that may add to bleeding risk. No human interaction study exists; ask your clinician before using clove supplements with these drugs or before surgery.
Glucose-lowering medicines: small clove extract studies reported lower post-meal glucose, so monitor blood sugar if you add a clove supplement.
If you take any prescription medicine, check with your health care provider before using concentrated clove products.

Frequently asked questions about Clove (Syzygium aromaticum)

Is a clove supplement the same as clove oil?

No. The supplements tested in people are water-soluble clove bud extracts standardized for polyphenols and taken at 250 mg a day. Clove oil is the steam-distilled essential oil, which is mostly eugenol. In Europe it is approved only for short-term use on teeth and in the mouth, and it is not meant to be swallowed.

Why is clove oil dangerous for small children?

Case reports describe infants and toddlers who swallowed about 5 to 10 mL of clove oil and developed liver failure, seizures, coma, very low blood sugar or clotting problems. Some recovered after hospital treatment with N-acetylcysteine. Store clove oil like a medicine and call poison control or emergency services after any swallow.

Who paid for the clove extract studies in people?

Almost all of them were run or funded by Akay, the company that makes the Clovinol extract, and one also had co-authors from a supplement seller. The studies were small, and only the alcohol-challenge crossover used a placebo. Independent, placebo-controlled trials have not been published.

Does cooking with cloves give the same amount studied in trials?

Not directly. The trials used a concentrated polyphenol extract at 250 mg a day, not whole spice, and no controlled trial has tested ground cloves as food. Normal cooking amounts are a flavoring, not a tested dose for any effect.

What is Clove?

Clove is the dried, unopened flower bud of the Syzygium aromaticum tree, a common kitchen spice. The bud holds about 15 to 17% essential oil, and that oil is mostly eugenol (about 75 to 88%).

What is Clove used for?

Clove is researched primarily for Antioxidant and Anti-Inflammatory. In a placebo-controlled crossover of 16 men who drank alcohol at 1 g/kg body weight, one 250 mg capsule of clove bud polyphenol extract lowered markers of oxidative stress and lipid peroxidation and raised glutathione and superoxide dismuta…

What is the recommended dosage of Clove?

The clinically studied dose is 250 mg once a day of a clove bud polyphenol extract (Clovinol) in every human study: around a single alcohol challenge, for 30 days in two uncontrolled studies, and for 84 days in an active-controlled trial. Always follow the product label and check with a healthcare provider for personal advice.

Is Clove safe, and does it have side effects?

Side effects and cautions reported for Clove include: Clove oil is not a food supplement and should never be swallowed or given to children. The EMA notes that 5 to 10 mL swallowed by children under 2 caused life-threatening poisoning, and case reports describe infants with liver failure after swallowing less than 8 mL and 10 mL, as… It may also interact with some medications. Clove is not right for everyone, so check with a healthcare provider first if you are pregnant or breastfeeding, have a medical condition, or take prescription medication.

Does Clove interact with any medications?

Possible interactions include: Anticoagulant and antiplatelet drugs (such as warfarin): eugenol and acetyl eugenol from clove inhibit platelet clumping in lab tests, and clove is listed among herbs that may add to bleeding risk. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Clove?

NutraSmarts rates the evidence for Clove as Limited (2 out of 5). It is backed by 5 study summaries and 17 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(17 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. Mammen RR, Natinga Mulakal J, Mohanan R, Maliakel B, Illathu Madhavamenon K. Clove Bud Polyphenols Alleviate Alterations in Inflammation and Oxidative Stress Markers Associated with Binge Drinking: A Randomized Double-Blinded Placebo-Controlled Crossover Study. J Med Food. 2018;21(11):1188-1196. doi: 10.1089/jmf.2017.4177.PubMedUsed to support: Randomized, double-blind, placebo-controlled crossover in 16 male social drinkers given alcohol at 1 g/kg body weight: one 250 mg capsule of a clove bud polyphenol extract (Clovinol) versus placebo, with a 2-week washout. Compared with placebo, blood acetaldehyde cleared faster, oxidative stress, lipid peroxidation, C-reactive protein and IL-6 were lower, glutathione and superoxide dismutase were higher, and the hangover severity score was 55% lower. All authors are from the extract maker (Akay) or a collaborating college; blood markers over 12 hours, not a liver outcome.
  2. Thomas JV, Patel AA, Das Sivadasan S, Sreevallabhan S, Illathu Madhavamenon K, Mohanan R. Clove bud (Syzygium aromaticum L.) polyphenol helps to mitigate metabolic syndrome by establishing intracellular redox homeostasis and glucose metabolism: A randomized, double-blinded, active-controlled comparative study J Funct Foods. 2022;98:105273. doi: 10.1016/j.jff.2022.105273.SourceUsed to support: Not PubMed-indexed (read via its published abstract). Randomized, double-blind trial in 70 adults with metabolic syndrome comparing a clove bud polyphenol extract (Clovinol) with synthetic glutathione, each 250 mg/day for 84 days, with no placebo arm. The clove arm improved plasma glutathione, antioxidant enzymes, fasting and post-meal glucose, HbA1c, HOMA-IR, insulin and blood lipids, while synthetic glutathione showed no significant effect on glucose or lipids; no significant side effects. Two authors work for the extract maker (Akay Natural Ingredients).
  3. Mohan R, Jose S, Mulakkal J, Karpinsky-Semper D, Swick AG, Krishnakumar IM. Water-soluble polyphenol-rich clove extract lowers pre- and post-prandial blood glucose levels in healthy and prediabetic volunteers: an open label pilot study. BMC Complement Altern Med. 2019;19(1):99. doi: 10.1186/s12906-019-2507-7.PubMedUsed to support: Open-label pilot with no control group: 13 volunteers (7 with normal and 6 with raised pre-meal glucose) took 250 mg of a water-soluble clove bud polyphenol extract after lunch for 30 days. Two-hour post-meal glucose fell from baseline by about 13 to 17 mg/dL by day 12; pre-meal glucose fell only in the higher-glucose group. Glucometer readings, no blinding. Funded by the extract maker (Akay), with co-authors from Akay and from a supplement company that sells the extract.
  4. NM J, RM R, G G, Maliakel B, D S, IM K. Beyond the flavour: a de-flavoured polyphenol rich extract of clove buds (Syzygium aromaticum L) as a novel dietary antioxidant ingredient. Food Funct. 2015;6(10):3373-82. doi: 10.1039/c5fo00682a.PubMedUsed to support: Development of a de-flavored clove bud polyphenol extract (Clovinol) for foods, plus a 30-day study in healthy office workers taking 250 mg a day in capsules or foods: catalase, superoxide dismutase, glutathione peroxidase and glutathione rose and lipid peroxidation fell. The abstract describes no placebo or control group. Authors are from the extract maker (Akay).
  5. Percival SS, Vanden Heuvel JP, Nieves CJ, Montero C, Migliaccio AJ, Meadors J. Bioavailability of herbs and spices in humans as determined by ex vivo inflammatory suppression and DNA strand breaks. J Am Coll Nutr. 2012;31(4):288-94. doi: 10.1080/07315724.2012.10720438.PubMedUsed to support: Thirteen groups of 10 to 12 adults each took capsules of one herb or spice for 7 days, with blood drawn before and after. Serum from the clove group reduced TNF-alpha expression in lab-grown immune cells exposed to oxidized LDL; clove was not among the spices whose serum protected blood cells from DNA strand breaks. An ex vivo lab readout with no placebo group, not a health outcome.
  6. Jung CH, Ahn J, Jeon TI, Kim TW, Ha TY. Syzygium aromaticum ethanol extract reduces high-fat diet-induced obesity in mice through downregulation of adipogenic and lipogenic gene expression. Exp Ther Med. 2012;4(3):409-414. doi: 10.3892/etm.2012.609.PubMedUsed to support: Mouse study: adding 0.5% clove bud ethanol extract to a high-fat diet for 9 weeks lowered weight gain, fat tissue mass, liver weight, and blood triglycerides, cholesterol, glucose, insulin and leptin versus high-fat diet alone, with lower expression of fat-building genes. The extract also blocked fat-cell formation in a cell line. Animal and cell findings only.
  7. Vijayasteltar L, Nair GG, Maliakel B, Kuttan R, I M K. Safety assessment of a standardized polyphenolic extract of clove buds: Subchronic toxicity and mutagenicity studies. Toxicol Rep. 2016;3:439-449. doi: 10.1016/j.toxrep.2016.04.001.PubMedUsed to support: Rat and bacterial safety study of the clove bud polyphenol extract (Clovinol): an acute oral test at 5 g/kg (14 days) and 90 days at up to 1 g/kg a day caused no toxicologically significant changes, giving a no-observed-adverse-effect level of 1000 mg/kg a day, the highest dose tested; no mutagenicity in Ames strains. Co-authored by the extract maker (Akay); applies to this polyphenol extract, not clove oil.
  8. Sanae F, Kamiyama O, Ikeda-Obatake K, Higashi Y, Asano N, Adachi I, Kato A. Effects of eugenol-reduced clove extract on glycogen phosphorylase b and the development of diabetes in db/db mice. Food Funct. 2014;5(2):214-9. doi: 10.1039/c3fo60514k.PubMedUsed to support: Lab and mouse study: a clove water-ethanol extract and its tannin eugeniin inhibited glycogen phosphorylase b and glucose output from rat liver cells, while eugenol did not. Eugenol-reduced clove extract in the diet lowered blood glucose, HbA1c, triglycerides and free fatty acids in diabetic db/db mice. Animal and cell work only.
  9. Garza MC, Pérez-Calahorra S, Rodrigo-Carbó C, Sánchez-Calavera MA, Jarauta E, Mateo-Gallego R, Gracia-Rubio I, Lamiquiz-Moneo I. Effect of Aromatic Herbs and Spices Present in the Mediterranean Diet on the Glycemic Profile in Type 2 Diabetes Subjects: A Systematic Review and Meta-Analysis. Nutrients. 2024;16(6):756. doi: 10.3390/nu16060756.PubMedUsed to support: Systematic review and meta-analysis of herbs and spices on blood sugar in adults with type 2 diabetes (77 studies reviewed, 45 pooled). Cinnamon, turmeric, ginger, black cumin and saffron lowered fasting glucose, but not enough studies were found on clove to analyze it, and the authors call for more clove research.
  10. Janes SE, Price CS, Thomas D. Essential oil poisoning: N-acetylcysteine for eugenol-induced hepatic failure and analysis of a national database. Eur J Pediatr. 2005;164(8):520-2. doi: 10.1007/s00431-005-1692-1.PubMedUsed to support: Case report: a 15-month-old boy developed fulminant liver failure (ALT above 13,000 U/L at 24 hours) after swallowing 10 mL of clove oil and recovered after intravenous N-acetylcysteine. A UK database showed a 14-fold rise in home accidents involving aromatherapy oils from 1994 to 1999. A single case.
  11. Eisen JS, Koren G, Juurlink DN, Ng VL. N-acetylcysteine for the treatment of clove oil-induced fulminant hepatic failure. J Toxicol Clin Toxicol. 2004;42(1):89-92. doi: 10.1081/clt-120028751.PubMedUsed to support: Case report: a 3-month-old girl developed fulminant liver failure after swallowing less than 8 mL of clove oil, was treated with intravenous N-acetylcysteine on the acetaminophen protocol, and recovered fully; earlier clove oil poisoning cases are reviewed. A single case.
  12. Hartnoll G, Moore D, Douek D. Near fatal ingestion of oil of cloves. Arch Dis Child. 1993;69(3):392-3. doi: 10.1136/adc.69.3.392.PubMedUsed to support: Case report from London: a child who swallowed oil of cloves developed coma, seizures, a clotting disorder and acute liver damage, which the authors liken to late-stage acetaminophen overdose. A single case.
  13. Srivastava KC. Antiplatelet principles from a food spice clove (Syzygium aromaticum L) [corrected]. Prostaglandins Leukot Essent Fatty Acids. 1993;48(5):363-72. doi: 10.1016/0952-3278(93)90116-e.PubMedUsed to support: Lab study in human platelets: eugenol and acetyl eugenol isolated from clove oil inhibited platelet aggregation triggered by arachidonate, adrenaline and collagen, partly by lowering thromboxane formation. Not a study in people taking clove.
  14. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-7; quiz 1228-30.PubMedUsed to support: Pharmacy review listing clove among herbal products that may increase bleeding risk or add to the effect of warfarin; the authors note that nearly all such information comes from lab data, animal studies or individual case reports.
  15. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment report on Syzygium aromaticum (L.) Merill et L.M. Perry, flos and Syzygium aromaticum (L.) Merill et L.M. Perry, floris aetheroleum (EMA/HMPC/534946/2010) European Medicines Agency. 2011;Final, 13 September 2011. Accessed 2026..SourceUsed to support: Not PubMed-indexed (EU regulatory document). Clove bud contains 15 to 17% essential oil, which is 75 to 88% eugenol and 4 to 15% acetyl eugenol. The HMPC supported only short-term dental and mouth use of clove oil in traditional herbal medicines and noted no clinical data for other uses. It reviews poisoning case reports in young children after swallowing clove oil (including 5 to 10 mL in a 2-year-old, less than 8 mL in a 3-month-old and 10 mL in a 15-month-old, with coma, seizures, unrecordable blood glucose, clotting failure and liver failure), notes that the antiplatelet effect may raise bleeding risk with blood thinners, found eugenol genotoxicity data inconsistent and equivocal, and said safety concerns did not allow a Community list entry.
  16. Joint FAO/WHO Expert Committee on Food Additives (JECFA). Eugenol (JECFA No. 1529): evaluation summary WHO IPCS INCHEM. 2005;ADI set at the 26th meeting (1982), maintained at the 65th meeting (2005). Accessed 2026..SourceUsed to support: Not PubMed-indexed (WHO expert committee summary). JECFA set an acceptable daily intake for eugenol, used as a flavoring agent, of 0 to 2.5 mg per kg body weight in 1982 and maintained it in 2005.
  17. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Community herbal monograph on Syzygium aromaticum (L.) Merill et L. M. Perry, floris aetheroleum (EMA/HMPC/534924/2010) European Medicines Agency. 2011;Final, adopted 13 September 2011. Accessed 2026..SourceUsed to support: Not PubMed-indexed (EU regulatory document). Traditional-use monograph for clove oil limited to mouth washes and dental application for no more than 1 week. Use under 18 years and in pregnancy and breastfeeding is not recommended; hypersensitivity to Peru balsam is a contraindication; mucosal irritation and allergic reactions are reported. It states that 5 to 10 mL of clove oil by mouth in children below 2 years of age caused life-threatening conditions, and that overdose may cause CNS depression, acidosis, worsening liver function, coma, seizures and low blood glucose.