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Pioglitazone + Metformin information from DrugsUpdate  

See Available Brands of Pioglitazone + Metformin in India

P - Contraindicated in pregnancy
L - Contraindicated in lactation

Pioglitazone/Metformin is a biguanide and thiazolidinedione antidiabetic combination. It works by decreasing the amount of sugar the liver produces and the intestines absorb. It also helps to make your body more sensitive to the insulin that you naturally produce.

Pharmacodynamics

Pharmacokinetics

Pioglitazone is as a potent and highly selective agonist for the peroxisome proliferator activated receptor-gamma. Activation of these receptors promotes the production of gene products involved in lipid and glucose metabolism. It also improves insulin response to target cells witho increasing the pancreatic secretion of insulin. Metformin decreases hepatic gluconeogenesis, decreases intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilisation).

Pioglitazone + Metformin Indications / Pioglitazone + Metformin Uses

Information Not Available

Pioglitazone + Metformin Adverse Reactions / Pioglitazone + Metformin Side Effects

Pioglitazone: Pharyngitis, oedema, headache, upper resp tract infection, sinusitis, anaemia; GI disturbances, weight gain, visual disturbances, dizziness, arthralgia, haematuria, impotence. Metformin: Anorexia, nausea, vomiting, diarrhoea, weight loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of vitamin B12.

Potentially Fatal: Lactic acidosis in presence of renal failure and alcoholism.

Precautions


Monitor
Obtain periodic fasting blood glucose and HbA 1c concentrations to monitor therapeutic response. Assess liver enzymes prior to initiation of therapy and periodically thereafter. Monitor all patients for signs and symptoms associated with fluid retention (eg, edema, heart failure). Assess renal function before starting therapy and at least annually thereafter. Monitor renal function more frequently in elderly patients and patients in whom renal function impairment is anticipated. Evaluate hematologic parameters on an annual basis and vitamin B 12 levels at 2- to 3-years intervals in patients at risk for deficiency. Patients should have regular eye examinations by an ophthalmologist. Promptly refer all patients reporting any visual symptoms to an ophthalmologist.

Special Precautions

Elderly. Monitor renal function regularly. Patients receiving pioglitazone in combination with insulin or oral hypoglycaemic agents may be at risk of hypoglycaemia. Oedema, congestive heart failure; hepatic dysfunction; jaundice. Premenopausal, anovulatory women, anaemia. Monitor liver function.

Other Drug Interactions

Pioglitazone: Ketoconazole inhibits the metabolism of pioglitazone (in vitro). Increased hypoglycaemic effect with alcohol. Metformin: Additive effect with sulphonylureas. Antagonistic effects with diuretics, corticosteroids, phenothiazines, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, Ca channel blockers and isoniazid.

Potentially Fatal: Pioglitazone: admin of a thiazolidinedione with OC reduces the plasma concentrations of the hormones which may result in the loss of contraceptive effectivity. Metformin: Lactic acidosis with alcohol and potentiation of hypoglycaemic effect. Cimetidine and furosemide may increase plasma-metformin levels. Drugs eliminated via renal tubular secretion may increase metformin levels.

Other Interactions

Information Not Available

Dosage

Oral
Type 2 diabetes mellitus
Adult: Starting dose should be based on patient's current dosage regimen of pioglitazone and/or metformin. For patients who are inadequately controlled on metformin monotherapy: Usual starting dose: pioglitazone/metformin: 15 mg/500 mg or 15 mg/850 mg 1-2 times daily, adjust dose gradually based on therapeutic response. For patients who are on pioglitazone monotherapy but require additional glycaemic control: Usual starting dose: pioglitazone/metformin: 15 mg/500 mg twice daily or 15 mg/850 mg once daily, adjust dose gradually based on therapeutic response. Daily max: pioglitazone/metformin: 45 mg/2250 mg.

Food(before/after)

Information Not Available

List of Contraindications

Pioglitazone + Metformin and Pregnancy

Contraindicated in pregnancy

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Pioglitazone + Metformin and Lactation

Contraindicated in lactation

Pioglitazone + Metformin and Children

Safety and efficacy not established

Pioglitazone + Metformin and Geriatic

Ensure that initial and maintenance doses are conservative because of potential for reduced renal function; avoid titration to max dose if possible.

Pioglitazone + Metformin and Other Contraindications

Hypersensitivity; diabetic coma, diabetic ketoacidosis; severe renal or hepatic impairment; recent MI, CHF; type 1 DM; severe infection; acute or chronic metabolic acidosis with or without coma; stress, trauma; severe impairment of thyroid function; dehydration, acute or chronic alcoholism; children <18 years, pregnancy, lactation.

Storage

Oral
Store at 25°C.

Lab interference

Oral
Store at 25°C.

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