Generic
Metformin Hydrochloride + Pioglitazone
16 brands available in the market
At a glance
Metformin Hydrochloride + Pioglitazone is a combination medicine used to improve glycemic control in type 2 diabetes mellitus. Metformin reduces glucose production and absorption, and Pioglitazone increases insulin sensitivity.
Description
Metformin is a biguanide that decreases hepatic glucose production, intestinal glucose absorption, and improves insulin sensitivity by increasing peripheral glucose uptake. Pioglitazone is a PPARγ agonist that modulates transcription of insulin-responsive genes involved in glucose and lipid metabolism.
Indications
- Type 2 diabetes mellitus - as an adjunct to diet and exercise to improve glycemic control (when combination of pioglitazone and metformin is appropriate)
Therapeutic class
Combination Oral Hypoglycemic Preparations
Pharmacological class
Biguanide + Thiazolidinedione
Pharmacology
Metformin reduces glucose production and absorption; Pioglitazone activates PPARγ receptors to increase insulin sensitivity and improve glucose and lipid metabolism.
Mechanism of action
Controls blood sugar by reducing glucose production and absorption and increasing insulin sensitivity.
Dosage
Adult Dose (Oral):
- Initial: 15/500 mg twice daily OR 15/850 mg once daily (with meals)
- Switching from metformin monotherapy: 15/500 mg twice daily OR 15/850 mg 1-2 times daily
- Switching from pioglitazone monotherapy: 15/500 mg twice daily OR 15/850 mg once daily
- Maximum: Pioglitazone 45 mg + Metformin 2,550 mg/day
Administration
- Swallow tablet whole; do not chew, crush or break
- Take with food (to reduce GI side effects)
- Take at the same time each day
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects:
- Nausea
- Loss of appetite
- Taste change
- Abdominal pain
- Diarrhea
- Edema (peripheral edema)
- Weight gain
- Respiratory tract infection
- Bone fracture
- Blurred vision
Precautions & warnings
- Inform doctor if symptoms of lactic acidosis occur (deep/rapid breathing, persistent nausea, vomiting, abdominal pain)
- Monitor blood sugar regularly to avoid hypoglycemia
- Avoid alcohol
- Monitor liver function regularly (do not initiate if ALT >2.5x ULN)
- Caution in history of heart failure or bladder cancer
Contraindications
- Renal disease or dysfunction (abnormal CrCl)
- Acute or chronic metabolic acidosis (including diabetic ketoacidosis)
- Hypersensitivity to components
- Current or history of cardiac failure
- Current or history of bladder cancer
Drug interactions
- Additive effect with sulfonylureas
- Thiazide diuretics, corticosteroids, OCs may worsen glycemic control
- ACE inhibitors may reduce fasting blood glucose
- Cimetidine may increase serum levels
- Strong CYP2C8 inhibitors (gemfibrozil) increase plasma levels
Food interactions
Alcohol consumption with Metformin + Pioglitazone is unsafe.
Use in pregnancy
Use in Pregnancy: Metformin + Pioglitazone may be unsafe during pregnancy (Category C); animal studies have shown harmful effects on the fetus. Consult your doctor.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Metformin + Pioglitazone is probably safe during breastfeeding; limited human data suggests no significant risk to the baby.
Pediatric use
Safety and efficacy not established in children.
Geriatric use
Elderly require dose adjustment due to potential decreased renal function; monitor renal function.
Renal / hepatic impairment
Renal Impairment: eGFR <30: contraindicated; eGFR 30-45: not recommended to initiate; discontinue if eGFR falls below 30; monitor renal function regularly.
Hepatic Impairment: Do not initiate in active liver disease; do not initiate if ALT >2.5x ULN; monitor liver enzymes regularly.
Overdose effects
Overdose may cause lactic acidosis; symptomatic and supportive treatment; hemodialysis is effective.
Storage conditions
Store in a cool and dry place, away from light and moisture; keep out of reach of children.
Chemical structure
Metformin Hydrochloride + Pioglitazone