Pioglitazone/metformin 15-850mg Tb
WARNING: This drug may cause or make heart failure worse. Tell your doctor if you have had heart failure. This drug may need to be avoided with some types of heart failure. You will be watched closely while starting this drug and if your dose is raised. Call your doctor right away if you have swelling in the arms or legs, shortness of breath or trouble breathing (especially when lying down), sudden weight gain, or you feel very tired.Rarely, metformin may cause too much lactic acid in the blood (lactic acidosis). The risk is higher in people who have kidney problems, liver problems, heart failure, use alcohol, or take certain other drugs, including topiramate. The risk is also higher in people who are 65 or older and in people who are having surgery, an exam or test with contrast, or other procedures. If lactic acidosis happens, it can lead to other health problems and can be deadly. Kidney tests may be done while taking this drug.Do not take this drug if you have a very bad infection, low oxygen, or a lot of fluid loss (dehydration).Call your doctor right away if you have signs of too much lactic acid in the blood (lactic acidosis) like confusion; fast breathing; fast or slow heartbeat; a heartbeat that does not feel normal; very bad stomach pain, upset stomach, or throwing up; feeling very sleepy; shortness of breath; feeling very tired or weak; very bad dizziness; feeling cold; or muscle pain or cramps. @ COMMON USES: It is used to lower blood sugar in patients with high blood sugar (diabetes).
Drug Class
Antidiabetic Agents
Pharmacologic Class
Thiazolidinedione; Biguanide
Pregnancy Category
Category C
FDA Approved
Aug 2005
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a combination of two drugs, pioglitazone and metformin, used to help control high blood sugar in people with type 2 diabetes. Pioglitazone helps your body use insulin better, and metformin helps reduce the amount of sugar your liver makes and your intestines absorb.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Take your medication with meals to help your body absorb it properly. Establish a routine by taking your medication at the same time every day. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.
Storing and Disposing of Your Medication
To maintain the quality and effectiveness of your medication, store the tablets in their original container at room temperature. Keep the container tightly closed and protect it from light. Store the medication in a dry place, avoiding areas like the bathroom where moisture may be present.
What to Do If You Miss a Dose
If you forget to take a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Take your medication with meals to help your body absorb it properly. Establish a routine by taking your medication at the same time every day. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.
Storing and Disposing of Your Medication
To maintain the quality and effectiveness of your medication, store the tablets in their original container at room temperature. Keep the container tightly closed and protect it from light. Store the medication in a dry place, avoiding areas like the bathroom where moisture may be present.
What to Do If You Miss a Dose
If you forget to take a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Follow a healthy diet plan as recommended by your doctor or dietitian.
- Engage in regular physical activity as advised by your healthcare provider.
- Monitor your blood sugar levels regularly as instructed.
- Do not drink excessive amounts of alcohol, as it can increase the risk of a serious side effect called lactic acidosis.
- Inform your doctor if you are scheduled for any X-ray procedures involving dye or any surgery, as you may need to temporarily stop this medication.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: Pioglitazone 15 mg/Metformin 500 mg or 15 mg/850 mg once daily. Titrate gradually based on glycemic response and tolerability. Max daily dose: Pioglitazone 45 mg, Metformin 2550 mg.
Dose Range:
15 - 850 mg
Condition-Specific Dosing:
type2Diabetes:
Initial: 15 mg/850 mg once daily. If current metformin dose is 850 mg BID, may start with 15 mg/850 mg BID. Max daily dose of pioglitazone is 45 mg and metformin is 2550 mg. Administer with meals to reduce GI side effects of metformin.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
eGFR 45-60 mL/min/1.73m2: Initiation of metformin is not recommended. If already on metformin, maximum dose is 1000 mg/day. Pioglitazone does not require dose adjustment.
Moderate:
eGFR 30-45 mL/min/1.73m2: Initiation of metformin is not recommended. If already on metformin, discontinue. Pioglitazone does not require dose adjustment, but monitor for fluid retention.
Severe:
eGFR <30 mL/min/1.73m2: Contraindicated due to metformin component (increased risk of lactic acidosis).
Dialysis:
Contraindicated due to metformin component.
Hepatic Impairment:
Mild:
Use with caution. Monitor liver function.
Moderate:
Pioglitazone is contraindicated in patients with active liver disease or elevated ALT >2.5 times ULN. Metformin generally avoided due to increased risk of lactic acidosis.
Severe:
Contraindicated (due to both pioglitazone and metformin components).
Pharmacology
Mechanism of Action
Pioglitazone is a thiazolidinedione that acts as a potent and highly selective agonist for peroxisome proliferator-activated receptor-gamma (PPAR-gamma). PPAR-gamma receptors are found in adipose tissue, skeletal muscle, and liver. Activation of PPAR-gamma modulates the transcription of insulin-responsive genes involved in the control of glucose and lipid metabolism, thereby improving insulin sensitivity in target tissues. Metformin is a biguanide that primarily decreases hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis. It also decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Pharmacokinetics
Absorption:
Bioavailability:
Pioglitazone: >80%; Metformin: 50-60% (oral)
Tmax:
Pioglitazone: 2 hours; Metformin: 2-3 hours (IR)
FoodEffect:
Pioglitazone: Food slightly delays Tmax but does not affect extent of absorption. Metformin: Food decreases and slightly delays the absorption of metformin, but this is not clinically significant for efficacy.
Distribution:
Vd:
Pioglitazone: 0.63 L/kg; Metformin: 654 L
ProteinBinding:
Pioglitazone: >99%; Metformin: Negligible
CnssPenetration:
Pioglitazone: Limited; Metformin: Limited
Elimination:
HalfLife:
Pioglitazone: 3-7 hours (parent), 16-24 hours (active metabolites); Metformin: 6.2 hours (plasma), 17.6 hours (blood)
Clearance:
Not available
ExcretionRoute:
Pioglitazone: Urine (15-30%), Feces (55-80%); Metformin: Urine (primarily unchanged)
Unchanged:
Pioglitazone: <2%; Metformin: >90%
Pharmacodynamics
OnsetOfAction:
Pioglitazone: Gradual, weeks for full effect; Metformin: Days to weeks
PeakEffect:
Pioglitazone: 2-3 months; Metformin: 2-3 weeks
DurationOfAction:
Pioglitazone: Prolonged (due to active metabolites); Metformin: 12-24 hours
Safety & Warnings
BLACK BOX WARNING
CONGESTIVE HEART FAILURE: Thiazolidinediones, including pioglitazone, cause or exacerbate congestive heart failure in some patients. After initiation of pioglitazone, and with dose increases, observe patients carefully for signs and symptoms of heart failure (e.g., excessive, rapid weight gain, dyspnea, and/or edema). If these signs and symptoms develop, heart failure should be managed according to current standards of care. Furthermore, discontinuation or dose reduction of pioglitazone must be considered. Pioglitazone is contraindicated in patients with established New York Heart Association (NYHA) Class III or IV heart failure. LACTIC ACIDOSIS: Postmarketing cases of metformin-associated lactic acidosis have resulted in death, hypothermia, hypotension, and resistant bradyarrhythmias. The onset of metformin-associated lactic acidosis is often subtle, accompanied only by nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain. Metformin-associated lactic acidosis was characterized by elevated blood lactate levels (>5 mmol/L), anion gap acidosis (without evidence of ketonuria or ketonemia), and an increased lactate/pyruvate ratio; metformin plasma levels were generally >5 mcg/mL. Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years or greater, radiological studies with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic impairment. If metformin-associated lactic acidosis is suspected, discontinue this combination product and institute general supportive measures promptly in a hospital setting. Prompt hemodialysis is recommended.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Bone pain
Changes in eyesight
Pain when passing urine or blood in urine
Frequent urination
Swelling
Stomach Problems and Lactic Acidosis
It's common to experience stomach problems like upset stomach, vomiting, or diarrhea when starting this medication. However, if you develop stomach problems later during treatment, contact your doctor right away, as this may be a sign of lactic acidosis, a serious condition.
Low Blood Sugar
Low blood sugar can occur, especially when this medication is used with other diabetes medications. Be aware of the following symptoms:
Dizziness
Headache
Feeling sleepy or weak
Shaking
Fast heartbeat
Confusion
Hunger
Sweating
If you experience any of these symptoms, contact your doctor right away and follow their instructions for managing low blood sugar, which may include taking glucose tablets, liquid glucose, or some fruit juices.
Liver Problems
Severe and potentially life-threatening liver problems have been reported with this medication. Seek medical help immediately if you notice any of the following symptoms:
Dark urine
Tiredness
Decreased appetite
Upset stomach or stomach pain
Light-colored stools
Vomiting
Yellow skin or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or only minor ones. However, if you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Diarrhea
Upset stomach or vomiting
Gas
Headache
Signs of a common cold
Weight gain
Feeling tired or weak
Reporting Side Effects
If you have questions about side effects or want to report any side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Bone pain
Changes in eyesight
Pain when passing urine or blood in urine
Frequent urination
Swelling
Stomach Problems and Lactic Acidosis
It's common to experience stomach problems like upset stomach, vomiting, or diarrhea when starting this medication. However, if you develop stomach problems later during treatment, contact your doctor right away, as this may be a sign of lactic acidosis, a serious condition.
Low Blood Sugar
Low blood sugar can occur, especially when this medication is used with other diabetes medications. Be aware of the following symptoms:
Dizziness
Headache
Feeling sleepy or weak
Shaking
Fast heartbeat
Confusion
Hunger
Sweating
If you experience any of these symptoms, contact your doctor right away and follow their instructions for managing low blood sugar, which may include taking glucose tablets, liquid glucose, or some fruit juices.
Liver Problems
Severe and potentially life-threatening liver problems have been reported with this medication. Seek medical help immediately if you notice any of the following symptoms:
Dark urine
Tiredness
Decreased appetite
Upset stomach or stomach pain
Light-colored stools
Vomiting
Yellow skin or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or only minor ones. However, if you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Diarrhea
Upset stomach or vomiting
Gas
Headache
Signs of a common cold
Weight gain
Feeling tired or weak
Reporting Side Effects
If you have questions about side effects or want to report any side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Signs of lactic acidosis: unusual muscle pain, trouble breathing, stomach pain, dizziness, lightheadedness, feeling cold, or very tired/weak.
- Signs of heart failure: unusual or rapid weight gain, swelling in your hands or feet, or shortness of breath.
- Signs of low blood sugar (hypoglycemia): sweating, shaking, fast heartbeat, hunger, confusion, or dizziness. Carry a source of sugar (e.g., glucose tablets, juice) for emergencies.
- Signs of liver problems: unusual tiredness, dark urine, yellowing of skin or eyes (jaundice), nausea, vomiting, or stomach pain.
- Signs of bladder cancer: blood in urine, painful urination, or urgent need to urinate.
- Signs of bone fracture: new or unusual pain in bones, especially in arms or legs.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Acidic blood problems
+ Bladder cancer
+ Type 1 diabetes (note: this medication is not intended to treat type 1 diabetes)
+ Kidney disease
+ Liver disease
+ Recent heart attack or stroke
If you have any issues with eating or drinking normally, such as before undergoing a procedure or surgery
If you are scheduled to have an exam or test that involves contrast or have had one within the past 48 hours
* If you are a child, as this medication is not suitable for pediatric use
Additionally, it is crucial to discuss all of your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. This will help ensure that it is safe to take this medication in conjunction with your other medications and health conditions. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Acidic blood problems
+ Bladder cancer
+ Type 1 diabetes (note: this medication is not intended to treat type 1 diabetes)
+ Kidney disease
+ Liver disease
+ Recent heart attack or stroke
If you have any issues with eating or drinking normally, such as before undergoing a procedure or surgery
If you are scheduled to have an exam or test that involves contrast or have had one within the past 48 hours
* If you are a child, as this medication is not suitable for pediatric use
Additionally, it is crucial to discuss all of your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. This will help ensure that it is safe to take this medication in conjunction with your other medications and health conditions. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Before consuming alcohol, discuss the potential risks with your doctor.
If you experience low blood sugar, avoid driving, as it increases the risk of accidents. Monitor your blood sugar levels as directed by your doctor. Additionally, follow your doctor's instructions for regular blood work and other laboratory tests.
Adhere to the diet and exercise plan recommended by your doctor. Be aware that stress, such as fever, infection, injury, or surgery, can affect blood sugar control. Changes in physical activity, exercise, or diet can also impact blood sugar levels.
Long-term treatment with metformin may lead to decreased vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor. In hot weather or during physical activity, be cautious and drink plenty of fluids to prevent dehydration.
There is a potential increased risk of bladder cancer associated with this medication. Discuss this risk with your doctor. Furthermore, this drug may increase the risk of fractures, particularly in females. Most fractures occurred in the upper arm, hand, or foot after one year of treatment. Consult your doctor about maintaining bone health and addressing any concerns.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. Women of childbearing age who have not been ovulating may experience a renewed risk of pregnancy. To avoid pregnancy, use birth control while taking this medication.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. It is crucial to discuss the benefits and risks of this medication to both you and your baby.
If you experience low blood sugar, avoid driving, as it increases the risk of accidents. Monitor your blood sugar levels as directed by your doctor. Additionally, follow your doctor's instructions for regular blood work and other laboratory tests.
Adhere to the diet and exercise plan recommended by your doctor. Be aware that stress, such as fever, infection, injury, or surgery, can affect blood sugar control. Changes in physical activity, exercise, or diet can also impact blood sugar levels.
Long-term treatment with metformin may lead to decreased vitamin B-12 levels. If you have a history of low vitamin B-12 levels, consult your doctor. In hot weather or during physical activity, be cautious and drink plenty of fluids to prevent dehydration.
There is a potential increased risk of bladder cancer associated with this medication. Discuss this risk with your doctor. Furthermore, this drug may increase the risk of fractures, particularly in females. Most fractures occurred in the upper arm, hand, or foot after one year of treatment. Consult your doctor about maintaining bone health and addressing any concerns.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. Women of childbearing age who have not been ovulating may experience a renewed risk of pregnancy. To avoid pregnancy, use birth control while taking this medication.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. It is crucial to discuss the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe hypoglycemia (dizziness, confusion, seizures, loss of consciousness)
- Lactic acidosis (severe abdominal pain, rapid breathing, muscle pain, weakness, hypothermia, hypotension)
- Fluid retention, edema
What to Do:
Seek immediate medical attention or call 911. For suspected overdose, contact a poison control center (1-800-222-1222). Management is supportive, including correction of hypoglycemia and treatment of lactic acidosis (e.g., hemodialysis for metformin).
Drug Interactions
Contraindicated Interactions
- Iodinated contrast media (temporarily discontinue metformin at time of or prior to procedure)
- Severe heart failure (NYHA Class III or IV) (due to pioglitazone)
- Active liver disease or elevated ALT >2.5x ULN (due to pioglitazone)
- Metabolic acidosis, including diabetic ketoacidosis (due to metformin)
- Severe renal impairment (eGFR <30 mL/min/1.73m2) (due to metformin)
Major Interactions
- Alcohol (increases risk of lactic acidosis with metformin)
- Gemfibrozil (increases pioglitazone exposure, consider dose reduction of pioglitazone)
- Rifampin (decreases pioglitazone exposure, consider dose increase of pioglitazone)
- Carbonic anhydrase inhibitors (e.g., topiramate, zonisamide, acetazolamide, dichlorphenamide) (may increase risk of lactic acidosis with metformin)
- Cimetidine (increases metformin exposure)
- Drugs that affect renal function (e.g., NSAIDs, ACE inhibitors, ARBs, diuretics) (may increase risk of lactic acidosis with metformin)
Moderate Interactions
- Nifedipine (increases metformin absorption and Cmax)
- Cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, vancomycin) (may compete for renal tubular transport with metformin)
- Corticosteroids, diuretics, thyroid products, phenothiazines, sympathomimetics, niacin, calcium channel blockers, isoniazid (may cause hyperglycemia, requiring dose adjustment of antidiabetic agents)
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
HbA1c
Rationale: To establish baseline glycemic control and guide initial therapy.
Timing: Prior to initiation
Renal function (eGFR)
Rationale: Metformin is renally eliminated; risk of lactic acidosis increases with impaired renal function.
Timing: Prior to initiation
Liver function tests (ALT)
Rationale: Pioglitazone is contraindicated in active liver disease.
Timing: Prior to initiation
Cardiac status (signs/symptoms of heart failure)
Rationale: Pioglitazone can cause or exacerbate congestive heart failure.
Timing: Prior to initiation
Vitamin B12 levels
Rationale: Metformin can decrease vitamin B12 absorption.
Timing: Prior to initiation (consider if risk factors present)
Routine Monitoring
HbA1c
Frequency: Every 3-6 months
Target: <7% (individualized)
Action Threshold: >7% (consider dose adjustment or additional therapy)
Renal function (eGFR)
Frequency: At least annually; more frequently (e.g., every 3-6 months) in elderly or those with risk factors for renal impairment.
Target: >60 mL/min/1.73m2 (for full dose metformin)
Action Threshold: <45 mL/min/1.73m2 (re-evaluate metformin dose/discontinue)
Signs/symptoms of heart failure (e.g., rapid weight gain, dyspnea, edema)
Frequency: At each visit
Target: Absence of symptoms
Action Threshold: Development or worsening of symptoms (discontinue pioglitazone)
Liver function tests (ALT)
Frequency: Periodically, or if symptoms suggestive of liver dysfunction develop.
Target: <2.5x ULN
Action Threshold: >3x ULN (discontinue pioglitazone)
Vitamin B12 levels
Frequency: Periodically (e.g., every 2-3 years) or if anemia/neuropathy suspected.
Target: Normal range
Action Threshold: Low levels (consider supplementation)
Symptom Monitoring
- Signs of lactic acidosis (e.g., malaise, myalgia, respiratory distress, increased somnolence, abdominal distress)
- Signs of heart failure (e.g., unusual weight gain, swelling of ankles/feet, shortness of breath)
- Symptoms of hypoglycemia (e.g., sweating, tremor, dizziness, confusion, hunger)
- Symptoms of bladder cancer (e.g., hematuria, dysuria, urinary urgency)
- Symptoms of bone fracture (e.g., new pain, swelling, deformity)
Special Patient Groups
Pregnancy
Generally not recommended during pregnancy. Insulin is typically the preferred treatment for glycemic control in pregnant women with diabetes. Pioglitazone is Category C (animal studies show adverse effects, no adequate human studies). Metformin is Category B (animal studies show no risk, human data limited but generally reassuring). Discuss risks and benefits with a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Limited data on congenital malformations. Insulin is preferred.
Second Trimester:
Risk of fetal macrosomia and other complications if diabetes is uncontrolled. Insulin is preferred.
Third Trimester:
Risk of fetal macrosomia and other complications if diabetes is uncontrolled. Insulin is preferred.
Lactation
Metformin is excreted into breast milk in small amounts and is generally considered compatible with breastfeeding by many experts. Pioglitazone is also excreted into breast milk in small amounts, but data are limited, and potential effects on the infant are not well established. Use with caution, and monitor the infant for adverse effects. Consider alternative agents if possible.
Infant Risk:
Metformin: Low risk; Pioglitazone: Unknown/Possible low risk (limited data)
Pediatric Use
Safety and effectiveness have not been established in pediatric patients. Not recommended for use in children.
Geriatric Use
Use with caution in elderly patients due to increased risk of renal impairment (metformin), heart failure (pioglitazone), and bone fractures (pioglitazone). Start with lower doses and titrate slowly. Closely monitor renal function and for signs of heart failure.
Clinical Information
Clinical Pearls
- Pioglitazone/metformin is a fixed-dose combination, meaning dose adjustments for one component may be limited by the other. If individual dose adjustments are needed beyond the available combinations, separate medications should be considered.
- Patients should be educated on the signs and symptoms of lactic acidosis and heart failure, and instructed to seek immediate medical attention if these occur.
- Pioglitazone has been associated with an increased risk of bladder cancer; patients should be advised to report any hematuria or other urinary symptoms.
- Pioglitazone can cause dose-related fluid retention, which may lead to or exacerbate heart failure. Monitor for edema and weight gain.
- Metformin can cause vitamin B12 deficiency with long-term use; periodic monitoring of B12 levels should be considered, especially in patients with neuropathy or anemia.
- Risk of bone fractures (especially in the upper arm, hand, and foot) has been observed in female patients taking pioglitazone.
Alternative Therapies
- Other oral antidiabetic agents (e.g., sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, alpha-glucosidase inhibitors)
- Insulin therapy
- Lifestyle modifications (diet, exercise)
Cost & Coverage
Average Cost:
Varies widely, typically $30-$150 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication.
This medication is accompanied by a Medication Guide, which provides crucial information about its use. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the quantity, and the time it occurred. This information will help healthcare professionals provide you with the most effective treatment.
This medication is accompanied by a Medication Guide, which provides crucial information about its use. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the quantity, and the time it occurred. This information will help healthcare professionals provide you with the most effective treatment.