Duetact

Generic Name: pioglitazone and glimepiride (Oral route)

glye-MEP-ir-ide, pye-oh-GLI-ta-zone hye-droe-KLOR-ide

Oral route(Tablet)

Pioglitazone hydrochloride, a component of glimepiride/pioglitazone hydrochloride, may cause or worsen congestive heart failure; monitor patients for signs and symptoms of heart failure after initiation or dose increase. Should heart failure develop, manage according to current standards of care. Consider discontinuation or dose reduction. Glimepiride/pioglitazone hydrochloride is not recommended in patients with symptomatic heart failure and is contraindicated in established NYHA Class III or IV heart failure .

Commonly used brand name(s)

In the U.S.

  • Duetact

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antidiabetic

Chemical Class: 2nd Generation Sulfonylurea

Uses For Duetact

Pioglitazone and glimepiride combination is used to treat a type of diabetes mellitus called type 2 diabetes. It is used together with a proper diet and exercise to help control blood sugar levels.

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Pioglitazone helps your body use insulin better. Glimepiride stimulates the release of insulin from the pancreas which will help your body turn food into energy.

This medicine is available only with your doctor's prescription.

Before Using Duetact

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of pioglitazone and glimepiride combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pioglitazone and glimepiride combination in the elderly. However, elderly patients are more likely to have hypoglycemia and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving pioglitazone and glimepiride combination.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alatrofloxacin
  • Balofloxacin
  • Ciprofloxacin
  • Clinafloxacin
  • Cobicistat
  • Disopyramide
  • Elvitegravir
  • Enoxacin
  • Fleroxacin
  • Flumequine
  • Gatifloxacin
  • Gemifloxacin
  • Grepafloxacin
  • Ifosfamide
  • Levofloxacin
  • Lomefloxacin
  • Metreleptin
  • Miconazole
  • Moxifloxacin
  • Nifedipine
  • Norfloxacin
  • Ofloxacin
  • Pefloxacin
  • Piperaquine
  • Pixantrone
  • Prulifloxacin
  • Rufloxacin
  • Sparfloxacin
  • Temafloxacin
  • Tolvaptan
  • Tosufloxacin
  • Trovafloxacin Mesylate
  • Voriconazole

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone Acetate
  • Acebutolol
  • Aceclofenac
  • Acemetacin
  • Alprenolol
  • Amtolmetin Guacil
  • Aspirin
  • Atenolol
  • Atorvastatin
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bitter Melon
  • Bromfenac
  • Bucindolol
  • Bufexamac
  • Carteolol
  • Carvedilol
  • Celecoxib
  • Celiprolol
  • Choline Salicylate
  • Clonixin
  • Clorgyline
  • Colesevelam
  • Desogestrel
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Dienogest
  • Diflunisal
  • Dilevalol
  • Dipyrone
  • Drospirenone
  • Esmolol
  • Estradiol Cypionate
  • Estradiol Valerate
  • Ethinyl Estradiol
  • Ethynodiol Diacetate
  • Etodolac
  • Etofenamate
  • Etonogestrel
  • Etoricoxib
  • Felbinac
  • Fenofibrate
  • Fenoprofen
  • Fenugreek
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Fluconazole
  • Flufenamic Acid
  • Flurbiprofen
  • Gemfibrozil
  • Glucomannan
  • Guar Gum
  • Ibuprofen
  • Ibuprofen Lysine
  • Indomethacin
  • Iproniazid
  • Isocarboxazid
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Labetalol
  • Levobunolol
  • Levonorgestrel
  • Linezolid
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Medroxyprogesterone Acetate
  • Mefenamic Acid
  • Meloxicam
  • Mepindolol
  • Mestranol
  • Metipranolol
  • Metoprolol
  • Moclobemide
  • Morniflumate
  • Nabumetone
  • Nadolol
  • Naproxen
  • Nebivolol
  • Nepafenac
  • Nialamide
  • Niflumic Acid
  • Nilotinib
  • Nimesulide
  • Norelgestromin
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Oxaprozin
  • Oxprenolol
  • Oxyphenbutazone
  • Parecoxib
  • Pargyline
  • Penbutolol
  • Phenelzine
  • Phenylbutazone
  • Piketoprofen
  • Pindolol
  • Piroxicam
  • Pranoprofen
  • Procarbazine
  • Proglumetacin
  • Propranolol
  • Propyphenazone
  • Proquazone
  • Psyllium
  • Rifampin
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Selegiline
  • Sodium Salicylate
  • Sotalol
  • Sulindac
  • Talinolol
  • Tenoxicam
  • Tertatolol
  • Tiaprofenic Acid
  • Timolol
  • Tolfenamic Acid
  • Tolmetin
  • Toloxatone
  • Topiramate
  • Tranylcypromine
  • Valdecoxib

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Adrenal gland problem (underactive) or
  • Glucose 6-phosphate dehydrogenase (G6PD) deficiency (an enzyme problem), history of or
  • Kidney problems or
  • Pituitary gland problem (underactive) or
  • Poorly nourished condition or
  • Weakened physical condition—Use with caution. May cause side effects to become worse.
  • Bladder cancer, active or
  • Diabetic ketoacidosis (ketones in the blood) or
  • Heart failure, severe or
  • Liver disease, active or
  • Sulfa drug allergy, history of or
  • Type I diabetes—Should not be used in patients with these conditions.
  • Diabetic macular edema (swelling of the back of the eye) or
  • Edema (fluid retention or swelling) or
  • Heart disease or
  • Liver disease—Use with caution. May make these conditions worse.
  • Fever or
  • Infection or
  • Surgery or
  • Trauma—Use with caution. These conditions may cause problems with blood sugar control.
  • Fragile bones (especially in women)—Use with caution. This medicine may increase the risk for fractures.

Proper Use of Duetact

Take this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Carefully follow the special diet your doctor gave you. This is the most important part of controlling your diabetes and will help the medicine work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

This medicine should be taken with the first meal of the day.

If you are taking colesevelam, take it at least 4 hours after taking Duetact™.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For type 2 diabetes:
      • For patients already taking glimepiride alone:
        • Adults—At first, 1 tablet (either pioglitazone 30 milligrams (mg) plus glimepiride 2 mg, or pioglitazone 30 mg plus glimepiride 4 mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than pioglitazone 45 mg plus glimepiride 8 mg per day.
        • Children—Use and dose must be determined by your doctor.
      • For patients already taking pioglitazone alone:
        • Adults—At first, 1 tablet (pioglitazone 30 milligrams (mg) plus glimepiride 2 mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than pioglitazone 45 mg plus glimepiride 8 mg per day.
        • Children—Use and dose must be determined by your doctor.
      • For patients switching from a combination of pioglitazone and glimepiride as separate tablets:
        • Adults—At first, 1 tablet (either pioglitazone 30 milligrams (mg) plus glimepiride 2 mg, or pioglitazone 30 mg plus glimepiride 4 mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than pioglitazone 45 mg plus glimepiride 8 mg per day.
        • Children—Use and dose must be determined by your doctor.
      • For patients switching from other diabetes medicines:
        • Adults—At first, 1 tablet (pioglitazone 30 milligrams (mg) plus glimepiride 2 mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than pioglitazone 45 mg plus glimepiride 8 mg per day.
        • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using Duetact

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Certain women may be at an increased risk for pregnancy while taking this medicine. If you had problems ovulating and had irregular periods in the past, this medicine may cause you to ovulate. This could increase your chance of becoming pregnant. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.

Check with your doctor right away if you start having chest pain, shortness of breath, excessive swelling of the hands, wrist, ankles, or feet, or if you are rapidly gaining weight. These may be symptoms of a serious heart problem.

This medicine may cause serious allergic reactions, including anaphylaxis. Anaphylaxis requires immediate medical attention. The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, wheezing, or fainting. Other signs may include changes in color of the skin of the face, very fast but irregular heartbeat or pulse, hive-like swellings on the skin, and puffiness or swellings of the eyelids or around the eyes. If these side effects occur, get emergency help at once.

If you have abdominal or stomach pain, dark urine, a loss of appetite, nausea or vomiting, unusual tiredness or weakness, or yellow eyes or skin, check with your doctor right away. These may be symptoms of a serious liver problem.

Check with your doctor right away if blurred vision, decreased vision, or any other change in vision occurs while you are taking this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

This medicine may increase the risk for bone fractures in women. Ask your doctor about ways to keep your bones strong to help prevent fractures.

This medicine may increase your risk for bladder cancer if you take it for more than 12 months. Tell your doctor right away if you have blood in the urine, a frequent, strong, or increased urge to urinate, painful urination, or pain in the back, lower abdomen, or stomach.

This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

It is very important to carefully follow any instructions from your doctor about:

  • Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your doctor.
  • Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
  • Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, diabetic patients may need special counseling about diabetes medicine dosing changes that might occur with lifestyle changes, such as changes in exercise or diet. Counseling on contraception and pregnancy may be needed because of the problems that can occur during pregnancy in patients with diabetes.
  • Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
  • In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says you have diabetes and that lists all of your medicines.
  • Symptoms of fluid retention—Know what to do if you start to retain fluid. Fluid retention may worsen or lead to heart problems.

This medicine can cause hypoglycemia (low blood sugar). Low blood sugar can also occur if you delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting. The symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly.

  • Symptoms of low blood sugar include anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty with thinking, drowsiness, excessive hunger, fast heartbeat, headache that continues, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, or unusual tiredness or weakness.
  • If the symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or drink fruit juice, non-diet soft drinks, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar. Glucagon is used in emergency situations when severe symptoms such as seizures (convulsions) or unconsciousness occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it. Members of your family also should know how to use it.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

  • Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination (frequency and amount), ketones in the urine, loss of appetite, stomachache, nausea, or vomiting, tiredness, trouble breathing (rapid and deep), unconsciousness, or unusual thirst.
  • If the symptoms of high blood sugar occur, check your blood sugar level and call your doctor for instructions.

Duetact Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Anxiety
  • bladder pain
  • bloody or cloudy urine
  • blurred vision
  • chills
  • cold sweats
  • coma
  • confusion
  • cool, pale skin
  • depression
  • difficult, burning, or painful urination
  • fast heartbeat
  • frequent urge to urinate
  • headache
  • increased hunger
  • increased weight
  • lower back or side pain
  • nausea
  • nightmares
  • seizures
  • shakiness
  • slurred speech
  • swelling of the feet or lower legs
  • unusual tiredness or weakness
Less common
  • Accidental injury
  • loss of appetite
  • pain or swelling in the arms or legs without any injury
  • pale skin
  • stomach pain
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • vomiting
  • weight loss
  • yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Body aches or pain
  • cough
  • diarrhea
  • difficulty with moving
  • dryness or soreness of the throat
  • ear congestion
  • fever
  • hoarseness
  • joint pain
  • loss of voice
  • muscle aching or cramping
  • muscle pains or stiffness
  • runny nose
  • sneezing
  • stuffy nose
  • swollen joints
  • tender, swollen glands in the neck
  • tooth disorder
  • trouble swallowing
  • voice changes
Less common
  • Dizziness
  • itching skin
  • lack or loss of strength
  • skin rash

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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